Ankle motility is a risk factor for healing of chronic venous leg ulcers

Objective: To investigate the effect of ankle motility on chronic venous leg ulcer healing, and to relate this to calf pump function and muscle bulk. Methods: This was a prospective cohort study undertaken in a leg ulcer clinic. Ankle motility, calf-ankle circumference ratio and calf pump power (derived from digital photoplethysmography) were assessed as to their effect on ulcer healing rate. Thirty consecutive patients undergoing multi-layer compression bandaging for open chronic venous ulcers were included. Results: Ankle motility was an independent risk factor for ulcer healing (p = 0.001, hazard ratio 1.08, 95% CI 1.03-1.13). Ankle motility correlated with calf-ankle circumference ratio (r = 0.48, p< 0.01). No relationship was found between photoplethysmography-derived calf Dump power, ankle motility or ulcer healing rate. Conclusions: Ulcers in legs with poor ankle motility are slower to heal and this may be related to reduced calf muscle bulk. Ankle exercises or physiotherapy could be considered in such patients.