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Assessment and Management of Venous Leg Ulcers
below-knee stockings are the most frequently used, and are more acceptable to the client.
There are three classes of compression stockings. The stockings are unsuitable in clients with
a high level of exudate, and are prescribed for use after compression therapy with bandages has
reduced the edema. When edema and exudate are controlled, the use of therapeutic compression
stockings may be considered. (See Appendix K for Classes of Compression Bandages).
The client should be prescribed regular vascular exercise by means of intensive controlled
walking and exercises to improve the function of the upper ankle joint and calf muscle pump
(Compliance Network Physicians, 1999; Kan & Delis, 2001).
50
Loss of ankle joint movement can accompany venous ulceration. Good calf muscle pump
function is an important aspect of ulcer healing. Walking and passive ankle exercises should
be encouraged. The immobility of the ankle joint is thought to influence ambulatory venous
hypertension and may be a factor in causing venous ulceration. Exercise is necessary to
enhance compression therapy. These can be modified to accommodate the needs of
non-ambulatory and obese individuals. A physical and/or occupational therapist should be
consulted. When resting, elevation of the limb above chest level is beneficial.
G. COMPLEMENTARY THERAPIES
Recommendation • 50
Consider electrical stimulation in the treatment of venous leg ulcers. (Level of Evidence = B)
Recommendation • 51
Hyperbaric oxygen may reduce ulcer size in non-diabetic, non-atherosclerotic leg ulcers.
(Level of Evidence = A)
Recommendation • 52
Therapeutic ultrasound may be used to reduce the size of chronic venous ulcers.
(Level of Evidence = A)
Discussion of Evidence:
The clinical research evidence for complementary therapies to treat chronic venous leg
ulcers is the subject of an article by Kunimoto et al. (2001).