Samantha Barker, Michael Ross, Kehua Zhou


Venous leg ulcers (VLUs) are the most common etiology of lower extremity ulceration, with approximately 70 to 80 percent of leg ulcers developing from venous insufficiency or disease. The financial burden of VLUs on society, increase in prevalence with age, the chronic nature of the disorder, and high recidivism rate are, in part, the driving forces behind efforts to determine the most effective management options to achieve complete wound healing in a timely and efficient manner. Thus, the purpose of this paper is to describe the etiology, diagnosis, and management of VLUs, with a particular emphasis on exercise intervention. While medical treatment of VLUs include wound debridement, infection control, and proper wound dressing, compression therapy and elevation are the most common and effective treatment option for VLUs. When combined with routine compression therapy, exercise intervention (e.g., aerobic, resistance, and flexibility exercises) significantly improves the healing of VLUs in a cost efficient manner and should be strongly considered in the routine management of patients with VLUs.


Article visualizations:

Hit counter

Demo: the current year (in your local time) is.


venous leg ulcer, exercise, wound care

Full Text:



O’Meara S, Al-Kurdi D, Ovington LG. Antibiotics and antiseptics for venous leg ulcers. Cochrane Database Syst Rev. 2008;(1):CD003557.

Alavi A, Sibbald RG, Phillips TJ, et al. What’s new: management of venous leg ulcers: approach to venous leg ulcers. J Am Acad Dermatol. 2016;74:627-640.

Valencia IC, Falabella A, Kirsner RS, et al. Chronic venous insufficiency and venous leg ulceration. J Am Acad Dermatol. 2001;44:401-421.

Rice JB, Desai U, Cummings AKG, et al. Burden of diabetic foot ulcers for Medi-care and private insurers. Diabetes Care. 2014;37:651-658.

Briggs M, Closs SJ. The prevalence of leg ulceration: a review of the literature. EWMA Journal. 2003;3:14-20.

de Araujo T, Valencia I, Federman DG, et al. Managing the patient with venous ulcers. Ann Intern Med. 2003;138:326-334.

Hodde J, Allam R. Submucosa wound matrix for chronic wound healing. Wounds. 2007; 19:157-163.

De Araujo TS, Hexsel CL, Kirsner RS. Treatment of venous ulcers. Curr Treat Options Cardiovasc Med. 2005;7:131-138.

Kurz X, Kahn SR, Abenhaim L, et al. Chronic venous disorders of the leg: epidemiology, outcomes, diagnosis and management. Summary of an evidence-based report of the VEINES task force. Venous Insufficiency Epidemiologic and Economic Studies. Int Angiol. 1999;18:83-102.

Heit JA. Venous thromboembolism epidemiology: implications for prevention and management. Semin Thromb Hemost. 2002;28:3-13.

Marieb EN. Essentials of Human Anatomy and Physiology (8th edn). San Francisco, CA: Benjamin-Cummings Pub Co., 2006.

Doughty DB, Holbrook R. Lower extremity ulcers of vascular etiology. In: Bryant RA, Nix DP, eds. Acute and Chronic Wounds. 3rd ed. Maryland Heights, MO: Mosby, 2007.

Kalra, M., Gloviczki, P. Surgical treatment of venous ulcers: role of subfascial endoscopic perforator vein ligation. Surg Clin North Am. 2003;83:671-675.

Yim E, Kirsner RS, Gailey RS, et al. Effect of physical therapy on wound healing and quality of life in patients with venous leg ulcers. JAMA Dermatology. 2015;151:320.

Etufugh CN, Phillips TJ. Venous ulcers. Clin Dermatol. 2007;25(1):121-130.

Raffetto JD. Pathophysiology of wound healing and alterations in venous leg ulcers - review. Phlebology 2016;31:56-62.

Mannello F, Raffetto JD. Matrix metalloproteinase activity and glycosaminoglycans in chronic venous disease: the linkage among cell biology, pathology and translational research. Am J Transl Res. 2011;3:149-158.

Singer AJ, Tassiopoulos A, Kirsner RS. Evaluation and management of lower-extremity ulcers. N Engl J Med. 2017;377:1559-1567.

Yim E, Vivas A, Maderal A, et al. Neuropathy and ankle mobility abnormalities in patients with chronic venous disease. JAMA Dermatol. 2014;150:385-389.

