Abadi S, Nelson EA, Dehghani A. Venous ulceration and the measurement of movement: a review. J Wound Care. 2007; 16:(9)396-401

Venous leg ulcer prevention 3: supporting patients to self-manage. 2019. (accessed 13 May 2021)

Abbade LPF, Lastória S. Venous ulcer: epidemiology, physiopathology, diagnosis and treatment. Int J Dermatol. 2005; 44:(6)449-456

Balcombe L, Miller C, McGuiness W. Approaches to the application and removal of compression therapy: A literature review. Br J Community Nurs. 2017; 22:(Sup10)S6-S14

Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977; 84:(2)191-215

Barwell JR, Davies CE, Deacon J Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial. Lancet. 2004; 363:(9424)1854-1859

Bérard A, Abenhaim L, Platt R, Kahn SR, Steinmetz O. Risk factors for the first-time development of venous ulcers of the lower limbs: the influence of heredity and physical activity. Angiology. 2002; 53:(6)647-657

Boccolon H, Janbon C, Saumet JL Characteristics of CVI in 895 patients followed in general practice. Int Angiol. 1997; 16:(4)226-234

Brooks J, Ersser SJ, Lloyd A, Ryan TJ. Nurse-led education sets out to improve patient concordance and prevent recurrence of leg ulcers. J Wound Care. 2004; 13:(3)111-116

Brown A. Life-style advice and self-care strategies for venous leg ulcer patients: what is the evidence?. J Wound Care. 2012; 21:(7)342-350

Brown A. Venous leg ulcers: treating a chronic condition. Nursing and Residential Care. 2016; 18:(5)255-259

Brown A Self-care strategies to prevent venous leg ulceration recurrence. Practice Nursing. 2018; 29:(4)152-158

Brown A, Kendall S, Flanagan M, Cottee M. Encouraging patients to self-care - the preliminary development and validation of the VeLUSET©, a self-efficacy tool for venous leg ulcer patients, aged 60 years and over. Int Wound J. 2014; 11:(3)326-334

Commissioning for Quality and Innovation. Guidance for 2020 – 2021 CCG11 Assessment, diagnosis and treatment of lower leg wounds. 2020. (accessed 13 May 2021)

Dix FP, Brooke R, McCollum CN. Venous disease is associated with an impaired range of ankle movement. Eur J Vasc Endovasc Surg. 2003; 25:(6)556-561

Dix FP, Reilly B, David MC Effect of leg elevation on healing, venous velocity and ambulatory venous pressure in venous ulceration. Phlebology. 2005; 2:87-94

Galazka AM. Evidence of social value in the Lindsay Leg Club® network: an evaluation. Br J Nurs. 2020; 29:(20)S12-S13

Guest JF, Ayoub N, McIlwraith T Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open. 2015; 5:(12)

Finlayson K, Edwards H, Courtney M. Factors associated with recurrence of venous leg ulcers: a survey and retrospective chart review. Int J Nurs Stud. 2009; 46:(8)1071-1078

Finlayson KJ, Parker CN, Miller C Predicting the likelihood of venous leg ulcer recurrence: The diagnostic accuracy of a newly developed risk assessment tool. Int Wound J. 2018; 15:(5)686-694

Heinen MM, Evers AW, Van Uden CJ, Van der Vleuten CJ, van de Kerkhof PC, Van Achterberg T. Sedentary patients with venous or mixed leg ulcers: determinants of physical activity. J Adv Nurs. 2007; 60:(1)50-57

Heinen M, Borm G, van der Vleuten C, Evers A, Oostendorp R, van Achterberg T. The Lively Legs self-management programme increased physical activity and reduced wound days in leg ulcer patients: Results from a randomized controlled trial. Int J Nurs Stud. 2012; 49:(2)151-161

Jull A, Parag V, Walker N, Maddison R, Kerse N, Johns T. The prepare pilot RCT of home-based progressive resistance exercises for venous leg ulcers. J Wound Care. 2009; 18:(12)497-503

McDaniel HB, Marston WA, Farber MA Recurrence of chronic venous ulcers on the basis of clinical, etiologic, anatomic, and pathophysiologic criteria and air plethysmography. J Vasc Surg. 2002; 35:(4)723-728

National Wound Care Strategy Programme. Lower Limb – recommendations for clinical care. 2020. (accessed 13 May 2021)

Nelson EA, Harper DR, Prescott RJ, Gibson B, Brown D, Ruckley CV. Prevention of recurrence of venous ulceration: randomized controlled trial of class 2 and class 3 elastic compression. J Vasc Surg. 2006; 44:(4)803-808

Venous leg ulcers. 2016. (accessed 12 May 2021)

