Foot disorders as a risk factor for venous disease

NewsBot · Jul 6, 2011

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Static foot disorders: a major risk factor for chronic venous disease?
Uhl JF, Chahim M, Allaert FA.
Phlebology. 2011 Jul 4. [Epub ahead of print]

OBJECTIVE:
To study the relationship between the static foot disorders (SFDs) and chronic venous disease (CVD). Material and methods A retrospective study of 824 feet in unselected 412 patients seen by one phlebologist using a standardized record form. A complete clinical, aetiological, anatomical and pathological elements (CEAP) classification was determined. Alleged venous symptoms were recorded using a 10-point visual analogue scale and scored using a customized questionnaire. A standardized measurement of the Djian-Annonier angle was used to quantify and identify the presence of any static disorder of the foot.

RESULTS:
There were 156 men (37.8%) and 256 women (62.2%) who were included in this study. A majority of patients (59.3%) had a CEAP classification of C3 or greater. Static disorders of the feet were found to be very common in the study population: 137 feet were hollow feet (16.6%) and 120 flat feet (14.5%). Thus, 31% of all of the feet had some form of SFD. A significant correlation was found between the incidence of SFD and body mass index (P < 0.01), the presence of symptoms (P<0.001) and prolonged standing during the day (>5 hours, P < 0.05). The severity of the CVD, represented by the CEAP clinical classes, was also found to be very significantly related to the SFD (P < 0.001). This correlation was found to be independent of age.

CONCLUSION:
Static disorders of the foot can be considered as an important risk factor that negatively affects CVD. In daily practice, it is often underestimated. This emphasizes the crucial importance of the detection of SFD during the clinical exam of all CVD patients. Correction of static disorders of the feet will improve symptoms due to the SFD, as well as those related to venous stasis. These results can easily be explained by improvement of foot pump efficacy during walking.
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Admin2 · Jul 6, 2011

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NewsBot · Apr 4, 2015

Association of foot and ankle characteristics with progression of venous disease.
Kim TI, Forbang NI, Criqui MH, Allison MA
Vasc Med. 2015 Apr;20(2):105-111.

Although risk factors have been identified for the cross-sectional prevalence of venous disease, few studies have investigated risk factors for venous disease progression. Therefore, the aim of this study was to investigate the relationship between foot and ankle characteristics and the progression of venous disease. A total of 1025 participants from the San Diego Population Study were assessed at baseline and at follow-up 11 years later. Risk factors were assessed by questionnaire and physical measurements, while venous disease was determined by physical examination and Duplex ultrasound. Change in venous disease from baseline to 11-year follow-up was characterized as stable or progression. Those with venous disease progression were less likely to spend increased time lying per day, more likely to have a history of hypertension, lie supine for a surgical procedure greater than an hour, and report an occupation that was professional, technical, administrative, or management. Those with a normal arch reported the greatest degree of plantar flexion. In multivariable logistic regression, including adjustment for weight-bearing arch characteristics, greater dorsiflexion (per 5 degrees) was significantly associated with progression of venous disease (OR = 1.11, p = 0.01). A weight-bearing flat arch compared to a weight-bearing normal arch was of borderline significance as a protective factor against progression of venous disease with adjustment for dorsiflexion (OR = 0.56, p = 0.07). Our results indicate that the ability to have higher levels of dorsiflexion is a risk factor for the progression of venous disease, and suggest a role for connective tissue laxity in the pathogenesis of venous disease.
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NewsBot · Jun 14, 2018

Transverse Flatfoot is a Potential Risk Factor for
Development of Varicose Veins in the Lower Extremities of
Middle-Aged Women
Bakhmetev AS et al
Clinics in Surgery - Vascular Surgery 2017; 2: 1552

