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


METHODS
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.


RESULTS
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).


CONCLUSIONS
Venous ulceration can affect the forefoot and toe areas and is associated with reflux in the pedal vein segments.
Department of Surgery, Section of Vascular Surgery, TempleUniversity, USA. vanbemp@tuhs.temple.edu
Paul S
PS
van Bemmelen
Daniel
D
Spivack
Patrick
P
Kelly
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D016523:Foot Ulcer / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D005545:Forefoot, Human / Q000098:blood supply*; D006801:Humans; D008875:Middle Aged; D015143:Philadelphia; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014034:Toes / Q000098:blood supply; D018616:Ultrasonography, Doppler, Duplex; D014689:Venous Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology