Gait,ankle mobility,muscle strength,and functional performance in chronic venous insufficiency: A CEAP-based analysis

Abstract

Objectives

Chronic venous disease (CVD) is a progressive condition affecting the lower limb venous system, leading to venous hypertension, muscle dysfunction, and gait alterations. Patients with CVD often experience muscle weakness, reduced ankle mobility, and impaired gait biomechanics. However, the impact of CVD severity on spatiotemporal gait parameters and plantar flexor strength remains little explored. The present study aimed to compare gait biomechanics, plantar flexor strength, dorsiflexion ankle range of motion, and functional performance among patients with mild, moderate, and severe CVD, classified according to the CEAP system.

Methods

A cross-sectional study was conducted in two phases. Phase 1 compared gait parameters between healthy individuals and patients with CVD. Phase 2 examined variations in movement patterns across CVD severity groups, classified according to CEAP class into mild CVD (CEAP 1; n = 11), moderate CVD (CEAP 2–3; n = 12), and severe CVD (CEAP 4–6; n = 6). Gait parameters, including speed, stride length, and stance time, were assessed using a motion capture system. Plantar flexor strength was measured with a handheld dynamometer. Ankle dorsiflexion range of motion was assessed using the Weight-Bearing Lunge Test (WBLT), and functional performance was evaluated using the Human Activity Profile (HAP) questionnaire.

Results

No significant differences were observed in spatiotemporal gait parameters between healthy individuals and patients with CVD or across disease severity groups. In contrast, normalized plantar flexor strength differed significantly among groups (p = .041). Ankle dorsiflexion range of motion was also reduced with increasing disease severity (p = .005), particularly in the severe group. No significant differences were found for HAP scores.

Conclusion

CVD severity was associated with reduced plantar flexor strength and ankle dorsiflexion range of motion, while spatiotemporal gait parameters remained unchanged. These findings suggest that musculoskeletal impairments may precede detectable alterations in gait, highlighting the importance of early assessment and targeted rehabilitation strategies in patients with CVD.

Keywords

chronic venous insufficiency gait muscle strength

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References

Raffetto

. Pathophysiology of chronic venous disease and venous ulcers. Surg Clin 2018; 98(2): 337–347. https://doi.org/10.1016/j.suc.2017.11.002

Eklof

Perrin

Delis

, et al. Updated terminology of chronic venous disorders: the VEIN-TERM transatlantic interdisciplinary consensus document. J Vasc Surg 2009; 49(2): 498–501. https://doi.org/10.1016/j.jvs.2008.09.014

Bergan

Schmid-Schönbein Geert

Smith

PDC

, et al. Chronic venous disease. N Engl J Med 2006; 355(5): 488–498. https://doi.org/10.1056/NEJMra055289

Lurie

Passman

Meisner

, et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg: Venous and Lymphatic Disorders 2020; 8(3): 342–352. https://doi.org/10.1016/j.jvsv.2019.12.075

American Venous Forum International Ad Hoc Committee for Revision of the CC Eklöf

Rutherford

Bergan

, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg 2004; 40(6): 1248–1252. https://doi.org/10.1016/j.jvs.2004.09.027

Salim

Machin

Patterson

, et al. Global epidemiology of chronic venous disease: a systematic review with pooled prevalence analysis. Ann Surg 2021; 274(6): 971–976. https://doi.org/10.1097/SLA.0000000000004631

Souza

Figueiredo

PHS

Silva

KLS

, et al. Factors associated with clinical severity in chronic venous disease: the role of functional parameters. J Bodyw Mov Ther 2024; 39: 258–262. https://doi.org/10.1016/j.jbmt.2024.03.015

Wittens

Davies

Bækgaard

, et al. Editor's choice – management of chronic venous disease: clinical practice guidelines of the european society for vascular surgery (ESVS). Eur J Vasc Endovasc Surg 2015; 49(6): 678–737. https://doi.org/10.1016/j.ejvs.2015.02.007

Back

Padberg

Jr. Araki

, et al. Limited range of motion is a significant factor in venous ulceration. J Vasc Surg 1995; 22(5): 519–523. https://doi.org/10.1016/s0741-5214(95)70030-7

10.

Dixy

Brooke

McCollum

. Venous disease is associated with an impaired range of ankle movement. Eur J Vasc Endovasc Surg 2003; 25(6): 556–561. https://doi.org/10.1053/ejvs.2002.1885

11.

Moura

RMF

Gomes

da Silva

SLA

, et al. Analysis of the physical and functional parameters of older adults with chronic venous disease. Arch Gerontol Geriatr 2012; 55(3): 696–701. https://doi.org/10.1016/j.archger.2012.05.005

12.

