Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android. Learn more here!


Robust calf muscles are essential for normal venous dynamics. Indeed, the grastrocnemius and soleus muscles in the calf have been described as a “physiological heart” comprising the main force propelling venous blood against gravity [1].

A meta-analysis of exercise intervention indicates that improving the strength of the calf muscles significantly increases the lower leg ejection fraction and reduces the residual venous volume of the lower leg [2]. In addition to weakness of the calf muscles in chronic venous insufficiency, there is evidence that impairment occurs as well in muscles of the thigh [3]. The severity of weakness correlates with the severity of the disorder.

Toning up muscles in the peripheral venous pump is an important component for successful management of venous reflux disease. People with venous insufficiency can improve calf muscle function, ankle strength, the range of motion, and healing rates with exercise. There is a significant increase in local tissue oxygen in patients with venous ulcers who performed regular dorsiflexion exercise [4]. Some form of exercise conditioning program can almost always be integrated into one’s daily routine with minimum demand of time and without special equipment.

In one clinical trial involving patients with venous ulcers, 10 dorsiflexions every hour during waking hours proved beneficial after 3 months [5]. Ulcer size decreased and the oxygen content in jeopardized tissue was higher. While other clinical trials have demonstrated no benefit of exercise in non-ulcerative venous insufficiency, these few studies lack a high quality of evidence [6]. The need for further more comprehensive investigations with larger sampling was emphasized.

Walking helps develop the muscles chiefly responsible for forcing venous blood upward. The gastrocnemius muscle, forming the bulk of the calf, contracts to lift the heel and push off with the foot. This muscle is the prime mover for locomotion; its power and endurance can be tremendously improved by ambulatory training.

The distance walked must be individually determined according to comfort and time available. Short and frequent walks within the limits of tolerance are recommended. If leg discomfort occurs or increases on walking a certain the distance, the pace or distance should be reduced. Patients will find that walking endurance increases with training along with other aspects of management that are incorporated into the regimen.

Running demands such a high blood flow in the legs that the venous system may be stressed excessively. For example, varicosities can become greatly distended if the perforating veins leading into them also have defective valves. Thus, the advisability of jogging as an aid for controlling venous insufficiency without wearable compression is questionable. Other forms of exercise should be considered. This subject is considered further in Chapter 20.

Toe stands are a convenient and effective exercise for compressing the venous plexus of the calf and for developing muscle tone, especially the ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.