A female, age 54, was referred to physical therapy for rehab including use of the Treadwell® System by her dermatologist after he evaluated her vascular status as including venous dermatitis. She was also being seen by a lymphedema specialist who was referred by a podiatrist, and is also under his care for skin breakdowns (recurrent).
Initially she presented with edema, redness and blistering in her lower legs, with edema on the top of her feet that had a bubble like appearance. Also noted were significant indentations on the anterior aspect of her ankles located at the junction of her foot and ankle, and a circumferential indentation approx 1 ½ inch below her knee on both legs. The latter indentation exhibited venous disruption as evidenced by dark discoloration.
The patient exhibited very good progress using the Treadwell® System including improving her balance, gait, and endurance. The indentations persisted, however.
The patient has been consistently advised to wear her compression hose during the day, and verbally threatened with potential amputation by her podiatrist, if symptoms continue.
The elastic banding at the top of her hose is where the upper leg indentation is located, and the compression hose dig into her ankles at the location of her ankle indentations. Both locations cause her discomfort leading to pain after 1-2 hrs of having her compression hose applied.
It appears that the compression hose are, and have been, negatively impacting and disrupting the flow in the superficial venous system and the lymphatic system, actually exacerbating the symptoms that the hose are purported to help. With over two years of hose application, there has apparently been some resultant damage to peripheral veins at the indentation sites.
An order to discontinue compression hose has been obtained from her dermatologist, and effects of no longer wearing same will be observed and assessed in the coming weeks.
Observation of the negative effects from compression hose observed by this therapist with the patient , but many similar patient responses have been noted. Compression hose, an accepted best practice for edema and lymphedema, may not be as beneficial as purported due to the negative affect upon both the superficial venous system and the lymphatic system. Folding of the compressive fabric at the ankle, and at the knee in above the knee garmets, and the increased pressure at the top of the stockings in below the knee garmets disrupt the fluid dynamics of both systems, and may, in fact, cause long term damage to the vessels.
Do many practitioners ignore the physical appearance of their patients’ legs after compression hose application, not listen to a patient’s description of discomfort with the application of the hose, or fail to understand the function and role of the superficial venous system of the lower extremities?
More study on the role of compression hose in treating edema and lymphedema and the effectiveness of this “best practice” is needed.