Should we test for neuropathy in patients with venous leg ulcers – a new hypothesis?

What is it about?

What is the rationale for proposing the assessment of neuropathy in venous leg ulcers? In the world of wound healing, neuropathy is commonly associated with diabetic foot ulcers or pressure ulcers. With respect to leg ulcers, peripheral arteriopathies with macroangiopathy or microangiopathy are known to lead to ischemic polyneuropathy, mainly due to hypoxic tissue and nerve damage.1 However, chronic venous insufficiency (CVI) can also lead to neuropathy, even though it is not commonly discussed.2 In fact, the most advanced stage of chronic venous disease, which is venous ulceration, also has microangiopathy among its pathogenesis, but little is said about possible involvement of peripheral nerves. In contrast to this lack of evidence in the subject, it is remarkable the frequent symptomatology of patients with CVI that can be considered neuropathic: cramps, dysesthesia, painful sensations and paresthesia.2 Furthermore, considering the extent of tissue damage in venous leg ulcers (Figure 1), it is intuitive to think that nerve damage is also occurring and that nerve damage may also impair healing. Additionally, nerve involvement may result in muscle dysfunction, alterations in mobility and a decrease in range of motion may lead to gait alterations all affecting calf muscle pump function and, consequently, promote CVI.3 Analogous to neuropathic ulcers in diabetes, the CVI-associated neuropathy may also be a cofactor in the development of venous ulcers.

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