A few years ago, one of my neighbours developed a venous leg ulcer. It was painful, leaked copious amounts of foul-smelling exudate, and restricted my neighbour’s mobility because his shoes did not fit over his compression bandages.
Sadly, despite having shown many of the warning signs of venous disease he had not received any preventative care to reduce his risk of ulceration.
For over 12 months he struggled to cope with his compression therapy and confessed to loosening his bandages; as a result, his ulcer failed to heal. I noticed that his relationship with his nurse deteriorated during this time and he appeared isolated and depressed.
“Such a high rate of delayed healing suggests there are gaps in services and some health professionals’ knowledge”
My neighbour’s experience was not unique. Venous leg ulcer management is complex, and patients often find compression therapy difficult to tolerate; this can lead to some being labelled ‘difficult’ or ‘non-compliant’. But if they are to persuade patients to adhere to what needs to be a lifelong treatment strategy, health professionals need to listen to patients’ opinions and experiences in order to understand how their ulcer and its management affects them. This is key to successful patient-centred treatment.
Leg ulcer management is expensive, costing the NHS £1.94bn a year. It has been calculated that an ulcer that heals within 12 months costs £698-£3,998 per patient, compared with £1,719-£5,976 for those that fail to heal in that time frame. And despite the existence of a robust evidence base to support venous leg ulcer management 41% of these debilitating wounds do take more than a year to heal.
Such a high rate of delayed healing suggests there are gaps in services and some health professionals’ knowledge. We have amazing leg ulcer services across the country but access to these depends on an accurate diagnosis and referral and sadly some patients do not receive an initial systematic assessment that could trigger referral.
This week is Leg Matters Week and health professionals and the public are being encouraged to think about our awareness and understanding of conditions that affect the lower legs and feet.
To support this important week of action we are publishing the first part in a three-part series on leg ulcer prevention, exploring the risk factors and warning signs that indicate a patient is at risk of venous disease. The important message is that venous disease can affect people at any age and ulceration can often be prevented. The issue of age is also explored in a blog by Tracy Goodwin, who describes her experience of developing a leg ulcer in her 20s and the problems she has getting health professionals to understand her condition.
To accompany this we have chosen an interesting article from our archive that reviews strategies for the treatment and management of lower-limb lymphorrhoea or ‘leaky legs’. Patients with this distressing condition not only have to cope with oedematous, heavy legs but also with fluid leakage that saturates their clothes, bedding and footwear.
The final article in this issue looks at the complex issue of leg ulcers associated with intravenous drug use. As the author notes, there has been a rise in the number of people with leg ulceration who have a history of injecting drug use. The article illustrates the importance of recording a thorough history, particularly if other more obvious risk factors are absent.
All three are Nursing Times self-assessment articles, which means you can take an online multiple-choice test after reading to them to provide evidence for your CPD and revalidation requirements.
Patients with lower-leg disease often have complex symptoms and co-morbidities that have a profound effect on their physical, psychological and social wellbeing. They deserve excellent evidence-based care and we have good evidence to support practice.
We all need to be ‘leg aware’ and aim to prevent rather than treat ulceration, but when treatment is required it is vital to involve patients and listen to their views on the care.
A supportive, pragmatic approach is likely to achieve better adherence to treatment than labelling people as difficult when they are struggling to cope with their treatment.