Prevalence of Lower-Limb Ulceration: A Systematic Review of Prevalence Studies

OBJECTIVE: To determine the prevalence of leg ulcers reported in the literature. DESIGN: A systematic review of prevalence studies of lower-limb ulceration in the adult population was conducted. Critical appraisal of the research papers was guided by published standards for methodologic review of prevalence studies, which were modified to address the issues related to leg ulcers. MAIN RESULTS: Twenty-two reports of prevalence studies were identified. Eight population-based prevalence studies used clinical validation and reported prevalence rates of open ulcers ranging from 0.12% to 1.1% of the population; the prevalence rate of open or healed ulcers was reported to be 1.8%. Seven population-based studies without clinical validation reported prevalence rates of open ulcers ranging from 0.12% to 0.32% of the population. Differences in the populations studied, study design, ulcer definition, ulcer etiology, inclusion of foot ulcers, method of clinical assessment, and clinical validation of ulcer cases indicate that it is inappropriate to pool the estimates of prevalence. In most studies that considered age and sex, the prevalence of ulcers increased with age and was higher for women. CONCLUSIONS: Better-quality prevalence studies are needed. These studies should clearly define the populations being studied, include large numbers of individuals and total populations, provide a clear definition of an ulcer, describe case identification procedures, and clinically confirm the presence of ulcers.