Reflux in foot veins is associated with venous toe and forefoot ulceration

To determine the prevalence of foot vein incompetence in a group of patients with chronic venous insufficiency and to assess the association of this, with venous ulceration located on the forefoot.

A total of 20 consecutive patients (21 limbs) with active or healed venous ulceration was prospectively studied with duplex ultrasound of the superficial and plantar foot veins. In these, four extremities had venous ulceration involving the forefoot. Specifically, the superficial venous arch near the metatarsal heads, the foot portion of the great and small saphenous veins, the anterior arch veins on the foot dorsum, and the plantar veins were interrogated with a 12-MHz probe.

Reflux was found in 32% of pedal vein segments in CEAP C5, C6 legs, with ulceration involving only the gaiter area (mean number of incompetent foot segments, 1.6 ± 1.2). Pedal reflux was present in 65% of foot vein segments when forefoot ulceration was present (mean number of incompetent foot segments, 3.3 ± 1.3). Student t-test for the difference in the mean number of incompetent foot vein segments was significant (P < .004).

Venous ulceration can affect the forefoot and toe areas and is associated with reflux in the pedal vein segments.