Causes of reddish brown staining / haemosiderin above the ankle
Venous hypertension / insufficiency
Venous hypertension / insufficiency happens when high pressure in the veins in the legs causes substances from the blood to leak into the tissues. Blood is pumped from the heart to the rest of the body through the arteries and returns through the veins. The blood is propelled back to the heart by the heart pumping and actions of the leg and foot muscles during walking and ankle movement.
The veins contain one-way valves to stop the blood falling back towards the toes. These valves can become weak or damaged. When this happens, the veins become so swollen (varicose veins) that blood is forced into the tissue of the skin.
The haemoglobin from red blood cells is released into the skin tissue and degrades into haemosiderin. It is this haemosiderin that causes brown patches of skin above the ankle. The stained skin is very fragile and may break down or, if knocked, fail to heal as usual.
Your patient’s legs might not be swollen as haemosiderin staining on its own is a sign of venous hypertension.
Assessment of a patient with haemosiderin
You should give everyone who presents with a lower leg problem a comprehensive assessment that includes:
- ABC of Wound Healing, Venous and Arterial Leg Ulcers
The BMJ (Web page)
- Doppler ultrasound to record an Ankle Brachial Pressure Index (ABPI). This test screens for clinically significant arterial impairment.
World Wide Wounds (Web page)
Nursing Times – Doppler assessment (Web page)
If your patient appears to have problems with their veins or arteries, you should refer them for further vascular tests.
Treatment of haemosiderin
The first line treatment for venous hypertension is compression therapy.
Wounds UK – compression hosiery (PDF Download – Open access – registration required to download)
NICE – Compression Stockings (Web page)
People with haemosiderin staining are likely to have vulnerable or dry skin on their lower legs. You should encourage them to use emollient based soap substitutes for washing their legs and to apply emollient creams daily to improve the strength of the skin barrier.
Publications & Evidence for haemosiderin
We’ve carefully curated resources to help in your everyday work.
Patient information for haemosiderin
The patients, family and friends section has lots of useful, accessible information for your patients.
If you need further information or support, we’d recommend the following organisations as trusted partners and reliable sources.
Accelerate Accelerate CIC is an independent specialist team who assess and management people with chronic swelling or non-healing lower leg wounds or ulcers. We're based in London but can accept national referrals from your GP / specialist. For those further afield, please call to discuss possible options.
The British Lymphology Society (BLS) is a dynamic and innovative body providing a strong professional voice and support for those involved in the care and treatment of people with lymphoedema and related lymphatic disorders, including lipoedema.
Find out more on the British Lymphology Society website
Lymphoedema Support Network (LSN) is a national UK charity which provides information and support to people with lymphoedema.
020 7351 0990
Find out more on the Lymphoedema Support Network website
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