Lower limb assessment

Chronic venous disease is a common problem that is often overlooked by healthcare practitioners. It is estimated to affect as much as 30% of the adult population although this is difficult to calculate due to a significant rate of under-diagnosis (Radak et al, 2016). Cost estimates for management of venous disease have varied from €600-900 million to as much as €2.5 billion a year across Western Europe. These costs include investigations, treatment and management, deterioration of quality of life and loss of working days (Rabe and Pannier, 2010). The main risk factors of chronic venous insufficiency (CVI) increase with age and obesity. It is therefore recognised that the prevalence is slowly rising, increasing the socioeconomic burden (Rabe and Pannier, 2010).

Venous blood flows from the skin to the superficial veins (found in the subcutaneous tissue), which drain into the deep veins. Bicuspid valves in the veins function to keep blood moving in one direction and prevent backflow of blood. Venous insufficiency is an impaired flow of blood through the veins caused by valve incompetence (where the valves are unable to close completely) (Woods, 2019). Blood leaks back through the valve and pools in the superficial veins increasing pressure, which can further weaken the valves and cause irreparable damage. Figure 1 shows the effect of an incompetent valve in the leg.