Which is the treatment for a venous ulcer near the medial malleolus?

• A. Compression therapy.
• B. Surgical removal only.
• C. High-dose anticoagulation.
• D. Antibiotics alone.

Answer: (A)

The key idea here is that venous ulcers from chronic venous insufficiency heal best when venous hypertension is controlled. Compression therapy provides external support to the leg, decreases venous reflux, and reduces edema, which lowers the hydrostatic pressure driving the ulcer. This creates a more favorable environment for wound healing and works alongside proper wound care and leg elevation.

Other options don’t address the underlying problem. High-dose anticoagulation targets clotting and isn’t a standard treatment for venous ulcers unless there’s a thrombotic issue. Antibiotics alone treat infection but don’t fix the venous hypertension, and surgical removal without addressing the venous flow problem won’t promote healing of a venous ulcer. So compression therapy is the most effective first-line treatment for a venous ulcer near the medial malleolus, with arterial perfusion checked beforehand to ensure compression is safe.