Background: Venous leg ulcers (VLUs) are common chronic recurrent, conditions, and major causes of morbidity and disability. VLUs usually associated with chronic venous insufficiency. Foam sclerotherapy (FS) has been applied to the treatment of a variety of venous conditions because of its efficacy, efficiency, low cost and minimally invasive nature of the procedure. Surgical correction of superficial, perforating, or deep-venous disease may be needed for healing of venous ulcer. Objective: To evaluate the clinical efficacy of saphenofemoral junction ligation with FS in comparison with FS alone in treatment of patients associated with chronic venous insufficiency that had isolated superficial venous and perforators reflux and complicated by VLUs. Patients and Methods: The present study included 40 patients with VLUs associated by isolated superficial venous and perforators reflux. They presented to the Vascular Surgery Department of Al-Azhar University Hospitals, Cairo, Egypt, over a 5- years period from November 2015 to October 2020.  Patients were divided into two equal groups: group A underwent FS ulcer related perforating veins only, and group B underwent ligation of saphenofemoral junction and FS. The two groups were followed by compression. The patients were followed up for ulcer healing time, rate of healing, and the rate of recurrence for at least 12 months. Results: The patient population was thirty-two males (80%) and eight females (20%), with VLUs and superficial venous system insufficiency over a 5-years period. In group A, thirteen patients (65%) reached the end point of adequate healing or complete healing within 14–24 weeks, while in group B sixteen patients (80%) reached the end point within 8–16 weeks. The recurrence rates at 12 months were 30% (six patients) in group A and 10% (two patients) after surgery in group B. Conclusion: Ligation of the saphenofemoral junction with FS can improve the outcomes of patients with venous ulcers in comparison with FS alone.