Effects of Kinesio Taping and compression stockings on pain, edema, functional capacity and quality of life in patients with chronic venous disease: a randomized controlled trial.

OBJECTIVE: The aim of this study was to compare the effects of Kinesio Taping and compression stockings on pain, edema, functional capacity and quality of life in patients with chronic venous disease (CVD). DESIGN: This is a prospective, randomized, controlled, single-blind clinical trial. SETTING: The study was conducted in a physiotherapy and rehabilitation unit of a university hospital. SUBJECTS: A total of 62 patients with early-stage CVD were allocated to either an experimental group or a control group. INTERVENTIONS: Experimental group (n = 29) received Kinesio Taping intervention once a week for four weeks, while control group (n = 29) received compression stockings for four weeks. All patients additionally undertook an exercise training programme including calf muscle pump exercises, flexibility exercises and diaphragmatic breathing. MAIN MEASURES: Visual analogue scale, lower limb circumference measurements, 6-minute walk test and Short Form 36 questionnaire were applied before and after four weeks of treatment. RESULTS: Control group showed statistically significant improvements in pain (P < 0.001), ankle circumferences (right, P = 0.002; left, P = 0.037), calf circumferences (right, P = 0.020; left, P = 0.022), knee circumference (left, P = 0.039) and thigh circumferences (right, P = 0.029; left, P = 0.002) compared with experimental group. There were no significant differences between groups with respect to functional capacity and quality of life (P > 0.05). Both groups significantly improved 6-minute walk distance (P < 0.001) and Short Form 36 physical component summary (experimental group, P = 0.002; control group, P = 0.006). CONCLUSION: This study demonstrated that Kinesio Taping and compression stockings revealed similar improvements of functional capacity and quality of life in patients with CVD. The symptoms of pain and edema caused by CVD can be decreased more efficiently with compression stockings than Kinesio Taping intervention.

Localização e papel hemodinâmico das veias perfurantes independentes das veias safenas / Location and hemodynamic role of perforating veins independent of saphenous veins

As veias perfurantes dos membros inferiores (MMII) apresentam válvulas que permitem o direcionamento do fluxo sanguíneo do sistema venoso superficial para o profundo e podem estar conectadas ou não ao sistema das veias safenas. Objetivos: Identificar, pela ultrassonografia vascular (USV), a frequência, localização, calibre e o papel hemodinâmico das veias perfurantes independentes das veias safenas no mapeamento pré-operatório das varizes dos MMII. Métodos: Foi realizado estudo transversal utilizando a USV em mulheres com o intuito de estudar a frequência, a localização, a altura em relação à base do pé e o papel hemodinâmico das veias perfurantes. Resultados: A frequência de veias perfurantes independentes das veias safenas foi de 92,6%, 5,1% e 2,3%, na perna, coxa e joelho, respectivamente, sendo 25,2% incompetentes e 72,3% de drenagem. O diâmetro médio das veias perfurantes foi de 2,9 mm, 3,5 mm e 3,7 mm, na perna, coxa e joelho, respectivamente. As veias perfurantes localizaram-se em média 23,8 cm, 43,6 cm e 59,4 cm acima da base do pé na perna, joelho e coxa, respectivamente. As veias perfurantes com refluxo apresentaram calibre médio de 3,5 mm, independentemente da localização. Conclusões: As veias perfurantes independentes das veias safenas são mais frequentes na perna, drenando refluxo de veias tributárias. Independentemente da localização, as veias perfurantes com refluxo apresentam calibre médio de 3,5 mm

