The three most common types of leg ulcers are venous stasis, ischemic (arterial) and diabetic. Treatment for all three types varies, but all three include a recommendation for some form of exercise, including walking.
Venous Stasis Ulcers
Venous insufficiency is the underlying problem that leads to venous stasis ulcers. There is a failure of the one-way valves in the veins to function, which interferes with venous blood return to the heart. The increased amount of fluid in the veins leaks out into the tissues. This results in reduced gas and nutrient/waste exchange between blood vessels and cells leading to death of the tissue, necrosis and ulcer formation. Other causes for venous insufficiency include blood clots that occlude and damage veins or edema caused by disorders such as congestive heart failure. The common location for venous stasis ulcers is on the inside of the ankle.
Diabetic Ulcers
Diabetes causes damage to blood vessels and nerves. This damage results in decreased arterial blood supply and loss of sensation. Diabetic ulcers most often occur at pressure points on the bottom of the feet or from an injury. Often the person does not know there is an injury because of the impaired sensation. Because of the lack of blood supply, healing is slowed and death of cells occurs with resultant ulcer formation.
Ischemic (Arterial) Ulcers
Ischemic ulcers are caused by an insufficient flow of blood through the arteries. This causes a decrease in oxygen supply to the cells, and eventually necrosis and ulcer formation. The most common cause is atherosclerosis – a condition characterized by cholesterol lining vessel walls, which narrows the lumen. Other causes are Raynaud’s disease and vasculitis, or inflammation of the blood vessels. Arterial ulcers are usually found on the outside of the calf, heel, back of the foot, or the tip of the toes. There is no edema with these ulcers, but there is burning pain, especially when the foot is elevated. There can be internal and external arterial ulcers
Walking and Leg Ulcers
Because the core problem with all of these conditions is a reduced blood flow, one of the ways in which the condition can be improved is by increasing blood flow. Exercise such as walking causes an increase in blood flow to the muscles. Walking compresses veins and improves the function of the valves. This helps reduce swelling and to increase arterial blood flow. A New Jersey Medical School article states that by walking every day muscles are trained to work more efficiently with less arterial flow. Hafner recommends walking exercise for arterial ulcers except for “chronic critical leg ischemia,” which may require bed rest. Patients are encouraged to walk 1 hour each day performed at intervals, stopping to rest when discomfort occurs. Walking and resting assist in the formation of collateral circulation, or new blood vessels. It is important that there be no pressure applied to any ulcer, and walking is not beneficial for foot ulcers.
Recommendations
It is highly recommended that persons with leg ulcers speak with their health care provider before starting an exercise program that includes walking, as there may be certain contingencies necessary to make walking beneficial to the healing process, such as a special walking boot or other pressure-relieving device for foot ulcers, or compression devices for venous stasis ulcers. In some instances it may be necessary to use crutches to avoid pressure on a foot ulcer.
Member Comments