LIMITED RANGE OF MOTION IS A SIGNIFICANT FACTOR IN VENOUS ULCERATION

Purpose: Calf muscle pump dysfunction is a recognized factor in chroni c venous insufficiency (CVI). We investigated the hypothesis that limb s with CVI have a reduced ankle range of motion (ROM) that may be resp onsible for the poor calf pump function associated with venous ulcerat ion. Methods: Ankle ROM and calf pump function were assessed in 32 lim bs of 26 adult men. Limbs were selected on the basis of clinical prese ntation: normal (n = 6 limbs), class 1 or 2 CVI with no history of ulc eration (n = 9 Limbs), class 3 CVI with healed ulceration (n = 9 limbs ), and class 3 CVI with active ulceration (n = 8 limbs). ROM was deter mined by goniometry during maximal plantar flexion and dorsiflexion of the ankle. Calf pump function was determined by air plethysmographic measurement of ejection fraction (EF) and residual volume fraction (RV F). Results: Ankle ROM was significantly (P < 0.05) reduced in each CV I: group compared with age-matched control subjects, because of decrea ses in both plantar flexion and dorsiflexion. Calf pump function was s ignificantly impaired (decreased EF and increased RVF) in ulcerated li mbs. ROM was significantly correlated to EF and RVP. Impairment of ROM and calf pump function was associated with deterioration in the clini cal classification of venous disease. Conclusions: Limbs with CVI have a limited ankle ROM that decreases with increasing severity of clinic al symptoms. This decreased ROM is associated with, and may contribute to, poor calf pump function.