The perforating veins of the lower limbs (LL) have valves that enable the blood flow to be directed from the superficial vein system to the deep vein system and they may or may not be connected to the saphenous vein system. Objectives: To use vascular ultrasonography (VUS) to identify the frequency, location, caliber, and hemodynamic role of perforating veins that do not connect to saphenous veins, during preoperative mapping of LL varicose veins. Methods: A cross-sectional study was conducted using VUS in women to study the frequency, location, distance from the sole of the foot, and hemodynamic role of perforating veins. Results: The frequencies of perforating veins independent of the saphenous veins were 92.6%, 5.1%, and 2.3%, in the leg, thigh, and knee, respectively, and 25.2% of them were incompetent while 72.3% were drainage veins. The mean diameters of perforating veins were 2.9mm, 3.5mm, and 3.7 mm, in the leg, thigh, and knee, respectively. Perforating veins were located at mean distances of 23.8cm, 43.6 cm, and 59.4 cm above the sole of the foot in the leg, knee, and thigh, respectively. Perforating veins with reflux had a mean caliber of 3.5 mm, irrespective of location. Conclusions: Perforating veins independent of the saphenous veins are most frequent in the leg, draining reflux from tributary veins. Irrespective of location, perforating veins with reflux had mean caliber of 3.5 mm

Thermal and Nonthermal Endovenous Ablation Options for Treatment of Superficial Venous Insufficiency.

Open saphenous removal, phlebectomy, and venous ligation were historic mainstays of surgical treatment of venous disease. Duplex ultrasound has become standard to diagnose venous insufficiency. Percutaneous modalities have allowed treatments to include thermal and nonthermal endovenous ablation. These treatments vary in preoperative planning, procedural steps, and postprocedural care, but all are safe and effective. An individualized approach should be taken in determining which modality is offered to each patient. Endovenous options, which often are minimally invasive and safely performed in an outpatient setting, allow access to effective treatments with low risk and discomfort.

Venous flow during manual lymphatic drainage applied to different regions of the lower extremity in people with and without chronic venous insufficiency: a cross-sectional study.

OBJECTIVES: To evaluate the effect of manual lymphatic drainage (MLD) on venous flow when applied to the medial and lateral aspects of the thigh and leg in patients with chronic venous insufficiency (CVI) and healthy subjects. DESIGN: Cross-sectional study. SETTING: Participants were assessed in a school-based health community attendant service. PARTICIPANTS: Fifty-seven subjects participated in this study {mean age: 43 [standard deviation (SD) 14] years, 38 women and 19 men}. Of these, 28 subjects had CVI [mean age 47 (SD 12) years] and 29 subjects did not have CVI [mean age 39 (14) years]. INTERVENTION: MLD was applied by a certificated physical therapist to the medial and lateral aspects of the thigh and leg. MAIN OUTCOME MEASUREMENTS: Cross-sectional area; blood flow velocities in the femoral vein, great saphenous vein, popliteal vein and small saphenous vein at baseline and during MLD, measured by duplex ultrasound. RESULTS: Flow volume in the femoral vein increased from baseline [5.19 (SD 3.25)cm3/second] when MLD was applied to the medial [7.03 (SD 3.65)cm3/second; P≤0.001; mean difference -1.69; 95% confidence interval (CI) -2.42 to -0.97] and lateral [6.16 (SD 3.35)cm3/second; P≤0.001; mean difference -1.04; 95% CI -1.70 to -0.39] aspects of the thigh. Venous flow augmentation in the femoral vein and great saphenous vein was higher when MLD was applied to the medial aspect of the thigh (P<0.001), while MLD had a similar effect on venous blood flow regardless of whether it was applied to the medial or the lateral aspect of the leg (P=0.731). CONCLUSIONS: MLD increases blood flow in deep and superficial veins. MLD should be applied along the route of the venous vessels for improved venous return.

