NHS Patient Information
Venous leg ulcer.
National Health Service
Leg Ulcer Treatment
A leg ulcer is an open wound on the lower leg or foot that has not healed within two weeks. Most leg ulcers in adults are caused by underlying venous disease, arterial disease or a combination of the two. Untreated, they tend to become chronic, slow to heal and prone to infection.
KONCEPT® runs a consultant-led leg-ulcer clinic at our Kingston upon Thames clinic, combining vascular consultant assessment (duplex ultrasound and ABPI on the same visit where indicated) with hands-on wound care delivered by a Tissue Viability Nurse, a compression fitter and, where appropriate, a Podiatrist. Our aim is to confirm the cause, treat it properly and get the wound closed and stable.
At a glance
Service
Consultant-led
First visit
Duplex + ABPI
MDT
TVN + compression + podiatry
Initial consult
from £325
Verified statistics
Drawn from NHS, NICE quality standards, the European Society for Vascular Surgery, the EVRA randomised trial and Cochrane systematic reviews. Every figure links to its citation in the References section at the bottom of this page.
How common leg ulcers are
Outcomes after treating the underlying cause
56%
lower 12-month ulcer recurrence after early endovenous ablation vs deferred (EVRA RCT)
Gohel MS et al., NEJM 2018[6]
Multi-layer
compression bandaging is the cornerstone of healing for venous ulcers
Types of leg ulcer
Not all leg ulcers are the same. Getting the diagnosis right is the most important step, because the treatment for each type is different, and treating the wrong cause can make the wound worse[1][4][8].
Caused by chronic venous insufficiency, most often from varicose veins or post-thrombotic syndrome. Usually appears around the inside of the ankle (the gaiter area), with surrounding skin changes (hyperpigmentation, eczema, lipodermatosclerosis). Most common type in adults.
Caused by impaired arterial blood supply, often from peripheral arterial disease (PAD). Usually appears on the toes, foot or outer ankle, with surrounding cool, pale or hairless skin. May be very painful, especially when the leg is elevated. Requires assessment of the arterial circulation before any compression is applied.
Combines features of both. Compression has to be modified (reduced compression) and the arterial component may need to be addressed first.
Caused by a combination of neuropathy (loss of sensation), arterial disease and pressure points, typically on the sole, heel or under the toes. Requires urgent diabetic-foot pathway management. See our dedicated Diabetic foot service.
Occasionally ulcers arise in lymphoedema-affected limbs, after trauma, in pressure-prone areas, or from less common causes (vasculitis, malignancy). All need consultant assessment.
The leg veins normally pump blood back to the heart against gravity. When valves in the veins fail (chronic venous insufficiency), pressure rises in the small veins of the skin (venous hypertension). Over time this leads to inflammation, skin changes and, eventually, breakdown of the skin into an ulcer[1][4].
Where arteries are also narrowed (peripheral arterial disease), tissues do not receive enough oxygen to heal, so even a small breach in the skin becomes an arterial or mixed ulcer.
In diabetes, the combination of nerve damage (so the patient does not feel a small injury), poor microcirculation, and pressure points on the foot creates an ulcer-prone environment that is reviewed at our Diabetic foot service.
Diagnosis
The right treatment depends on the right diagnosis. Our assessment is built around the international gold standard for leg-ulcer work-up[4][8]:
Initial venous consultation with duplex ultrasound is £325 (one leg) or £495 (both legs). ABPI is included in the consultation where clinically indicated. Please see the pricing page for the full schedule.
Management
This is the single most important step, the wound will not stay healed unless the cause is treated[4][6].
Delivered by our Tissue Viability Nurse alongside the consultant:
Once the wound is closed, lifelong medical-grade compression reduces recurrence[1][4][7]. Fitting is delivered by our compression specialist, replacement is every 3 to 6 months. See Compression therapy fitting.
For ulcers that do not close with optimal wound care and treatment of the underlying cause, options include split-thickness skin grafting, bilayer skin substitutes and fish-skin grafts (Omega-3 acellular matrix). KONCEPT® offers selected advanced wound-care products in clinic, with skin grafting and any microvascular reconstruction referred to a suitable specialist centre.
Where surgery is being considered, your consultant will discuss the published evidence with you and, where appropriate, support a referral to a suitable specialist centre. This referral pathway, the second opinion and the post-procedure follow-up sit within our scope.
First visit
For full pre-care and post-care instructions, see our Patient instructions page. Leg ulcers sit alongside the wound-care and compression pathways in that guide.
You receive a written quote before any treatment is booked.
Insurance
Leg-ulcer treatment is recognised by most major UK private medical insurers when there is a clinical indication, particularly where there is an underlying venous, arterial or diabetic cause. Cover for ongoing wound care, compression garments and any onward referral varies by policy.
Recognition at KONCEPT® is at both clinic and consultant level, and cover is expanding. Call 020 8129 1011 with your insurer and policy details and we will come back to you within one working day with confirmation, before any appointment is booked.
Read more on the Insurance & access page →
Your consultants and team
Leg-ulcer consultations at KONCEPT® are carried out by one of our Consultant Vascular Surgeons, both on the GMC Specialist Register for Vascular Surgery and both Platinum BUPA Consultants. They hold substantive NHS consultant posts at St George’s University Hospitals NHS Foundation Trust and see private patients here on a practice-privileges basis.
Day-to-day wound care is delivered by our Tissue Viability Nurse (NMC registered), compression-garment fitting by our compression specialist, and any foot-pressure or diabetic-foot input by our HCPC-registered Podiatrist.
FAQs
A leg ulcer is an open wound on the lower leg or foot that has not healed within two weeks. The most common cause is underlying venous disease (around 70%), followed by arterial disease, mixed venous-and-arterial, and diabetes. Getting the diagnosis right is the most important first step because the treatment for each type is different.
Healing time depends on the cause, the size of the ulcer and how quickly the underlying problem is treated. With optimal compression therapy, treatment of the underlying venous disease and good wound care, many venous ulcers heal within 12 to 24 weeks. Some chronic ulcers take longer and need a multidisciplinary plan.
Most leg ulcers in UK adults are caused by chronic venous insufficiency (failed valves in the leg veins). Other causes include peripheral arterial disease, diabetes, lymphoedema, trauma, pressure and rarely vasculitis or skin malignancy. Each cause is treated differently, so a proper assessment is essential.
At KONCEPT® we use a 30 to 45-minute consultation with a Consultant Vascular Surgeon, a careful history, examination of the wound and the surrounding skin, duplex ultrasound of the leg veins on the same visit, and Ankle-Brachial Pressure Index (ABPI) to screen for peripheral arterial disease before any compression is applied.
A venous ulcer is usually around the inside of the ankle with surrounding skin changes, has a sloping edge and is moderately painful. An arterial ulcer is usually on the toes, foot or outer ankle, has a “punched-out” edge, is painful (especially when the leg is elevated) and surrounding skin is cool, pale or hairless. Compression is the cornerstone of venous-ulcer treatment but must be modified or avoided in arterial disease, which is why ABPI is essential before any compression bandaging.
Many leg ulcers can be fully closed and kept closed, particularly venous ulcers when the underlying vein reflux is treated. Without treating the cause, recurrence is common. The Early Venous Reflux Ablation (EVRA) trial showed early closure of the refluxing vein reduces 12-month recurrence by 56% compared with deferred treatment.
It can. Pain depends on the cause, the size and any infection. Arterial ulcers are typically more painful than venous ulcers, especially with the leg elevated. Pain control is part of every leg-ulcer plan, and worsening pain should be reviewed promptly.
For venous ulcers with adequate arterial supply, multi-layer compression bandaging is the cornerstone of healing. For arterial or mixed ulcers, compression must be modified or sometimes avoided altogether. This is why every patient has an ABPI before compression bandaging starts.
