Venous leg ulcers and arthropathy

Reduced ankle mobility impairs the venous muscle pump and this leads to an increase in mean venous pressure in the lower leg. We have previously shown that pressure-induced venous distension leads to cutaneous hypoxia which is caused by arteriolar vasoconstriction in response to a spinal reflex. The prolonged cutaneous hypoxia which is thus a consequence of sustained elevation of venous pressure is an important factor in the development of gravitational ulcers. It is postulated that the increased incidence of leg ulcers in patients with rheumatoid arthritis is the result of impairment of the efficiency of the venous muscle pump by reduced ankle mobility. Conversely, the elevation of venous blood pressure in patients with venous insufficiency may lead to arthropathy in the ankle. The hypothesis is presented that prolonged elevation of venous blood pressure causes injury to both the ankle joint and veins leading to chronic reciprocal damage to both. This explains the frequent association between arthropathy of the ankle and venous leg ulcers.