Trombose induzida pelo calor endovenoso: relato de dois casos tratados com rivaroxabana e revisão da literatura / Endothermal heat-induced thrombosis (EHIT): reports on two case treated with rivaroxaban and literature review

Define-se trombose induzida pelo calor endovenoso como a propagação do trombo a partir de uma veia superficial em direção a uma veia mais profunda. Em geral, é considerada clinicamente insignificante quando não há propagação do trombo para o sistema venoso profundo. Essa condição pode ser tratada com terapia anticoagulante, embora a observação pareça ser suficiente, principalmente para graus menores. Neste estudo, relatamos dois casos de trombose induzida pelo calor endovenoso que teriam indicação de heparina de baixo peso molecular até a resolução do quadro. Porém, optou-se pelo uso da rivaroxabana (15 mg de 12 em 12h), com resolução completa do trombo em 4 semanas (caso 1) e em 7 dias (caso 2). A rivaroxabana pode ser uma alternativa promissora no tratamento da trombose induzida pelo calor endovenoso avançada, pela simplicidade da posologia, sem comprometimento da eficácia ou da segurança. São necessários estudos prospectivos, randomizados e controlados que possibilitem melhor entendimento da condição e o desenvolvimento de recomendações mais definitivas sobre opções de prevenção e tratamento.

Endothermal heat-induced thrombosis (EHIT) is defined as propagation of a thrombus from a superficial vein into a deeper vein and is generally considered clinically insignificant if the thrombus does not propagate to the deep venous system. The condition can be treated with anticoagulation therapy, although monitoring may be sufficient, especially in less severe cases. In this paper we report on two cases of EHIT that met the criteria for indication of low molecular weight heparin until resolution of symptoms. However, the treatment actually chosen was 15 mg of rivaroxaban every 12 h and the outcomes were complete thrombus resolution in 4 weeks in Case 1 and 7 days in Case 2. Rivaroxaban may be a promising alternative for treatment of severe EHIT because the dosage regimen is simplified without compromising efficacy or safety. Prospective, randomized, controlled studies are needed to better understand EHIT and to develop more definitive recommendations on prevention and treatment options for this condition.

Randomized clinical trial of endovenous laser ablation versus steam ablation (LAST trial) for great saphenous varicose veins.

BACKGROUND: The aim was to compare endovenous laser ablation (EVLA) and endovenous steam ablation (EVSA) for great saphenous varicose veins in a non-inferiority study. METHODS: Patients with primary great saphenous vein reflux were randomized to EVLA (940 nm) or EVSA (SVS™). Primary outcomes were treatment success (vein obliteration or abolition of reflux) [corrected] at 52 weeks, and Venous Clinical Severity Score (VCSS) at 12 weeks. Secondary outcomes were pain, satisfaction with treatment, duration of analgesia use and days lost from daily activities, changes in Aberdeen Varicose Vein Questionnaire (AVVQ) and EQ-5D™ scores after 12 weeks, and complications at 2 and 12 weeks. RESULTS: A total of 227 legs were treated (EVSA, 117; EVLA, 110); 36 legs treated with EVSA received a low dose and the remaining 81 a higher dose. At 1 year, the treatment success rate after high-dose EVSA was not inferior to that of EVLA: 92 (95 per cent confidence interval (c.i.) 86 to 98) versus 96 (92 to 100) per cent respectively. Changes in VCSS after 12 weeks were similar: -2·69 (95 per cent c.i. -2·34 to -3·04) and -2·51 (-2·10 to -2·93). AVVQ, EQ-5D™ and EQ VAS scores improved equally 12 weeks after both treatments. Patients treated with EVSA reported less postprocedural pain, fewer days of analgesia use, were more satisfied with therapy, and had a shorter convalescence. Complication rates were comparable. CONCLUSION: The 1-year treatment success of high-dose EVSA was not inferior to that of EVLA. Several secondary outcomes were in favour of EVSA. Registration number NCT02046967 (http://www.clinicaltrials.gov).

Effect of a mixed kinesio taping-compression technique on quality of life and clinical and gait parameters in postmenopausal women with chronic venous insufficiency: double-blinded, randomized controlled trial.