Nepomuceno de Souza

Fernandes de Oliveira

Geraldo Izalino de Almeida

, et al. Impairments in ankle range of motion, dorsi and plantar flexors muscle strength and gait speed in patients with chronic venous disorders: a systematic review and meta-analysis. Phlebology 2022; 37(7): 496–506. https://doi.org/10.1177/02683555221094642

13.

Qiao

Liu

Ran

. The impact of gastrocnemius muscle cell changes in chronic venous insufficiency. Eur J Vasc Endovasc Surg 2005; 30(4): 430–436. https://doi.org/10.1016/j.ejvs.2005.05.017

14.

van Uden

CJT

van der Vleuten

CJM

Kooloos

JGM

, et al. Gait and calf muscle endurance in patients with chronic venous insufficiency. Clin Rehabil 2005; 19(3): 339–344. https://doi.org/10.1191/0269215505cr809oa

15.

Attaran

Carr

. Chronic venous disease of the lower extremities: a state-of-the art review. J Soc Cardiovasc Angiogr Interv 2023; 2(1): 100538. https://doi.org/10.1016/j.jscai.2022.100538

16.

Redmond

Crane

Menz

. Normative values for the foot posture index. J Foot Ankle Res 2008; 1(1): 6. https://doi.org/10.1186/1757-1146-1-6

17.

Robertson

DGE

Dowling

. Design and responses of butterworth and critically damped digital filters. J Electromyogr Kinesiol 2003; 13(6): 569–573. https://doi.org/10.1016/s1050-6411(03)00080-4

18.

Tang

SF-T

Chen

C-H

C-K

, et al. The effects of total contact insole with forefoot medial posting on rearfoot movement and foot pressure distributions in patients with flexible flatfoot. Clin Neurol Neurosurg 2015; 129: S8–S11. https://doi.org/10.1016/S0303-8467(15)30004-4

19.

Telfer

Abbott

Steultjens

, et al. Dose–response effects of customised foot orthoses on lower limb muscle activity and plantar pressures in pronated foot type. Gait Posture 2013; 38(3): 443–449. https://doi.org/10.1016/j.gaitpost.2013.01.012

20.

Andrade

Ferreira

APL

Brioschi

, et al. Acute effect of kinesiotherapy and neuromotor electrostimulation on thermal variation in individuals with chronic venous insufficiency. Fisioterapia em Movimento 2024; 37: e37129. https://doi.org/10.1590/fm.2024.37129

21.

Carvalhais Mesquita

Eliziário

Fernandes de Oliveira

, et al. Is the weight-bearing lunge test a better tool for assessing ankle mobility in chronic venous insufficiency? A reliability and validity study. Phlebology. 2025; Online first: 02683555251377308. https://doi.org/10.1177/02683555251377308

22.

Nery

Reis

Mesquita

IRC

, et al. Use of the human activity profile to evaluate functional performance in chronic venous insufficiency: a validity study. J Vasc Nurs 2026; 44(1): 6–11. https://doi.org/10.1016/j.jvn.2025.09.003

23.

Souza

Magalhães

Teixeira-Salmela

. Adaptação transcultural e análise das propriedades psicométricas da versão brasileira do Perfil de Atividade Humana. Cad Saúde Pública 2006; 22: 2623–2636. https://doi.org/10.1590/s0102-311x2006001200012

24.

Magrath

Qiu

Hanwright

, et al. A systematic review of muscle synergies during a walking gait to define optimal donor-recipient pairings for lower extremity functional reconstruction. Plastic Reconstr Surg, Glob Open 2022; 10(8): e4438. https://doi.org/10.1097/GOX.0000000000004438

25.

Panny

Ammer

Kundi

, et al. Severity of chronic venous disorders and its relationship to the calf muscle pump. VASA Zeitschrift fur Gefasskrankheiten 2009; 38(2): 171–176. https://doi.org/10.1024/0301-1526.38.2.171

26.

Lee

. New treatment of varicose veins through muscle regeneration of lower leg muscles (especially calf muscle) without removal of varicose veins. Ann Phlebology 2022; 20(2): 68–77. https://doi.org/10.37923/phle.2022.20.2.68

27.

Mansilha

Sousa

. Pathophysiological mechanisms of chronic venous disease and implications for venoactive drug therapy. Int J Mol Sci 2018; 19(6): 1669. https://doi.org/10.3390/ijms19061669

28.

Kamel

Blebea

Onida

, et al. (eds) Pathophysiology of edema in patients with chronic venous insufficiency . Servier / Les Laboratoires Servier, 2020.