We work alongside your GP and any NHS service you are seeing. With your consent we send a copy of the consultation letter and any imaging report to your GP, so any management you continue under the NHS is fully informed. Many patients use KONCEPT® for the consultant assessment, the duplex scan and the underlying vein procedure, then continue community wound care with their GP.
For self-pay, no, you can book directly. Most insurers also allow direct booking. A small number still require a GP referral letter, we will confirm what your insurer needs when you enquire.
Most leg ulcers heal without skin grafting once the underlying cause is treated and wound care is optimised. For large or non-healing ulcers, skin grafting (or a bilayer skin substitute or fish-skin allograft) may be considered. Skin grafting is referred to a specialist centre, with the second opinion and post-procedure follow-up at KONCEPT®.
The first appointment is 30 to 45 minutes with a Consultant Vascular Surgeon, plus the duplex ultrasound and ABPI. Allow 60 to 90 minutes for your visit including arrival, reception and the scan.
Most major UK private medical insurers cover leg-ulcer treatment where there is a clinical indication. Cover for ongoing wound-care appointments and compression garments varies by policy. Call 020 8129 1011 with your insurer and policy details before booking.
After healing, lifelong medical-grade compression, treatment of the underlying vein reflux, daily skin care, treating any new breaks in the skin early and managing other risk factors (diabetes, smoking, weight) reduces recurrence significantly.
Surrey catchment also includes Esher, Cobham, Weybridge, Walton-on-Thames, Oxshott and Hampton.
Related vascular services
To book a leg-ulcer consultation with one of our Consultant Vascular Surgeons, or to discuss your case, get in touch.
Email info@konceptmedicalclinic.com · Visit 46-48 Wood Street, Kingston upon Thames, KT1 1UW · See full self-pay pricing →
Regulation and standards
KONCEPT® Medical Clinic is registered with the Care Quality Commission (CQC) for the regulated activities provided at our Kingston upon Thames premises. All consultants are on the General Medical Council (GMC) Specialist Register for Vascular Surgery and remain personally accountable to the GMC under Good Medical Practice. Allied-health clinicians supporting the leg-ulcer service are registered with their relevant professional bodies (NMC for the Tissue Viability Nurse, HCPC for the Podiatrist). Information on this page is written to be factual and verifiable in line with the Committee of Advertising Practice (CAP) Code and Advertising Standards Authority (ASA) rules for medical advertising.
Claims about prevalence, ulcer-type distribution, diagnosis, management and outcomes on this page are drawn from NHS, NICE, the European Society for Vascular Surgery, the EVRA randomised trial, Cochrane systematic reviews and Society for Vascular Surgery / American Venous Forum guidelines. Each source is linked for verification.
Venous leg ulcer.
National Health Service
Leg ulcers, symptoms and treatment.
BUPA
Quality Standard QS67, Varicose veins.
NICE, August 2014, last updated 2019
Management of Chronic Venous Disease, Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS).
European Journal of Vascular and Endovascular Surgery 2015, 49(6), 678-737
Quality Standard QS167, Lower limb peripheral arterial disease.
NICE, August 2018
A randomized trial of early endovenous ablation in venous ulceration (EVRA).
New England Journal of Medicine 2018, 378(22), 2105-2114
Compression for venous leg ulcers.
Cochrane Database of Systematic Reviews 2012, (11), CD000265
Management of venous leg ulcers, Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum.
Journal of Vascular Surgery 2014, 60(2), 3S-59S
Management of chronic venous leg ulcers (Guideline 120).
SIGN, 2010
Consent, Supported Decision-Making, A Guide to Good Practice.
RCS England, 2018
Last clinical review: Dr Maryam Attarzadeh, Medical Director (GMC 7193218), 2026-05-28. Next review due: 2026-11-28. Statistical claims are re-verified every 6 months, or sooner if peer-reviewed evidence changes.