Objectives: To evaluate the effect of transverse flatfoot on the severity of varicose veins in the lower
extremities (VVLE) of middle-aged women.
Materials and Methods: This was a cross sectional study which included 50 women between
39-54 years old who were scheduled for their routine care outpatient visit for their varicose vein
lower extremity (VVLE) disease at the Mirotvortseva hospital, which is affiliated with Saratov State
Medical University (SSMU). Both orthopedic and vascular surgeons examined all patients. Patients
were excluded, if they were diagnosed prior with any of the following conditions: veins affected
by thrombosis, post-thrombophlebitic disease, isolated severe varicose transformation of the main
trunk of the great saphenous vein at hip level, ectasia and ultrasound signs of valvular insufficiency
of the iliac and deep femoral veins, as well as women with clinical manifestations of chronic venous
disease of the C4 to C6 categories by CEAP classification. All patients underwent triplex scanning
(TS) ultrasound test of the lower extremities. All images were acquired on the Philips HD 11 XE
scanner and expert class linear (2-5 MHz) transducer was utilized for all ultrasound tests.
Results: The VVLE was found in majority of patients: out of 50 patients initially screened for
this study, 48 patients have had clinics symptoms of varicose vein disease in their limbs with coexistent
flatfoot condition and were included into final analysis, which had resulted in 88 lower
limbs qualified after vascular surgeon clinical examinations and TS test of the lower limbs (96%
participation rate). Varicose transformation of reticular or saphenous veins, corresponding to C1
category by CEAP classification, was found only in 3 out of 48 examined subjects (6%) with 6 of the
lower limbs affected by venous disease. The C2 category of venous disease by CEAP classification was
detected in 36 patients with 68 lower limbs out of 48 assessed subjects (75%). Clinical manifestations
of C3 category of venous disease were detected in 9 women with 14 lower extremities affected
(18.75%). There was no more severe degree of venous disease observed in this study. TS ultrasound
of superficial and deep veins of the lower limbs revealed varicose transformation in the great
saphenous vein in 43 women. In majority of cases expanded and/or incompetent perforating veins
were detected (86% noted in 60 of the lower limbs). Small saphenous veins were less often affected:
as observed in 8 patients only out of 48 (16%) with 10 lower limbs examined. Also noteworthy was
ectasia of shin vein in 33 women (66%) with 46 of the lower limbs examined. The most common
cause of deep vein extension was attributed to ectasia of medial sural veins (observed in 26 patients
out of 48 (52%) with 32 of the lower limbs examined. Ectasia of soleus veins was detected in 24
patients out of 48 (48%) with 30 of the lower limbs examined.
Conclusion: Transverse flatfoot is a potential risk factor in VVLE in middle-aged women. Despite
an active lifestyle flatfoot was found to be associated with VVLE in 96% of cases. The main cause of
VVLE was attributed to the reflux in the great saphenous vein, and in some occasions the expansion
of perforators was observed. In addition, ectasia of deep shin veins was detected in 66% of analyzed
subjects, which considerably affects patients’ quality of life. Based on the finding of this study women
diagnosed with flatfoot and at risk for development of varicose vein disease should be screened once
a year prophylactically to prevent further exacerbation of venous disease.
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NewsBot · Aug 1, 2023

The relationship between pes planus and venous insufficiency
Şahika Burcu Karaca, Hatice Ağır
Phlebology. 2023 Jul 30

Introduction: The presence of pes planus may be responsible for the disorder of venous return during ambulation. Our aim in this study is to reveal that the risk of venous insufficiency may be increased in patients with pes planus.

Methods: A total of 59 patients with 29 bilateral pes planus and 30 normal arches included in the study. Djian Annonier angle measurement, bilateral lower extremity venous Doppler ultrasonography (USG), foot function index (AFI), Comprehensive Classification System for Chronic Venous Disorders (CEAP) clinical scoring and Short Form-36 (SF-36) was evaluated.

Results: There was a statistically significant difference in AFI total, AFI pain, AFI disability and AFI activity limitation scores, bilateral lower extremity doppler USG and CEAP clinical scores in the patient group compared to the control group.

Conclusion: These findings suggest that there may be a relationship between pes planus and venous insufficiency. However, large-scale studies with more patient involvement are needed.
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NewsBot · Mar 6, 2024

Impact of static foot disorders on the conservative treatment success in chronic venous disease patients without wounds
Abdulkerim Özhan, Fatih Günaydın
J Vasc Surg Venous Lymphat Disord. 2024 Feb 11

Objective: Chronic venous disease (CVD) and static foot disorders (SFDs) are prevalent conditions that commonly cause lower extremity pain. These conditions share common factors such as age and weight in their etiology. This study aimed to investigate the impact of SFDs on the treatment response of patients undergoing conservative treatment for CVD without wounds.

Materials and methods: A retrospective evaluation was conducted on 328 patients (60 males, 268 females) with CVD. Parameters including age, gender, affected side, body mass index, Visual Analog Scale (VAS), Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification, and revised Venous Clinical Severity Score (rVCSS) were considered for evaluation. Radiological measurements of calcaneal pitch angle (CPA) were analyzed as a determinant of SFDs.

Results: VAS and rVCSS of the patients were evaluated before and after conservative treatment of CVD without concomitant treatment of SFDs. The presence of SFDs was associated with decreased treatment success (P < .001). Among different types of SFDs, the pes cavus group exhibited the lowest change in VAS and rVCSS scores before and after conservative CVD treatment. In contrast, the normal group demonstrated the highest improvement. Patients with a normal foot medial arch consistently achieved the best treatment outcomes compared with patients with other SFDs.

Conclusions: In conclusion, SFDs affect outcomes of conservative treatment of CVD in CEAP 0 to 3 patients, with the efficacy of treatment dependent upon the severity of SFDs.
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NewsBot · Jun 6, 2025

Impact of static foot disorder and ankle range of motion in chronic venous insufficiency patients
Sree Vani Paladugu et al
Phlebology . 2025 Mar 17:2683555251326046.

