Varicose Veins & Chronic Venous Disease
Varicose Veins & Chronic Venous Disease Explained:
Chronic venous disease is the cause of Varicose Veins and Edema, which is swelling in the leg and foot due to the pooling of blood, which can become severe if left untreated.
Signs & Symptoms of Varicose Veins & Chronic Venous Disease:
- Leg pain, heaviness, fatigue and/or achiness
- Leg throbbing, cramping and/or burning
- Leg restlessness
- Exercise intolerance
- Itchiness of the skin, Stasis Dermatitis
- Skin Discolouration, hyperpigmentation and/or hemosiderin staining (advanced)
- Eczema (advanced)
Compression Therapy Treatment:
Compression therapy is considered the "gold standard" for treating chronic venous disease and varicose veins.
Compression hosiery with graduated compression produce graded external compression directly to the legs and reduce pressure in the veins.
For people who have varicose veins above the knee, thigh-length graduated compression hosiery are preferable if tolerated. Compression hosiery should at the minimum reach the level of the upper calf.
Hosiery with moderate pressure (20-30 mmHg) are recommended for patients with varicose veins and mild swelling, without skin pigmentation changes.
In more severe cases, 30-40 mmHg is recommended.
When worn daily, compression hosiery is the ideal treatment for patients who do not want surgery.
Leg Veins - Our Second Heart
The heart pumps oxygen and nutrients to all the cells and organs in the body. Veins work against gravity and bring blood that no longer has oxygen, back to the heart. Each beat of our heart causes a certain amount of pressure to exist in our veins. In the leg, blood flows from superficial (closer to the skin surface) veins to deep veins.
Veins have valves in them that make sure that blood flows in one direction only, towards the heart and when those valves are healthy, the amount of pressure within them is normal.
It is very important to know that the largest volume of blood returned from the legs is by the contraction of the calf muscles. This is called the calf muscle pump, often referred to as the peripheral or second heart. These important muscles are called the gastrocnemius and soleus muscles. Other feet and thigh muscles are also involved to a lesser extent as is the structure of the feet.
The calf pump is best activated during proper heel-toe walking. If a person uses a shuffling gait, venous disease gets worse.
Prevention is the Key:
- Compression Therapy
- Keeping the Calf-Muscle Pump Healthy
- Choosing Appropriate Footwear and Custom Orthotics if Needed
- Maintaining a Health Body Weight
- Daily Walking/Exercise
- Proper Nutrition & Supplements if Required
- Avoiding Prolonged Standing in One Place
- Regular Moisturizing of the Legs
- Smoking Cessation
A Healthy Calf-Muscle Pump:
Failure to use the calf-muscle pump effectively cannot be overestimated when addressing the treatment of venous hypertension.
For the calf-muscle pump to function properly, the following are required:
- Increasing range of motion around the ankle joint and the ability to dorsiflex the foot at least 10 degrees
- Strength training for the gastrocnemius and soleus muscles
- Gait Training/Proper Heel-Toe Walking to activate the calf-muscle pump
- Maintaining the feet in proper position by using appropriate footwear and/or orthotics if required
- Avoid a shuffling gait
- Moderate physical weight-bearing activity to maintain healthy circulation.
What Causes Venous Disease & Varicose Veins?
There are both Intrinsic (things that we did not cause or cannot change) and Extrinsic (Changeable) Factors that lead to Chronic Venous Disease and Varicose Veins.
Intrinsic Risk Factors:
- Family History/Genetics - have a strong influence as they tend to run in families (estimated 17% contribution)
- Hormonal Changes and Multiple Pregnancies * - changes in veins are seen by some people as early as 6 weeks of pregnancy, are related to genetics and hormonal changes and become worse with each pregnancy.
- Sex - women experience Varicose Veins more than men
- Increased Age - usually affect middle-aged people
- Deep Vein Thrombosis
* It is estimated that 20% of women over 40 years old who have not given birth have varicose veins. One study found that for women who have had 1-4 pregnancies, this percentage increases to 40% and for women who have had 5 more children, the number who suffer from varicose veins climbs to 65%.
Extrinsic Risk Factors
- Standing for long periods
- Obesity - A large body mass index (>33 kg/m2)**
- Short walking distance during the day (<200 m) and people who shuffle their legs rather than walking while pushing off with their calf muscles
- Sedentary lifestyle
- Smoking
**People who are overweight or obese tend to have more foot and leg swelling.
Chronic Venous Disease:
Chronic Venous Disease is a persistent, progressive and often underestimated condition that involves serious compromise to blood flow back to the heart.
It is a common condition, where the cusps of the valves become weak from physical and chemical injury. It is also known as Venous Reflux. Veins in the legs are the most vulnerable.
The leg veins no longer pump blood back to the heart efficiently. As a result, blood begins to flow in reverse and the wrong direction (back into superficial veins). This causes venous hypertension, which further harms the veins and valves. Venous hypertension is a key risk factor for the development of venous insufficiency. Chronic venous insufficiency leads to approximately 80% of lower leg ulcers.
It is called chronic because it either recurs or exists for a long time.
Venous Edema is fluid that indents with skin pressure. It can be seen and felt usually in the ankle region but may also be seen in the leg and foot. Edema worsens when a person is standing and improves when the legs are elevated above the level of the heart.
Varicose Veins:
More than just an esthetic concern, varicose veins are a result of lower leg venous insufficiency and hypertension. The veins become dilated, swollen, twisted and blueish purple in colour and can become visible in our thighs, legs and at our ankles. Telangiectasias and reticular veins (spider veins) may be visible.
Due to the effect of gravity, varicose veins become even more pronounced when we are standing and walking. They affect approximately 25% of people and often have a considerable impact on a person's lifestyle.
Chronic Venous Insufficiency:
Chronic Venous Insufficiency refers to the most severe cases of venous disease that include edema, skin changes and/or leg ulcers. Approximately 5% of people suffer from Ulcers and Edema, which greatly negatively affects their quality of life. Infections can also occur.
Prognosis:
There is no cure for varicose veins and chronic venous disease. Even after surgical removal, recurrences are common and surgical procedures have potential complications that should be discussed with your medical specialist.
It is important to know that when varicose veins are left untreated, they can lead to a venous ulcer which is very difficult to cure.
Yet research has shown that even people with poor calf muscle pump function and chronic venous ulceration show improvements with physical exercise.