OBJECTIVE: To investigate the short-term effect of a mixed Kinesio taping (KT) model on range of ankle motion (ROAM), gait, pain, perimeter of lower limbs, and quality of life in postmenopausal women with chronic venous insufficiency (CVI). DESIGN: Double-blinded, randomized controlled trial. SETTING: Clinical setting. PARTICIPANTS: Consecutive postmenopausal women (N=130; mean age ± SD, 65.44±14.7y) with mild CVI. No participant withdrew because of adverse effects. INTERVENTION: Participants were randomly assigned to either (1) an experimental group to receive a mixed KT-compression treatment following KT recommendations for gastrocnemius muscle enhancement and functional correction of the ankle, and adding 2 tapes to simulate traditional compression bandages (no KT guidelines); or (2) a placebo control group for sham KT. Both interventions were performed 3 times a week during a 4-week period. MAIN OUTCOME MEASURES: ROAM, gait, pain, perimeter of right and left lower limb, and quality of life were assessed at baseline and 48 hours posttreatment. RESULTS: Quality of life was better in the intervention group by a mean of 8.76 points (95% confidence interval [CI], 4.96-12.55). The experimental group also showed significant pre-/posttreatment improvements in both lower limbs in gait dorsiflexion ROAM (95% CI, 1.02-2.49), cadence (95% CI, 3.45-1.47), stride length (95% CI, 21.48-10.83), step length (95% CI, 1.68-6.61), stance phase (95% CI, 61-107), and foot (95% CI, .56-.92) and malleolus (95% CI, 1.15-1.63) circumference. None of these variables were significantly modified in the placebo group. Both groups reported a significant reduction in pain. CONCLUSIONS: Ankle dorsiflexion during gait, walking parameters, peripheral edema, venous pain, and quality of life remain improved in patients with CVI at 1 month after mixed KT-compression therapy. KT may have a placebo effect on pain perception.

[Physiotherapy potentials improve the calf muscle pump function in chronic venous insufficiency]. / Mozliwosci fizjoterapii w usprawnianiu funkcji pompy miesniowej goleni w przewleklej niewydolnosci zylnej.

Mechanism of the calf muscle pump plays a major role in venous blood return from peripheral parts of blood vessels of lower extremities. It enables a smooth venous blood movement from the deep venous system segment located below in a direction to the segment lying above which effectively prevents a distal blood stasis and veno-lymphatic edema of lower limbs. Calf muscle pump dysfunction together with disorders in the construction of blood vessels walls and with endurance weakness of valves, leads to venous hypertension and contributes to the development of venous insufficiency. The aim of this paper is to demonstrate the theoretical basis including venous return physiology and the mechanism of lower limbs venous--muscle pump as well as provide practical application of physiotherapy methods to support the properfunction of presented calf muscle pump. Examples in the field of physical medicine, compression therapy and kinesiotherapy for improving the efficiency of lower extremity muscles, providing a physiological venous return.

Increase in calf post-occlusive blood flow and strength following short-term resistance exercise training with blood flow restriction in young women.

The response of calf muscle strength, resting (R (bf)) and post-occlusive (PO(bf)) blood flow were investigated following 4 weeks resistance training with and without blood flow restriction in a matched leg design. Sixteen untrained females performed unilateral plantar-flexion low-load resistance training (LLRT) at either 25% (n = 8) or 50% (n = 8) one-repetition maximum (1 RM). One limb was trained with unrestricted blood flow whilst in the other limb blood flow was restricted with the use of a pressure applied cuff above the knee (110 mmHg). Regardless of the training load, peak PO(bf), measured using venous occlusion plethysmography increased when LLRT was performed with blood flow restriction compared to no change following LLRT with unrestricted blood flow. A significant increase (P < 0.05) in the area under the blood time-flow curve was also observed following LLRT with blood flow restriction when compared LLRT with unrestricted blood flow. No changes were observed in R (bf) between groups following training. Maximal dynamic strength (1 RM), maximal voluntary contraction and isokinetic strength at 0.52 and 1.05 rad s(-1) also increased (P < 0.05) by a greater extent following resistance training with blood flow restriction. Moreover, 1 RM increased to a greater extent following training at 50% 1 RM compared to 25% 1 RM. These results suggest that 4 weeks LLRT with blood flow restriction provides a greater stimulus to increase peak PO(bf) as well as strength parameters than LLRT with unrestricted blood flow.

