[Repercussions of venous diseases on the osteoarticular system of the lower extremities]

Two centuries ago, a leading light of phlebology (J.-L. Petit) wrote, "When ulcers, located beside bones, have been present for more than one year, the bones rot". Today, on the basis of many anatomical and radiological studies, this statement can be modified as follows: bone lesions may occur even before the onset of an ulcer; their nature is very variable and they are certainly more extensive in long-standing phlebopathies. In legs presenting open ulcers for more than 5 years, bone lesions are nearly always present but may not coincide with the location of the ulcer; the changes occur in the same way and follow the same pattern in post-phlebitic ulcer and in essential varices. Within the legs, notable reciprocal potentially pathogenic relationships are set up between the joints and the veins. These are more marked in the distal section of the limb than in the proximal section. It is therefore essential that at the first phlebological consultation, particularly in the presence of serious cutaneous lesions, an in-depth investigation should be carried out of the functional state of the osteoarticular system in order to be able to combine treatment of the venous pathology with a correct restoration of the hemokinetic pump.