Joel Kowski, DPM
Podiatric Medicine & Wound Care
OakLeaf Advanced Wound Care & Hyperbaric Medicine Center

Approximately 15% of the population in the United States is affected by venous disease. This condition involving numerous abnormalities and diseases of the veins rarely poses a problem when mild. However, as these abnormalities worsen, venous disease can become debilitating and chronic. Chronic venous disease is often painful and may cause swelling along with skin changes in the lower legs that lead to skin breakdown and ulceration. Three million people in the United States suffer from a venous ulcer.

Venous ulcers are caused by poor blood circulation from the legs back to the heart. With venous disease, blood often pools in the veins of the lower leg and can lead to skin changes and skin ulcers.

Some things that increase the risk of venous skin ulcers include:

  • Blood clots forming in the deep veins of the legs
  • Lack of physical activity
  • Sitting or standing for hours without movement
  • Smoking
  • Obesity
  • Pregnancy
  • Varicose veins


One of the first signs of a venous skin ulcer is an area of dark red or purple skin overlying a prominent vein, which goes on to become a thickened, dry and itchy area. As these areas become chronic the skin takes on a purplish-brown color and will often progress to a skin ulcer. Diagnosis of venous disease is made based on physical examination by a physician and may involve the use of a Doppler ultrasound to evaluate the veins and how well blood is flowing through them.


Treatment for venous ulcers includes compression therapy, local wound care, specialized dressings, proper diet, and exercise. Compression therapy reduces lower leg swelling and assists in the flow of blood from the veins of the leg back to the heart. Common compression techniques include specialized multi-layered wraps and compression stockings. Debridement which involves the selective removal of debris or dead tissue from the ulcer using surgical instruments has been proven to be effective in speeding the rate of healing. In addition to traditional instruments used for debridement, OakLeaf Advanced Wound Care and Hyperbaric Medicine Center utilizes a device capable of generating ultrasonic sound waves to assist in cleaning and debriding the ulcer. Advanced dressings that maintain proper wound moisture and extended wear times are available. These advanced dressings improve the rate of healing and often require less frequent dressing changes while ultimately improving healing success. Today’s wound care specialist has access to dressings containing growth stimulants and agents to reduce bacteria while potentially reducing the pain associated with venous ulcers. Specialized dressings can reduce the risk of infection, however when necessary antibiotics to treat infections are used.

In general the combination of debridement, compression therapy and advanced dressings will heal most venous ulcers. For those ulcers that do not heal, additional treatments such as skin grafting and surgical procedures using lasers or vein stripping may be considered.


As with many conditions prevention is the best practice. Steps toward preventing venous ulcers include:

  • Maintain a healthy body weight
  • Exercise regularly including brisk walks
  • If you smoke, stop
  • Protect your legs from injury
  • Avoid sitting or standing in one place for long periods
  • If you must sit or stand for long periods of time, tap your feet 10–20 times every 10–15 minutes to promote circulation
  • Treat dry skin with the daily application of skin moisturizers

Venous skin ulcers can be painful and debilitating, however today’s wound specialists have access to many advanced dressings and techniques to help manage and resolve these skin ulcers. If you have questions about venous ulcers or other wounds and would like more information please contact OakLeaf Advanced Wound Care and Hyperbaric Medicine Center.

Dr. Kowski –OakLeaf Advanced Wound Care & Hyperbaric
For information or to schedule an appointment:
715-895-9384 |
Dr. Kowski sees patients in Altoona.