Venous insufficiency and foot dysmorphism: effectiveness of visco-elastic rehabilitation systems on veno-muscle system of the foot and of the calf.

Chronic venous disease is very common and widespread. Chronic Venous Insufficiency (CVI) is a condition characterized by hypertension of the venous system of the lower limbs which manifests itself through a large range of symptoms. The main cause of CVI is hypertension of the venous system of lower limbs, which in most cases is due to reflux for the incontinence of the valvar system of veins. Other causes are related to obstruction of the venous outflow, or at a reduced venous emptying due to inefficiency of the system of the veno-muscular pumps of the calf and of the foot. The purpose of this study was to evaluate if the use of a non-invasive rehabilitative mode to improve the efficiency of the veno-muscular pumps of the foot and of the calf using photoplethysmography in reflected light. Fifty (50) patients suffering from flatfoot and ped cavus, were studied doing a stabilometric and baropodometric test to evaluate the angle of the foot and the podalic angle. Patients were evaluated by examining vascular examination and venous reography in basal condition, using corrective visco-elastic insoles for the correction of dysmorphisms that we were studying. An improvement of the angle of the Right and Left axis (p<0.05) and the podalic angle (p<0.001), using the right insole both in the flatfoot and cavus foot, was shown by the podobarographic examination. A not important tendency to improvement was also shown by the use of non-specific insole in both pathologies. The vascular examination showed an improvement of 38 percent in venous emptying capacity of the foot/calf veno-muscular pump in cavus foot with the specific B insole (p<0.002). An important improvement of 24 percent, using the specific A insole (p<0.05), was documented in flatfoot. The photoplethysmography examination documented a significant improvement of the venous emptying capacity of foot-calf veno-muscular system due to the use of specific insoles for the studied dysmorphism, with an improving tendency even with the use of non-specific insoles. The hemodynamic improvement is correlated with the improvement of the analyzed biomechanical parameters: contact time, lenght of the halfstep, podalic angle and angle of the foot. The partial normalization of biomechanical parameters allows a reorganization of relationships of forces between ground and foot, as well as the improvement of the function of the subtalar joint, causing a partial recovery of the complex physiological mechanism of activation of the veno-muscular pumps of the foot and of the calf.

[Improvement of rehabilitation efficiency in patients with chronic venous insufficiency of the lower extremities].

The relationship between functional incompetence, development and severity of chronic venous insufficiency of the lower extremities was investigated by the method of clinical analysis of locomotor activity. Results of the study may be used to choose an optimal therapeutic modality and assess dynamics of its efficiency. It was shown that the treatment of chronic venous insufficiency in the majority of the patients is inefficient unless functional activity of the lower extremities is recovered. Stimulation of the muscular-venous pump improves the outcome of postoperative rehabilitation, permits to reduce its duration, and improves quality of life of the patients.

Eficacia de la fisioterapia en la insuficiencia venosa crónica en evolución / Efficacy of physical therapy in chronic venous insufficiency in evolution

Objetivos: Estudiar la eficacia de la fisioterapia en la insuficiencia venosa y la úlcera como complicación de ésta. Método: Búsqueda realizada en PEDro (puntuación mayor de 6), Cochrane, MEDLINE y CEBP. Resultados: El edema venoso se redujo hasta 2,2ml mediante movilizaciones activas y derivación circulatoria. En la úlcera venosa se comprobó que el ultrasonido no fue eficaz tras la revisión de siete ensayos; en cuatro se comparó con el ultrasonido simulado y en los tres restantes se cotejó con un tratamiento estándar. Otros estudios con ultrasonidos pulsátil de 0,5W/cm2 a 1MHz durante 12 semanas tampoco evidenciaron mejoría. El láser no mostró significación para la úlcera si bien evidenció sus efectos terapéuticos en aplicación combinada con luz infrarroja. Conclusiones: La cinesiterapia de la bomba venomuscular periférica es eficaz en la insuficiencia venosa. Los tratamientos mediante láser y ultrasonidos en forma aislada no modifican la evolución de la úlcera flebostática(AU)

