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Identify and Treat the Cause - Determine the Cause of Venous Insufficiency Based on Etiology

When a patient is lying down the pressure is close to zero inside the deep veins compared to standing, where the pressure could increase to 80-90 mmHg. When walking, the calf-muscle-pump contracts allowing the blood to flow proximally towards the heart. Blood flow from the superficial veins to the deeper veins occurs when the pressure decreases. In fully functional vessel valves, retrograde blood flow is prevented as the leg muscles relax.

Venous hypertension occurs when the venous system becomes damaged or when the valves become leaky causing the pressure not to decrease normally. When the action of the calf-pump-muscle is disrupted the venous pressure is also affected.

  1. Valve dysfunction or reflux
    Often occurs in the deep perforator and/or superficial veins
  2. Obstruction (complete or partial)
    May be caused by deep vein thrombosis
  3. Calf-muscle-pump failure
    Usually occurs from decreased activity level which may be secondary to paralysis, localized deformity or injury. Decreased range of motion of the lower leg and ankle joint are often the cause

Physical Activity

RNAO Evidence Level:

Level A

Physical activity has also been identified as a vital factor to prevent and heal venous leg ulcers. Lower leg exercises including tip-toe exercises in the standing position, flexing and stretching of feet in the sitting position are important exercises to enhance venous return. Walking will activate the calf muscle pump that is essential to support venous circulation. A diminished calf muscle pump function or absence of calf muscle pump will result in edema in the lower legs and other chronic venous insufficient symptoms. The immobility of the ankle joint will influence ambulatory venous hypertension and is a factor in causing venous ulceration. A referral to physiotherapy is recommended for patients that have reduced or no ankle joint mobility to loosen soft-tissue contractures through the use of physical therapy. Studies have shown that patients with venous leg ulcers have low level of physical activity. Heinen et al concluded that 35% of venous leg ulcer patients did not walk 10 minutes once a week1.

Identify and Treat the Cause - Implement Appropriate Compression Therapy
  1. Heinen M, van der Vleuten C, de Rooij M, Uden Caro, Evers A, Van Achterberg T. Physical activity and adherence to compression therapy in patients with venous leg ulcers. Archives Dermatology. 2007; 143(10):1283-1288.

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