ObjectiveChronic venous insufficiency (CVI) is a progressive disease, leading to calf muscle pump dysfunction and reduced range of ankle motion (ROAM). A full ROAM increases venous return decreasing venous hypertension. The dysfunction of foot pump in static foot disorder (SFD) further contributes to chronic venous insufficiency. In present study we studied the effect of ROAM and SFD on CVI.MethodsA prospective observational study was conducted from July 2022 to June 2023, with Institute Ethical clearance (INT/2022/MS-533). A total of 402 legs were included, of which 368 legs of the study group had CVI and 34 legs were in control C0 group. Patients were divided into control C0, mild C1-C3 and advanced C4-C6 disease group based on the severity of CVI. SFD and ROAM were evaluated from X-rays by Djian-Annonier angle and goniometry respectively. The primary objective was to study, impairment of ROAM in patients from C1-C6 and its comparison with control C0 group and impact of static foot disorders on ROAM.ResultsROAM was highest in controls and decreased towards the lowest value in progression to advanced stages of CEAP classification (87° in C0, 71° in mild CVI and 45° in advanced CVI, p < .001). Controls had just nine % legs afflicted with SFD whereas 62.3% and 68.6% with mild and advanced disease had SFD, p < .001. ROAM was highest in those without SFD (68.9°) and least in hollow feet (58.3°), p < .001. ROAM was lower in the symptomatic C2 disease (80°) than asymptomatic type (69°) (p < .001).ConclusionThis study showed that poor ROAM is associated with higher rate of advance CVI. In addition patients with SFD had advance CVI and poor ROAM. So, it is important to consider treatment of SFD and physical rehabilitation to improve ROAM and break vicious cycle of progression to severe CVI.
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scotfoot · Jun 7, 2025

NewsBot said: ↑

Impact of static foot disorder and ankle range of motion in chronic venous insufficiency patients
Sree Vani Paladugu et al
Phlebology . 2025 Mar 17:2683555251326046.
Click to expand...

IMO venous return from the foot is not just about the plantar venous foot pump ,large diameter veins on the plantar surface which empty when the foot flattens, but also about blood being moved out of the dorsal veins ,medial and lateral marginal veins, during the same foot flattening process. In effect the whole foot is an osseofascial pump . As the foot changes shape during wight acceptance, the fascia surrounding the foot is stretched compressing the dorsal veins which lie between the bony arch and the superficial fascia . Think "hand in a crisp packet".

How can the function of the osseofascial pump be improved ?

I believe in many cases through better foot flexibility esp at the cuneonavicular joint .

See video were the cardboard represents the the bony arch of the foot the blue glove a marginal vein and the cling film, the fascia enveloping the foot. The shaving foam represent blood being extruded from a vein.

Venous foot pump , dorsal aspect ,a theory 20210320 110916

www.youtube.com › shorts

0:08
In my opinion, almost the entire foot can be viewed as an osseofascial pump .All aspects of the pump are activated during weight bearing ...
YouTube · Gerrard Farrell · 20 Mar 2021

scotfoot · Jun 9, 2025

NewsBot said: ↑

Impact of static foot disorder and ankle range of motion in chronic venous insufficiency patients
Sree Vani Paladugu et al
Phlebology . 2025 Mar 17:2683555251326046.
Click to expand...

The active propulsion of blood out of the foot is during upright stance clearly very important, and the plantar and dorsal venous components need to be carefully considered .
Some time ago, in ground breaking work , Fox and Gardner introduced a contrast medium into the foot and looked at venous blood flow . They calculated that around 20-35 ml of blood was moved out of the plantar veins with enough pressure to reach the heart during weightbearing. But look at the before and after photographs below.

Note how the dorsal veins are also emptied during weight bearing in the figure below. This was not addressed by Fox and Gardiner presumably because they could not identify a mechanism by which the plantar veins were emptied. The youtube video in the previous post explains that mechanism.

The total volume of blood expelled under pressure during gait could easily be estimates to be 30-45 mm of blood under considerable pressure.

Foot disorders as a risk factor for venous disease

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scotfoot Well-Known Member

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Live with Doug Richie talking "Pathomechanics of Common Foot Disorders"

Edmonton Frail Scale (EFS) in older adults with foot disorders

Medial Foot Column Disorders (Morton's and Rothbart's)

Influence of dosing on effect size of exercise therapy for musculoskeletal foot and ankle disorders

Neale's Disorders of the Foot; 9th Edition

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Foot disorders as a risk factor for venous disease

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Admin2 Administrator Staff Member

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NewsBot The Admin that posts the news.

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scotfoot Well-Known Member

scotfoot Well-Known Member

Foot deformities in MECP2 disorders

Foot disorders in patients with genodermatoses

Live with Doug Richie talking "Pathomechanics of Common Foot Disorders"

Edmonton Frail Scale (EFS) in older adults with foot disorders

Medial Foot Column Disorders (Morton's and Rothbart's)

Influence of dosing on effect size of exercise therapy for musculoskeletal foot and ankle disorders

Neale's Disorders of the Foot; 9th Edition

Share This Page

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