In elderly patients, even those with a typical venous (stasis) ulcer, coexisting conditions like peripheral arterial insufficiency and diabetes are very common. Therefore, all elderly patients with leg ulcers should have a complete medical assessment. The mainstay of treatment for venous ulcers is compression therapy, exercise and leg elevation at rest. Long term treatment with double bandages (zinc paste bandages and elastic compression), changed once weekly, is the recommended standard treatment in the elderly. Hydrocolloid dressings are also suitable for long term treatment in clean ulcers, and should be changed once or twice weekly and combined with compression. Sloughy, exudating ulcers might need redressing daily with a desloughing agent for a short period of time. The risk of sensitising patients with chronic leg ulcers is high and few topical preparations, with low antigenicity, should be used. Infection and ulcerated skin cancers should be ruled out in nonhealing ulcers if the patient complies with compression therapy. After healing, the patient should be advised to continue compression therapy with stockings to prevent recurrences. New noninvasive techniques for investigation of venous insufficiency can select patients suitable for venous surgery, but many elderly patients are not interested in surgery or have other ailments that prevent surgery.