Dix FP, Brooke R, McCollum CN. Venous disease is associated with an impaired range of ankle movement. Eur J Vasc Endovasc Surg. 2003;25:556-561.

Carpentier PH, Maricq HR, Biro C, et al. Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population-based study in France. J Vasc Surg. 2004;40:650-659.

Nelson EA, Bell-Syer SE, Cullum NA. Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev. 2000;(4):CD002303.

Carville K. Wound Care Manual. Osborne Park, WA: Silver Chain Nursing Association, 2005.

Nelzén O, Bergqvist D, Lindhagen A. Venous and non-venous leg ulcers: clinical history and appearance in a population study. Br J Surg. 1994;81:182-187.

Stacey MC, Burnand KG, Layer GT, et al. Measurement of the healing of venous ulcers. Aust N Z J Surg. 1991;61:844-848.

European Wound Management Association. Position Document: Identifying Criteria for Wound Infection. London: MEP Ltd., 2005.

König M, Vanscheidt W, Augustin M, et al. Enzymatic versus autolytic debridement of chronic leg ulcers: a pro-spective randomised trial. J Wound Care. 2005;14:320-323.

Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59:e10-52.

Serra R, Grande R, Butrico L, et al. Chronic wound infections: the role of Pseudomonas aeruginosa and Staphylococcus aureus. Expert Rev Anti Infect Ther. 2015;13:605-613.

White RJ, Cutting KF. Critical colonization--the concept under scrutiny. Ostomy Wound Manage. 2006;52:50-56.

O’Meara S, Martyn-St James M. Foam dressings for venous leg ulcers. Cochrane Database Syst Rev 2013;(5):CD009907.

Thomas DR. Managing venous stasis disease and ulcers. Clin Geriatr Med. 2013;29:415-424.

Meaume S, Dompmartin A, Lok C, et al. Quality of life in patients with leg ulcers: results from CHALLENGE, a double-blind randomised controlled trial. J Wound Care. 2017;26:368-379.

O’Meara S, Cullum N, Nelson EA, et al. Compression for venous leg ulcers. Cochrane Database Syst Rev 2012;(11):CD000265.

Meagher H, Ryan D, Clarke-Moloney M, et al. An experimental study of prescribed walking in the management of venous leg ulcers. J Wound Care. 2012;21:421-2, 424-6, 428 passim.

Kurd SK, Hoffstad OJ, Bilker WB, et al. Evaluation of the use of prognostic information for the care of individuals with venous leg ulcers or diabetic neuropathic foot ulcers. Wound Repair Regen. 2009;17:318-325.

O’Brien J, Finlayson K, Kerr G, et al. Evaluating the effectiveness of a self-management exercise intervention on wound healing, functional ability and health-related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial. Int Wound J. 2016;14:130-137.

Pieper B, Templin TN, Birk TJ, et al. Chronic venous disorders and injection drug use: impact on balance, gait, and walk speed. J Wound Ostomy Continence Nurs. 2008;35:301-310.

Klonizakis M, Tew GA, Gumber A, et al. Supervised exercise training as an adjunct therapy for venous leg ulcers: a randomized controlled feasibility trial. Br J Dermatol. 2018;178:1072-1082.

Margolis DJ, Knauss J, Bilker W. Medical conditions associated with venous leg ulcers. Br J Dermatol. 2004;150:267-273.

DOI: http://dx.doi.org/10.46827/ejprs.v2i1.98


  • There are currently no refbacks.

Copyright (c) 2021 Samantha Barker, Michael Ross, Kehua Zhou

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright © 2015 - 2022. European Journal of Physiotherapy and Rehabilitation Studies (ISSN 2668-9928) is a registered trademark of Open Access Publishing Group. All rights reserved.

This journal is a serial publication uniquely identified by an International Standard Serial Number (ISSN) serial number certificate issued by Romanian National Library. All the research works are uniquely identified by a CrossRef DOI digital object identifier supplied by indexing and repository platforms. All the research works published on this journal are meeting the Open Access Publishing requirements and standards formulated by Budapest Open Access Initiative (2002), the Bethesda Statement on Open Access Publishing (2003) and Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities (2003) and can be freely accessed, shared, modified, distributed and used in educational, commercial and non-commercial purposes under a Creative Commons Attribution 4.0 International License. Copyrights of the published research works are retained by authors.