evident. Swelling of the lower part of the legs and feet which is called oedema, and some pain may be felt. There may be a primary cause, for example a cut or other injury. An injury which is common is bumping into a low lying coffee table. This leads to an open sore, and because of some underlying disease or poor circulation caused by heart disease, diabetes or sickle cell anaemia the initial injury to the issues does not heal but develops into a problem which then needs medical care.

During this initial period a person often does not seek professional advice believing that the "sore will heal soon''. However, the soonest appropriate treatment is commenced the sooner the healing process can begin.

There are three different types of leg ulcers, Arterial, Venous and Diabetic and each one is caused by disease processes or injury which result in essential oxygen and nutrients not reaching the tissues. Arteriosclerosis (commonly known as hardening of the arteries) high blood pressure, and diabetes are part of the arterial disease processes. These ulcers are usually found on any part of the leg but mostly below the ankle, they are small and quite deep and there may be some swelling in the immediate area. Pain is present especially at night, or whilst resting. With arterial problems the skin looks thin and shiny and the toenails are thick and ridged.

Venous ulcers are caused by insufficient blood supply return to the heart, because veins are more elastic, thinner than artieris and become enlarged the blood return is sluggish. This is called stasis and results in generalised swelling of the tissues. These ulcers occur around the ankle and above, they are usually large but shallow, produce a lot of fluid, and a dull ache is often present. Shoes become light and uncomfortable, the skin is dark and thickened because of the changes in circulation and there may be narrowing of the ankle where old ulcers were, leaving scar tissue.

Diabetic ulcers are found on any part of the leg but commonly below the ankle and in the foot. They are small and deep with "clifflike'' edges, there is often hard callused skin around the ulcer. The do not produce a lot of fluid and there may be some pain, but because of nerve change in diabetics a person may not feel the ulcers. It is usually seen whilst bathing or caring for one's feet. The diagnetic is often made by a chiropodist.

The goal in caring for leg ulcers in healing of the tissue involved restoring the patients mobility and replacing any nutrition that may be lacking in the diet.

Specific care must be ordered by a doctor and may be carried out in hospital or at home using the services of the community health nurse. There are many treatments available, depending on the type and severity of the ulcer. The ulcer is cleaned with saline (saltwater solution) or peroxide, and one of the following treatments. In arterial ulcers a light bandage may be applied. In venous ulcers a crepe bandage or tubigrip to help the blood supply return to the heart, elevating the legs above the heart level at least 30 minutes every two hours, and sleeping with the foot of the bed raised will help the healing process.

If you need help or advice the community nurses may be contacted by calling 292-3095. Beryl Bartlett Community Health Nurse.

HEALTH HTH