Nelson EA, Bell-Syer SE. Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev. 2014; 2014:(9)

O'Brien JA, Finlayson KJ, Kerr G, Edwards HE. Testing the effectiveness of a self-efficacy based exercise intervention for adults with venous leg ulcers: protocol of a randomised controlled trial. BMC Dermatol. 2014; 14

O'Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2012; 11:(11)

Padberg FT, Johnston MV, Sisto SA. Structured exercise improves calf muscle pump function in chronic venous insufficiency: a randomized trial. J Vasc Surg. 2004; 39:(1)79-87

Parker CN, Finlayson KJ, Edwards HE. Predicting the likelihood of delayed venous leg ulcer healing and recurrence: development and reliability testing of risk assessment tools. Ostomy Wound Manage. 2017; 63:(10)16-33

Probst S, Turcotte M, Buehrer Skinner M. Internal consistency and reliability of the Swiss-French translation of the venous leg ulcer self efficacy tool (VeLUSET). BMJ Open. 2019; 9:(12)

Raju S, Hollis K, Neglen P. Use of compression stockings in chronic venous disease: patient compliance and efficacy. Ann Vasc Surg. 2007; 21:(6)790-795

Roaldsen KS, Rollman O, Torebjörk E, Olsson E, Stanghelle JK. Functional ability in female leg ulcer patients--a challenge for physiotherapy. Physiother Res Int. 2006; 11:(4)191-203

Shenoy MM. Prevention of venous leg ulcer recurrence. Indian Dermatol Online J. 2014; 5:(3)386-389

Sinabulya H, Östmyren R, Blomgren L. Editor's choice - mid-term outcomes of endovenous laser ablation in patients with active and healed venous ulcers: a follow-up study. Eur J Vasc Endovasc Surg. 2017; 53:(5)710-716

Challenges faced by healthcare professionals in the provision of compression hosiery to enhance compliance in the prevention of venous leg ulceration. 2016. (accessed 13 May 2021)

Turcotte M, Buehrer Skinner M, Probst S. Translation and cross-cultural adaptation of the Venous Leg Ulcer Self Efficacy Tool for use in a Swiss-French setting. Journal of the European Wound Management Associations. 2020; 21:(1)7-10

van Uden CJ, van der Vleuten CJ, Kooloos JG, Haenen JH, Wollersheim H. Gait and calf muscle endurance in patients with chronic venous insufficiency. Clin Rehabil. 2005; 19:(3)339-344

Weller CD, Buchbinder R, Johnston RV. Interventions for helping people adhere to compression treatments for venous leg ulceration. Cochrane Database Syst Rev. 2013; (9)

Yarwood-Ross L, Haigh C. Managing a venous leg ulcer in the 21st century, by improving self-care. Br J Community Nurs. 2012; 17:(10)460-465

Vowden K, Vowden P. Factors influencing venous leg ulcer recurrence: Implications for practice. in From the laboratory to the patient: Future organisation and care of problem wounds. EWMA Conference Abstracts.Stuttgart, Germany: EWMA; 2005

Recurrent venous leg ulcers: management in general practice

02 June 2021
8 min read
Volume 32 · Issue 6


Venous leg ulcers commonly recur. Annemarie Brown highlights some self-care strategies that patients can use to reduce their risk

Chronic venous leg ulcers are commonly seen in general practice and although healing rates for leg ulcers have improved, recurrence rates are high with around 60–70% reported to recur after healing. The primary prevention strategy is the life-long wearing of compression hosiery; however, compliance is low for several reasons including lack of understanding of the need to wear compression hosiery and difficulties applying and removing it. Self-care strategies such as physical exercise and mobility, leg elevation and appropriate skin care, can help to prevent recurrence of venous leg ulcers. Practice nurses are ideally placed to provide this advice, which can help improve patient's quality of life while reducing the financial burden of treating open ulceration for the NHS.

Chronic venous leg ulcers (VLU) are commonly seen in general practice. Guest et al (2015) estimate that approximately 1.5% of the adult population in the UK is affected by active leg ulceration, meaning that up to 730 000 patients have open leg ulceration at any given time (Guest et al, 2015). With the implementation of the gold standard treatment – compression therapy – healing rates of 76.3% have been recorded at 24 weeks (O'Meara et al, 2012; Nelson and Adderley, 2016).

Despite improved healing rates, however, recurrence rates are depressingly high. Around 60–70% of all VLUs are reported to recur after healing, with the highest recurrence rate within 3 months and the majority recurring within 12 months (McDaniel et al, 2002; Abbade and Lastória, 2005). A quarter of all patients will experience in excess of 10 episodes of active ulceration in their lifetime (Weller et al, 2013).

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