Objectives: To study the effectiveness of physical therapy in venous insufficiency and ulcer as a complication of it. Method: Search conducted in PEDro (score greater than 6), Cochrane, MEDLINE and CEBP. Results: Venous edema was reduced to 2.2 cc by active mobilizations and circulatory shunt. It was found that ultrasound was not effective on the venous ulcer after 7 trials were reviewed. Sham ultrasound was compared in 4 of them and the remaining 3 were collated with the standard treatment. Other studies with ultrasound pulses of 0.5W/cm2 to 1MHz for 12 weeks also showed no improvement. Laser showed no significance for the ulcer although its therapeutic effects were verified when it was combined with infrared light. Conclusions: Pump kinesiotherapy is effective in venomuscular peripheral venous insufficiency. Therapeutic laser and ultrasound when used separately do not alter the development of the phlebostatic ulcer(AU)

Fear-avoidance beliefs and pain as predictors for low physical activity in patients with leg ulcer.

BACKGROUND AND PURPOSE: Previous studies have shown that patients with chronic venous insufficiency are deconditioned and physically inactive. The present study aimed to examine the occurrence of fear-avoidance beliefs in patients with chronic venous insufficiency, and to investigate the role of fear-avoidance beliefs and pain severity in predicting the low level of physical activity in these patients. METHOD: Data were collected by a postal questionnaire sent to 146 patients with chronic venous insufficiency and current or previous venous leg ulcer. Complete data were collected from 98 patients aged 60-85 years - 63% women - giving a response rate of 67%. Fear-avoidance beliefs were assessed by the Fear-Avoidance Beliefs Questionnaire, physical activity subscale. Pain and physical activity were assessed by the Six-point Verbal Rating Scale of Pain Assessment and the Physical Activity Questionnaire, respectively. RESULTS: Fear-avoidance beliefs were present in 81 (83%) of the patients with chronic venous insufficiency (range 0-24, median 12). Forty patients (41%) had strong fear-avoidance beliefs. One-third of the patients with healed ulcers had strong fear-avoidance beliefs. Patients with low physical activity had significantly stronger fear-avoidance beliefs and more severe pain than patients with high physical activity. Multiple logistic regression showed that the odds ratio (OR) for low physical activity were about three times higher for patients with strong fear-avoidance beliefs (OR 3.1, 95% confidence interval 1.1-8.3; p = 0.027) than for patients with weak fear-avoidance beliefs. CONCLUSIONS: Fear-avoidance beliefs were present in most patients with chronic venous insufficiency and were associated with low physical activity. Clinical implications ought to include a better recognition of fear-avoidance beliefs, early information about the negative consequences of such beliefs, and the importance of physical activity to counteract poor mobility.

[3rd degree chronic venous insufficiency: physiotherapy treatment]. / Insuffisance veineuse chronique stade III: Prise en charge physio- thérapeutique.

A venous ulcer is the end result of a long pathological process where venous hypertension represents the principal cause of a number of complications. The physiotherapist by adapting various different therapeutic approaches improves the vascular, joint and respiratory problems of these patients.

[Diseases of veins in the elderly: stepwise treatment and rehabilitation].

A specially developed card including 147 parameters was used in examination of 118 elderly phlebological patients. Pathology of the veins occurs in the elderly 5.4 times more often than in subjects younger than 60. A six-step system was developed for treatment of such patients: primary step, day hospital, specialized vascular and surgical unit, rehabilitation center, health resort treatment, dispensary examinations. Laboratory investigation of thrombophilic conditions, ultrasonic angioscanning and using minimally invasive methods of operative treatment should be introduced in the laboratory practice for the improvement of quality of life and prevention of complications.

