Venous leg symptoms in healthy subjects assessed during prolonged standing.

Abstract

The core symptoms of venous disease include leg discomfort or pain accompanied by sensations of heavy, weighty, or swollen legs. This suggests the presence of a cause and effect relationship between swelling and pain, resulting inthe assumption that a venous disorder is responsible. The aim of this study was to investigate the relationship between leg volume increase and symptoms provoked by a period of stationary standing and also to investigate the effect of medical compression stockings (MCS). Healthy volunteers were subject to stationary standing. Lower leg volume and the intensity and nature of the emerging symptoms were assessed seven times during 10minutes. Of 46 subjects analyzed after an initial test with bare legs, 18 (39%) developed no or few symptoms (≤2 on a Numeric Rating Scale [NRS] of 0 to 10). However, their leg volume increased as much as in the 28 subjects who experienced more symptoms. Oligosymptomatic subjects scored lower in a baseline questionnaire on leg symptoms of somatic and psychic origin than did volunteers with more symptoms. The oligosymptomatic subjects were excluded from the tests with MCS. In the 24 subjects who completed the whole study, the lower leg volume increased in two phases, reaching an increment of 44mL (standard deviation [SD], 18) or 1.73% (SD, 0.65) after 10minutes. Symptoms emerged and increased in a linear fashion, reaching a mean score of 2.93 NRS points (SD, 1.52) at 10minutes. The most prominent symptom was tingling (NRS, 5.07; SD, 3.05), followed by feelings of pressure and tension (NRS, 2.17; SD, 1.87). No correlation was found between volume increase and symptoms. MCS exerting an ankle pressure of 10 to 15mm Hg reduced the volume increase to 32mL (SD, 20), and MCS exerting 23 to 32mm Hg reduced it to 24mL (SD, 20; bothP< .001; difference between stockings, P= .06). Symptom intensity was reduced to NRS 2.06 (SD, 1.52) and 2.21 (SD,1.23; both P< .001), respectively. Both MCS reduced the symptoms equally (P= .38). Symptom reduction was not correlated with the prevention of volume increase. On prolonged stationary standing, leg volume increase and symptoms occur independently. MCS reduce volume increase according to the pressure they exert. Symptoms are reduced independent of the pressure exerted and the volume increase prevented. This suggests that MCS act in more ways than by a simple reduction in volume.