Lower Leg Ulcer Diagnosis & Treatment

Significant challenges remain in Europe with regards to consistently offering patients with lower leg ulcers a fast and correct diagnosis, and thereby prevent lengthy treatment plans with little success and substantial patient suffering.

Too many patients are never offered the right treatment due to incorrect diagnosis and failure to see the right specialist. EWMA wishes to address this in a project with multiple deliverables addressing the current needs and challenges in leg ulcer diagnosis across Europe.

Aims and objectives

The overall aim of the project is to achieve a uniform and consistent approach to diagnosis and treatment of lower leg ulcers across Europe, taking into consideration the various structural differences.
Across Europe, it should be clear, that all patients with a non-healing lower leg wound:

  • Must receive a differential diagnosis, defining the wound as either arterial, venous or atypical (The project will exclude pressure ulcers and diabetic foot ulcers, as comprehensive guidelines exist for these wound types).
  • Must receive a diagnosis at the recommended time, with reference to the occurrence and healing status.

NEW EWMA Document: Lower Leg Ulcer Diagnosis & Principles of Treatment

The document is published as a supplement to the Journal of Wound Management, vol. 24, 1.

You can download the document here: 



External document appendices (referred to in the document) can be downloaded here:

One-page guidance: Assessment, Diagnosis and Referral Pathway for Patients with Lower Leg Ulcers

Based on the EWMA Document: 'Lower Leg Ulcer Diagnosis & Principles of Treatment'. One-page clinical guidance with assessment, diagnosis and referral pathways for patients with lower leg ulcers.

Read and download for free.


The one-pager is translated into other European languages:

Webinars on-demand

EWMA & European Society for Vascular Surgery (ESVS): Lower leg ulcer diagnostics and treatment

The webinar was held on the 26th of October 2023.

Watch the webinar on-demand here.



EWMA & Finnish Wound Care Society (FWCS) Joint Webinar: Lower Leg Ulcer Diagnosis and Principles of Treatment

The webinar was held on the 27th of September 2023. 

Language: Finnish

Watch the webinar on-demand here. 

Programme deliverables

The project will include four deliverables, aiming to support the project aims:

1) A document describing:

a. the diagnostical procedures, methods and tools, including potential errors and mistake
b. the related treatment actions

2) European checklists defining the implications for clinical practice in primary care and wound specialist clinics.

3) Development of an online course targeting GPs and other medical specialists involved in wound management

4) Information material for leg ulcer patients, describing the diagnostical pathways (With engagement of the EWMA Cooperating Organisations in the translation of materials)

5) An awareness campaign supporting the dissemination of the document and educational material via the relevant societies, collaboration with the UEMS Multidisciplinary Joint Committee on Wound Healing, including

a. Meetings with relevant contacts in the targeted societies
b. Support for implementation actions on national level

Working group:

  • Kirsi Isoherranen, Specialist In Dermatology, HUS Helsinki Wound Healing Centre, EWMA council member
  • Elena Conde Montero, Dermatology consultant, Hospital Universitario Infanta Leonor, Madrid, EWMA council member
  • Leanne Atkin, Vascular Nurse Consultant, Mid Yorks NHS Trust & Research Fellow, University of Huddersfield, UK
  • Mark Collier, Nurse Consultant and Associate Lecturer, Tissue Viabillity (UK) & Universities of Lincoln and Sunderland, UK
  • Annette Høgh, Associate Professor and Senior Consultant in vascular surgery and, Department of Clinical Medicine Aarhus University & Wound Care Center, HEM Viborg, Denmark
  • John Ivory, PhD Candidate, School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
  • Klaus Kirketerp-Møller, Consultant, Department of Dermatology & Copenhagen Wound Healing Centre, Bispebjerg University Hospital, Denmark
  • Sylvie Meaume, Head of department at Hôpital Rothschild, Hôpitaux universitaires Est Parisien, Geriatry, Dermatology and Wound Healing, France
  • Hayley Ryan, Director at Wounds Rescue (Australia & New Zealand), Board Director & Chair at Wounds Australia, Wound Clinical Nurse Consultant at NSW & ACT Uniting, Emergancy Department Clinician at John Hunter Hospital, PhD researcher at  Newcastle University, Australia
  • Ewa K. Stürmer, Professor, University Medical Center Hamburg, Eppendorf, Department of Vascular Medicine - University Heart Centre, Germany
  • George-Sorin Tiplica, Professor of Dermatology, Head of the Dermatology 2 Clinic in Colentina Clinical Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, President of the UEMS Multidisciplinary Joint Committee Wound Healing
  • Sebastian Probst, Professor of Tissue Viability and Wound Care Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, President of EWMA

Project sponsors

This project is supported by an unrestricted grant from: