Chronic Venous Insufficiency

Overview of Chronic Venous Insufficiency

This condition is a decreased venous return due to venous stasis and increased venous pressures from damage to vein valves. Clients with this condition typically have a history of chronic venous inflammation and vein thrombosis. The condition results in venous hypertension due to excessive fluids in the veins, leading to fluids and whole blood cells migrating into the interstitial spaces. Clients exhibit edema in the legs and ankles, degenerative changes in the skin, and possibly ulcerations. Clients may have open wounds in the distal leg and need proper wound care and ongoing assessment of the legs, ankles, and feet for signs of increasing edema and skin breakdown. Clients experience fatigue as well as aching and heaviness in the legs with walking activities due to inadequate return of blood flow to heart and lungs. Clients typically adopt slower walking velocities that may lead to diminished plantarflexor muscle endurance and decreased plantar flexor muscle lengths.¹ Diminished walking activities will lead to decreased daily activities and limited endurance.

Comorbidities to Consider

• Clients may also have heart disease, diabetes mellitus, intermittent claudication, or a history of leg skin burns and grafting.

Client Examination

Keys to Examination of Clients

• Clients can be assessed with Doppler arterial blood flow studies and brachial and ankle blood pressures.

• Air plethysmography assesses the venous flow from the legs and the amount of venous reflux.

• Clients with a history of heart disease need ongoing monitoring of vital signs and for physical signs of congestive heart failure.

Recommended Baseline Testing of Fitness Levels

• Client's exercise tolerance is best assessed with the 6-minute walk test for endurance or the 10-meter walk velocity test.

• Assess the severity of the client's venous insufficiency with the venous severity score.²

• Use the standing heel raise test or a dynamometer to assess the strength of the ankle plantar flexor muscles.

• Motion at the ankle joint and gastrocnemius-soleus muscle length and fitness should be assessed before starting strength testing activities.

• Inspect the lower extremity skin, and assess for pain and edema to determine the client's present condition and to determine if these signs have changed during treatment.

Exercise Prescription

Type: Walking, standing exercises

Intensity: Moderate pace

Duration: 5–10-minute periods

Frequency: Daily

Getting Started

A supervised program of calf muscle stretching, lower extremity strengthening activities, and walking has been used to increase activity levels and to improve venous return from the legs.^3,4 A calf or plantar flexor muscle strengthening program using standing heel raising exercises has been used to improve muscle strength and leg venous return levels.⁵ Heel raising exercises can begin with clients ...