Chronic lower extremity ulcers present a significant burden on patients and physicians worldwide. Chronic leg ulcers affect 1% of the population, these wounds can be difficult to treat and present a challenge to physicians. Treatment has often been based on unreliable, informal and unscientific accounts; however, there is a growing emphasis on using evidence-based conclusions to guide clinical decisions. This review gives insights into currently available knowledge on the epidemiology, pathophysiology, prognosis and treatment (standard therapy, adjuvant therapy, general measures and surgical management) of chronic lower extremity ulcers presented from an evidence-based perspective. The role of radical surgery will also be discussed in detail.