Estudo piloto dos efeitos da pressoterapia, drenagem linfática manual e cinesioterapia na insuficiência venosa crônica / Pilot study of the effects compression therapy, limphatic drainage and exercises on the chronic insufficiency venous

O objetivo desde estudo comparativo foi avaliar os efeitos da drenagem linfática manual, pressoterapia e cinesioterapia na insuficiência venosa crônica, com a finalidade de se verificar, através dos resultados, os efeitos causados e se algum desses métodos evidenciou maior benefício. A pesquisa foi caracterizada como quase-experimental e de grupos não equivalentes, tipo randomizada, pois teve como amostra oito pacientes portadores de insuficiência venosa crônica, sendo todas do sexo feminino, com idade média de 65 anos. Foi utilizado com instrumento de medida a volumetria, exame clínica e a ultrasonografia com Doppler no início e término do tratamento. As voluntárias submeteram-se aos três métodos fisioterapêuticos (drenagem linfática manual, pressoterapia e cinesioterapia), sendo cada método aplicado em duas pacientes e duas fizeram parte do grupo-controle. Após a análise dos dados, foi observado que as pacientes apresentaram melhora quanto ao quadro clínico em relação à dor, edema, fadiga e sensação de cansaço nos membros inferiores por meio da utilização dos três métodos. O grupo submetido à pressoterapia demonstrou melhora do edema enquanto o grupo submetido à drenagem linfática manual apresentou alívio da dor e sensação de cansaço. A análise estatística mostrou que não foi possível evidenciar o método terapêutico de maior eficácia devido à amostra ter sido insuficiente. Esta pesquisa foi realizada com o intuito de beneficiar os pacientes portadores de patologias que necessitem desse tipo de tratamento. Como se trata de um projeto piloto, pretende-se contribuir cientificamente para novos trabalhos como forma de validar as idéias apresentadas, seja para aperfeiçoá-las ou mesmo consolidadas.

Gait and calf muscle endurance in patients with chronic venous insufficiency.

OBJECTIVE: To gain insight in gait and calf muscle endurance in patients with severe chronic venous insufficiency. METHODS: Fifteen patients with severe chronic venous insufficiency (healed or active ulcers) and 19 healthy controls were selected for this study. Subjects had to perform eight trials at preferred walking speed and eight trials at instructed walking speed (1.25 m/s) during which the gait parameters were recorded. The calf muscle endurance was tested by use of the heel-rise test. RESULTS: Patients had a significantly lower preferred walking speed (1.25 m/s +/- 0.31) compared with healthy controls (1.44 m/s +/- 0.0.15) (p = 0.039). During preferred walking speed patients had a wider base of support (p = 0.003), a bigger step time (p = 0.005), and a bigger stride time (p = 0.004) compared with healthy controls. At instructed walking speed only base of support was different between the two groups (p = 0.016). Patients had a significantly (p = 0.003) smaller number of heel rises (14.6 +/- 7.34), indicating decreased calf muscle endurance compared with controls (23.5 +/- 6.54). CONCLUSION: This study indicates a disturbed gait and decreased calf muscle endurance in patients with severe chronic venous insufficiency. The results of this study point to a possible role for gait and strength training in the rehabilitation process of patients with severe chronic venous insufficiency.

[Physical exercise in thte treatment of ulcus cruris venosum]. / Bringen Sie lhre Venenkranken auf Trab!

As an adjuvant measure, physical exercise should be recommended for all patients with an ulcus cruris venosum, and should be a permanent part of the patient's lifestyle on completion of wound healing. Although clinical studies have shown that physical exercise has a positive effect on numerous factors of relevance for the development of an ulcer, sports activities undertaken for therapeutic and prophylactic purposes are still made little use of by patients.