It is thought that venous stasis ulcers result from sustained high pressures in the venous system, even during ambulation, where the pressure in the venous system should be the lowest (compared to at rest measurements). This is called ambulatory venous hypertension:

1) from superficial and/or deep venous reflux with or without deep vein thrombosis

2) miccrovascular dysfunction

3) congenital and acquired thrombophilia

4) obesity and diet

5) dysfunction of the calf muscle pump from muscle loss (sarcopenia)

6) skin inflammatory conditions like lipodermatosclerosis

7) recruitment of white blood cells

8) production and secretion of cytokines

9) stimulation of adhesion molecules and metalloproteinases

10) disordered fibroblast function andmatrix rearrangement

11) bacterial colonization;

12) failure of epithelialization

13) acute and chronic wound necrosis

adapted from Mannello and Raffetto, Am J Transl Res 2011;3(2):149-15