[3] Venous ulcers develop mostly along the medial distal leg, and can be painful with negative effects on quality of life.

When venous hypertension exists, arteries no longer have significantly higher pressure than veins, and blood is not pumped as effectively into or out of the area.

[10][11][12][13] Venous hypertension may also stretch veins and allow blood proteins to leak into the extravascular space, isolating extracellular matrix (ECM) molecules and growth factors, preventing them from helping to heal the wound.

[10][13] Leakage of fibrinogen from veins as well as deficiencies in fibrinolysis may also cause fibrin to build up around the vessels, preventing oxygen and nutrients from reaching cells.

It is based on the CEAP (clinical, etiology, anatomy, and pathophysiology) classification system developed by an expert panel.

Additional causes include neutrophilic skin conditions such as pyoderma gangrenosum or Sweet's syndrome; vasculitic processes such as cryoglobulinemia; calciphylaxis (often seen in people with end-stage kidney disease but may also occur with medications such as warfarin); cancers such as squamous cell carcinoma (Marjolin's ulcer) or myelodysplastic syndrome; neuropathy (e.g., diabetic peripheral neuropathy); or atypical infections such as nocardiosis, sporotrichosis, or mycobacterial infections.

[17] Most venous ulcers respond to patient education, elevation of foot, elastic compression, and evaluation (known as the Bisgaard regimen).

A number of articles demonstrate the efficacy of sugar application in the treatment of ulcers of diabetic origin,[23] as well as necrotic wounds.

[24][unreliable medical source] A study of 50 leg ulcer patients demonstrated the efficacy of a weekly treatment consisting solely of a 60% / 40% glucose/vaseline mixture applied to the wound, without debridement.

[27] Non-elastic, ambulatory, below knee (BK) compression counters the impact of reflux on venous pump failure.

[10] A 2021 systematic review found that compression dressings probably reduce pain and help ulcers to heal more quickly (usually within 12 months) and may also improve quality of life.

[citation needed] An oral dose of aspirin is being investigated as a potential treatment option for people with venous ulcers.

[38] Oral zinc supplements have not been proven to be effective in aiding the healing of venous ulcers, however more research is necessary to confirm these results.

[39] Treatments aimed at decreasing protease activity to promote healing in chronic wounds have been suggested, however, the benefit remains uncertain.

[41] There is low certainty evidence that protease modulating matrix treatment is helpful in the healing of venous ulcer.

[44] It is uncertain whether the choice of cleaning solution or method of application makes any difference to venous leg ulcer healing.

[46] A systematic review found that bilayer artificial skin with compression bandaging is useful in the healing of venous ulcers when compared to simple dressings.

[47] Local anaesthetic endovenous surgery using the thermoablation (endovenous laser ablation or radiofrequency), perforator closure (TRLOP) and foam sclerotherapy showed an 85% success rate of healing, with no recurrence of healed ulcers at an average of 3.1 years, and a clinical improvement in 98% in a selected group of venous leg ulcers.

[51] A 2013 Cochrane systematic review aimed to determine the effectiveness of foam dressings for helping to heal venous leg ulcers.

[48] Without proper care, the ulcer may get infected leading to cellulitis or gangrene and eventually may need amputation of the part of limb in future.

It is questionable as to whether endovenous treatment should be offered before ulcer healing, as current evidence would not support this approach as standard care.