Venous ulcers: A reappraisal analyzing the effects of neuropathy, muscle involvement, and range of motion upon gait and calf muscle function

Abstract

Chronic venous insufficiency is a complex disease that can result in severe sequelae including venous ulceration. Though the exact progression from chronic venous insufficiency to venous ulcer remains unclear, the high cost and burden of this disease on patients and society is quite clear. Sustained ambulatory venous pressures or venous hypertension plays an integral role in the development of venous ulceration and involves the failure of the calf muscle pump system. Standard of care involves compression therapy to assist the calf muscle pump. However, several cofactors may contribute to or exacerbate this disease and understanding their impact may provide insight into new treatment modalities. Nerve involvement, which may result in neuropathic pain and muscle dysfunction, alterations in mobility and a decrease in range of motion may lead to gait alterations all affecting calf muscle pump function. In this paper, we analyze these cofactors and discuss possible treatment options to target them. Physicians treating this disease should be aware of the numerous factors involved in its development. Exploring new treatment options may 1 day lessen the burden and suffering caused by venous insufficiency.

Manual Lymphatic Drainage in the Treatment of Chronic Venous Disease

“…Several studies show the presence of both neuropathic and nociceptive pain in patients with CVD [4,43]. Nevertheless, patients with CVD may present other comorbidities that make it difficult to isolate the CVD-related pain [43,44].…”

“…Nevertheless, patients with CVD may present other comorbidities that make it difficult to isolate the CVD-related pain [43,44].…”

“…According to self-reports, functional status is diminished in these patients [36,39] also because of some physical dysfunctions, like abnormalities in gait [45], impaired balance, peripheral neuropathy [43,46] weak leg muscles (plantar flexion and dorsiflexion muscles) [29,30,45], or diminished ankle range of motion [10,30,47]. These dysfunctions are also associated with impaired muscle pump function in the lower extremity [43], an important risk factor for venous ulceration [48].…”

“…The venous system returns the blood to the heart and is a low-pressure, slow-velocity, largevolume and low-resistance vascular system [1]. Venous return results from the interaction of diverse mechanisms, like a central pump (respiratory cycle and heart), a pressure gradient, a peripheral venous pump, and veins valvular system [43]. The venous volume in the lower limb is the result of the interaction between these mechanisms and reflects the balance between blood inflow and outflow [1].…”

“…The venous return from the periphery to the heart via the venous system is linked to the action of a central pump (heart and respiratory cycle), periphery venous pump, a pressure gradient, and competent veins and/or venous valves [43,75].…”