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A venous leg ulcer (VLU) has a major impact on the quality of life and functional ability of individuals, but no single treatment is yet effective. This study investigates the changes induced by dorsiflexion exercise on skin perfusion in VLU patients to achieve a better understanding of venous ulcer pathophysiology.Seventy-eight venous leg ulcer patients were randomised into four groups. The non-exercise groups included a control group (n = 18) and a compression therapy group (n = 20) and the exercise groups included an exercise-only group (n = 20) and a compression and exercise group (n = 20). The exercise groups were expected to perform exercise for three months. Measurements included transcutaneous oximetry (tcPO2) and laser Doppler flowmetry (LDF). Skin perfusion measurements for all groups were taken twice: at the beginning and end of the three-month period.Initially, all participants showed a low level of tcPO2. The exercise groups showed a significant increase after three months of exercise (p<0.001), the tcPO2 level remained the same in the non-exercise groups.The LDF parameters decreased significantly (p<0.001) in the compression and exercise group and decreased to a lesser extent in the exercise-only group. There were no LDF changes in the non-exercise groups.Perfusion measurements showed significant changes after three months of regular exercise. We conclude that exercise has a significant effect on tissue perfusion parameters in venous leg ulcer and this effect may play a role in understanding the pathophysiology of VLU.