Venous Leg Ulcers and the Canadian Standard of Compression Care

Last reviewed: June 15, 2026 · Compression Socks Canada Team

Venous leg ulcers (VLUs) are the most common type of leg ulcer seen in Canadian clinics, and they are one of the clearest examples of how compression therapy moves from "helpful" to "foundational." When a VLU is correctly diagnosed and managed, compression is the lever that drives healing. This article walks through what venous leg ulcers are, how they are assessed, and how compression — first as bandages and later as stockings — sits at the centre of the Canadian standard of care. It is general information for patients and caregivers and not a substitute for direct clinical management by a wound care team.

What is a venous leg ulcer?

A venous leg ulcer is a chronic open wound on the lower leg, most often near the inner ankle, that develops because of underlying venous disease. Years of venous hypertension stretch the vein walls, distort surrounding tissue, and impair the small blood vessels in the skin. The skin becomes more fragile, and a small injury — sometimes one the patient does not remember — fails to heal. Without treatment of the underlying venous problem, the wound can persist for months or years and tends to recur after healing.

The Merck Manual outlines the venous mechanism behind these wounds. Wounds Canada also publishes patient and clinician resources specific to the Canadian context.

Recognising a venous ulcer

VLUs share several characteristics:

• Location around the inner (medial) ankle is most common.
• Shallow shape with irregular borders.
• Surrounding skin often shows pigmentation, dryness, or eczema-like changes.
• Often accompanied by ankle and lower leg swelling.
• Pain that improves with elevation.

Not all leg ulcers are venous. Arterial ulcers, diabetic foot ulcers, and pressure injuries look and behave differently and have different treatment principles. Accurate diagnosis is the most important first step.

The ABPI: why arterial assessment matters

Before high-compression therapy is applied to any leg ulcer, a clinician should confirm that arterial circulation is adequate. The standard non-invasive test is the ankle-brachial pressure index (ABPI), which compares blood pressure at the ankle to blood pressure at the arm. A low ABPI suggests peripheral artery disease and changes the compression plan, because high-strength compression can cause harm in legs with significantly impaired arterial flow.

A simple rule clinicians use is that the cause of the ulcer dictates the treatment: a clean venous ulcer in a leg with adequate arterial flow is typically treated with strong, sustained compression. An arterial ulcer is treated very differently. ABPI is the gateway test that supports a safe decision.

Compression bandaging in the active phase

For active venous leg ulcers, the Canadian standard of care has long centred on multilayer compression bandaging applied by trained wound care clinicians. These systems combine padding, short-stretch bandages, and an outer cohesive layer to deliver sustained, high-level pressure (often in the 30-40 mmHg range at the ankle) that is maintained between dressing changes. Bandages are usually changed once or twice a week depending on the system and the wound. Browse the bandages collection for the underlay and short-stretch products used in these protocols.

Modern alternatives include two-component and four-component compression systems, and various ready-to-apply wraps designed for community wound care. The selection depends on the wound, the leg shape, the patient's mobility, and the resources available in the local healthcare setting.

The role of compression stockings

Once a venous leg ulcer has healed, the underlying venous disease has not. Recurrence rates are high without ongoing compression. The transition from bandages to graduated medical compression stockings is therefore a key step, and clinicians often recommend long-term daily use of stockings in the 30-40 mmHg range to maintain healing and prevent recurrence. For patients who cannot tolerate that pressure, 20-30 mmHg with adjunctive measures may be considered. Browse the 30-40 mmHg compression stockings, the 20-30 mmHg range, and the dedicated leg ulcer collection for typical post-healing options.

Donning support for ulcer patients

Higher-pressure stockings can be difficult to don, especially for older adults, patients with arthritis, and anyone with limited grip strength. Common solutions include:

• Donning frames or butler-style devices.
• Silk under-liners that reduce friction.
• Two-piece systems with a stocking and an ankle-piece that can be put on separately.
• Family or caregiver assistance, especially in the first few weeks after the wound heals.

Browse easy-on compression options for products designed with these challenges in mind.

The role of the patient outside of clinic visits

VLU outcomes hinge on what happens between dressing changes:

• Leg elevation. Lifting the legs above heart level for 15 to 20 minutes several times a day reduces venous pressure quickly.
• Walking. The calf muscle pump is a powerful venous return engine; short walks beat one long sedentary stretch.
• Skin care. Gentle moisturisers maintain the skin barrier on the leg that is not bandaged.
• Diet and weight. Adequate protein supports wound healing; weight management reduces ongoing venous load.
• Smoking cessation. Smoking impairs wound healing on multiple fronts.
• Following the bandage protocol. Bandages should not be removed between visits unless the clinician advises it.

The Wounds Canada patient resources cover these practical steps in more detail.

Signs that warrant a clinical call

Any of the following deserve a quick call to your wound care team:

• Sudden increase in pain, swelling, or wound size.
• New redness, warmth, or fever (possible cellulitis).
• A strong odour or change in wound drainage.
• Tingling or numbness developing under the bandage.
• Toes that become unusually cold, pale, or blue.

Putting it together

Venous leg ulcers are chronic wounds with a clear underlying cause, and they respond to a clear treatment principle: sustained compression. In the active phase, compression bandages applied by a trained clinician are the engine of healing. After the wound closes, daily graduated compression stockings keep the venous pressure low and dramatically reduce the chance of recurrence. The Canadian model of care brings ABPI assessment, multilayer bandaging, careful skin care, and long-term stocking use together into a structured plan. With consistent execution, most venous leg ulcers heal — and stay healed.

Frequently asked questions

How long does it take a venous leg ulcer to heal?

Healing time varies widely. Many uncomplicated ulcers heal within 12 to 24 weeks under appropriate compression. Others take longer, especially if there are coexisting conditions or if compression is inconsistent.

Can I take my bandages off to shower?

Only if your wound care team has explicitly allowed it. Most multilayer compression systems are designed to stay on between scheduled dressing changes.

Do I need stockings after the ulcer heals?

In almost all cases, yes. The underlying venous disease has not gone away, and long-term compression dramatically reduces recurrence.

Is high-strength compression always safe?

No. Inadequate arterial circulation is a key contraindication, which is why ABPI assessment is part of standard practice before high-compression therapy.

Can I buy compression stockings before my ulcer heals?

You can prepare, but the right product and pressure should be confirmed by your wound care team. Many clinics issue a specific prescription that aligns with the bandaging system you used.

Related reading

• Managing edema with compression socks
• Different types of compression socks: understanding the grades
• How to put on compression stockings

This article is general information. Active venous leg ulcers should always be assessed and managed by a clinician who can perform an arterial assessment and tailor the compression plan to the wound.