Phlebology
Venous insufficiency
How does the circulation of the blood work?
The heart propulses the blood, full of oxygen and nutrients, towards the organs via the arteries.
The gaseous and metabolic exchanges take place through the capillary network at the level of the organs and muscles.
The veins return the blood to the heart, depleted in oxygen and full of metabolic waste. The return of the blood towards the heart is possible thanks to:
- breathing movements (aspiration by the movements of the diaphragm),
- contraction of the leg muscles,
- massage of the instep with each step,
- the vein valves (oriented from bottom to top).
What is venous insufficiency?
Venous insufficiency groups together different conditions, depending on which veins are affected: superficial veins which drain 10% of the blood or deep veins which drain 90%.
The most common condition is
superficial venous insufficiency, which is often responsible for varicose veins.
In the vast majority of cases, the varicose veins are primary because they are of hereditary origin.
The walls of superficial veins undergo enzymatic alterations. They lose their tonicity and the valves widen. The blood flow is no longer from the bottom to the top, but the opposite. The blood pools and the superficial veins dilate. Varicose veins appear, accompanied or not by a variety of functional signs: "heavy legs", cramp, pins-and-needles, restless leg syndrome and a range of leg pains. The legs can appear swollen at the ankle (and at the calf). This is what is called an oedema.
After progressing for a few years, and in the absence of treatment of the varicose veins, complications may start to appear: eczema, dermatitis ocre, hypodermatitis, ulcers, paraphlebitis and phlebitis.
Physical inactivity, long periods spent standing or shuffling and high temperatures are all factors that aggravate the hereditary condition.
In addition, for women, there is also the problem of pregnancy and hormonal treatments (contraceptive pill and menopause).
Deep venous insufficiency is much rarer. It can be primary, with the absence of valves at birth, or secondary to phlebitis.
Phlebitis (or deep vein thromboses) are the consequence of the formation of a blood clot which blocks a deep vein. The main risk is pulmonary embolism through the detachment of microscopic fragments of the clot which then migrate towards the lungs. Heredity also plays an important role as there are whole families prone to phlebitis. There is effectively an anomaly in blood coagulation. In addition, phlebitis is often provoked by prolonged bedrest.
Orthopaedic treatment
The orthopaedic solution for venous insufficiency is medical contention which is a complement to all the phlebological treatments that doctors can prescribe to treat the causes, functional signs and complications.
Medical contention means the use of elasticated tights, stockings or socks. These elasticated spports apply degressive pressure to the lower limb. They allow the blood to return to the heart because the pressure is higher at the ankle than at the calf of thigh. It could be said that the support tights, stockings or socks restore the "anti-reflux" function to the valves.
There are several degrees of contention, from class I to class III in the standard range.
Class IV is made-to-measure for particular cases of lymphoedema.
It is important that you accept that you must wear the tights, stockings or socks prescribed because the functional signs (pain, swollen legs) will be relieved, the progression of the venous insufficiency delayed and the complications limited.
Medical contention can also be achieved by the use of elasticated or non elasticated bands in particular cases (ulcers, phlebitis and prevention of phlebitis, for example)
In all cases, a medical treatment is necessary.
Orthopaedic management can fit into the framework of a medical treatment prescribed by your doctor. In case of doubt, ask your doctor or orthopaedist for advice.
