Venous Leg Ulcers

Common Symptoms

• An open wound, typically near the inner ankle, often with irregular borders
• Surrounding skin changes: swelling, brownish discoloration, or thickened, hardened skin
• Aching or heaviness in the leg, often worse by the end of the day
• Slow healing or wounds that recur after previously healing

Why It Happens

When the valves in the leg veins don't work properly, blood pools in the lower legs, increasing pressure in the small blood vessels near the skin surface. Over time, this impairs the skin's ability to get adequate oxygen and nutrients, making it prone to breakdown and slow to heal once a wound forms.

Why It Can Become Persistent

The underlying venous insufficiency doesn't resolve on its own, so without adequately addressing that underlying pressure problem (primarily through compression), the skin conditions that allowed the ulcer to form in the first place tend to persist, and ulcers can recur even after healing.

Who Commonly Gets It

Venous leg ulcers are more common in older adults, people who are overweight, people with a history of blood clots or varicose veins, and people who stand for long periods.

How It Is Usually Diagnosed

Diagnosis is generally clinical based on wound location and appearance along with signs of venous disease, sometimes confirmed with a vascular ultrasound to assess vein function.

Traditional Treatment Options

• Compression therapy: The well-established cornerstone of venous ulcer treatment, addressing the underlying venous pressure problem directly.
• Wound care and dressings: Regular, specialized wound care.
• Leg elevation: Helps reduce venous pressure when possible.
• Treating underlying vein problems: Procedures to address faulty veins, when appropriate, per a vascular specialist.

Why Someone Might Start Looking for Another Option

Because venous ulcers can be slow to heal and prone to recurrence even with good compression therapy, there's research interest in adjunct treatments, including shockwave therapy — though as this page explains, the evidence doesn't currently support it outperforming standard care.

Where Shockwave Therapy May Fit

We want to lead with the most important finding here: a 2018 Cochrane systematic review — generally considered the most rigorous standard for evidence review — found zero randomized controlled trials meeting its quality criteria for shockwave therapy and venous leg ulcers at that time, meaning no efficacy conclusion could be drawn. Since then, real randomized trials have been published: one pilot trial found both radial and focused shockwave therapy outperformed standard wound care alone in reducing ulcer size over 8 weeks. However, the most recent and best-designed trial we found, comparing shockwave therapy with intermittent pneumatic compression (a compression-based standard treatment), found the compression therapy significantly outperformed both forms of shockwave therapy. Our honest read: shockwave therapy may add something over no treatment, but current evidence does not show it beats standard compression-based care, which remains the primary, best-supported treatment.

How Shockwave Treatment Works for This Area

Compression therapy remains the foundation of care and would not be replaced by shockwave therapy. If shockwave therapy is considered at all, it would be as a possible addition alongside — never instead of — compression treatment, coordinated with your physician or wound care specialist.

What the Treatment Feels Like

Your provider will discuss the specific treatment approach and what to expect based on your evaluation.

What Happens During Your First Visit

Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.

Who May Not Be Appropriate

• Anyone not already receiving standard compression therapy for venous insufficiency
• Active, uncontrolled infection, which needs to be addressed first
• Significant untreated arterial disease, which needs its own evaluation before compression therapy can safely be used
• Certain circulatory, neurological, or bleeding-related conditions, per your provider's screening

This list is not exhaustive. Your provider will screen for contraindications during your evaluation.