The slow, inexorable march of time takes a toll on the human body. The result of our aging population is a variety of health problems brought into the limelight. These are problems which previously occurred infrequently and were rarely discussed, because we didn’t generally grow old enough to suffer them. But that has changed. One such malady, a consequence of being on this planet long enough, is called venous insufficiency.

Veins are a series of tubes which return blood to the heart. Unlike arteries, which have muscle in their walls, veins rely on the action of many small valves to keep the blood moving up. It’s a fascinating system that allows blood to resist the pull of gravity and make its return to the heart, by repeatedly being blocked from flowing backward, ie down, by the valves. They prevent our blood from flowing backwards when muscle contraction squeezes these deep tubes. The valves keep the blood moving only one way, up, and this is what keeps our circulation, well, circular!

Critical to this discussion is the effect of gravity and fluid pressure. As in the ocean, the pressure at the bottom of the body is much greater, when all the fluids above are pushing down on the fluids in the lower leg. When a person stands, pressure in the veins of the leg is increases. If the valves in our veins begin to function poorly, they can allow leakage of blood back down. This is the essence of Venous Insufficiency (V.I.), in which the valves become “incompetent”, and allow some blood to flow backwards, in the wrong direction. Blood will begin pooling in the lower veins and, over time, substances that are part of our blood will leak out of the veins, into the surrounding tissues.

One of the things that can leak out of the vein is a molecule which contains iron, called heme. This is an essential component of our blood. When heme leaks out of the bloodstream, it stains the skin with a brownish tint, because iron is brown. If the process continues, as it typically does, the skin can become stiffened and hard, and the leg noticeably swollen, a hallmark of the condition.

This poisoning of the skin can lead to true ulcers, painful, open, draining sores. If appropriate treatment is instituted, these lesions can almost always be prevented, but this happens far too rarely. which tend to be messy and painful. Most ulcers of the ankle and lower leg are the result of venous insufficiency. These painful, ugly open sores of the lower leg tend to be chronic and lasting. Doesn’t sound very attractive, does it?

If the disease process has advanced to the point where ulcers have developed, it has been around quite some time. A better approach, as is so often the case, is prevention. Some keys are the maintenance of a healthy body weight, participating in exercise on a regular basis, and protecting your legs from trauma (since skin, diseased from VI, will often not heal, resulting eventually in the formation of a venous ulcer). One of the best remedies is to keep moving. Literally, keep the legs moving, since it is muscle contraction which keeps the blood moving upward, on its long journey back to the heart and lungs.

Treatment has generally revolved around the use of tight stockings, tight enough to keep the blood from pooling. These come in various levels of compression (measured in millimeters of Mercury, mmHg). Although these are prescribed to individuals every day, in clinics and offices across the country, their actual day to day use is different matter entirely. And the actual real-world benefits are far less than they should be. If these stockings are tight enough to actually do anything, people can’t get them on or find them too uncomfortable to wear.

A new arrival in this arena is a new device, basically a sleeve, of sorts, which uses Velcro tabs attached to bungee cords to provide the compression. This means the individual wearing the sleeve determines the level of compression. There are four sets of these tabs, applying the (adjustable) compression evenly across the surface of the lower leg. The effect is profoundly different from the traditional stockings since the amount of compression is ‘dynamic,’ i.e. meaning it can be changed. The wearer makes it smaller as the limb shrinks down! It generally produces obvious improvement.

If an ulcer has developed, a special type of wrap can be applied, providing medicine to the surface of the wounds. But these wraps are primarily intended as a means of immediately applying compression. It’s all about the flow of blood up through the lower leg. How well does it traverse this intimidating distance?

Properly functioning valves are essential, of course. Just as consequential is the ‘calf-muscle pump.’ This refers to the pumping power for the flow of blood through the calf. The pump driving the blood are muscles that compose the calf. When you walk, these muscles are contracting and relaxing. The first part, the contraction, squeezes the veins, making them smaller. This increases the pressure inside the vein, driving the blood upwards to the next section of the vein above.

There are multiple options for treatment of venous insufficiency, although most include some means of compression. There are surgical procedures but these tend not to have the best success rate. But once again, prevention is “worth a pound” of cure. In this case, the cure is often messy wraps, stockings, and pain. So get going, get fit, and get healthy…….by getting moving. It’s good for your heart, your head, and your veins!

Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with an upcoming expansion to the Hancock-Houghton area. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.