Another long day on my feet and legs, thank goodness for practical footwear and compression hosiery. Like many nurses, healthcare professionals and working people, the majority of us are working longer and harder hours and the effect on our legs may be beginning to take its toll. The Royal College of Nursing (RCN, 2017) have reported 40,000 nurse vacancies across the NHS in England; more than ever our bodies are being pushed to the limit.
How many steps have you walked today? Are your legs swollen? What time did you get up this morning? How many hours have you been on your feet? Many of you may have experienced heavy, aching, tired legs when returning home from work. We tend to put this down to a long day and to some extent we are right. However, over time, these symptoms could be a clinical manifestation of a condition known as chronic venous hypertension. Veins return deoxygenated blood back to the right heart; the veins contain valves which prevent backflow (reflux), if the values become incompetent through trauma, surgery to the lower legs, pregnancy, obesity or genetic predisposition, the volume of stagnant venous blood in the deep and/or superficial veins will increase. The permanent rise in the venous pressure is referred to as chronic venous hypertension. Varicose veins, skin changes, leg ulcers may be progressive signs of such a clinical condition (Anderson, 2008).
Many of you may have experienced heavy, aching, tired legs when returning home from work. We tend to put this down to a long day and to some extent we are right. However, over time, these symptoms could be a clinical manifestation of a condition known as chronic venous hypertension.
Keeping legs healthy, both inside and out, may help to prevent and treat the consequences of chronic venous hypertension, such as thread veins, varicose veins and ultimately skin breakdown — and yes, even leg ulceration in later life. This is not only an issue for the patients we care for, who are presenting with lower limb oedemas, skin conditions and ulceration, we also need to address this with ourselves, our family and friends and the wider public. Many professionals present to us in clinical practice with lower limb problems, i.e. chefs, hairdressers and nurses, who have spent their working life on their legs and are now experiencing complications.
Varicose veins are perceived as the first visible sign of a problem with our legs; however, there are other early symptoms such as aching, uncomfortable legs, swollen feet and ankles at the end of a long day, burning or throbbing and varicose eczema (NHS Choices, 2017).
The Circulation Foundation
The Circulation Foundation (2018) have produced useful information and describe how varicose veins and spider veins often run in the family, with one in two women more likely to be affected. Other factors, such as hormonal changes during puberty, pregnancy, and menopause or due to contraception may affect the disease. Although varicose veins are rarely a serious condition, in the early stages they can be perceived as uncomfortable, unattractive and even embarrassing, and in the late stages they may lead to chronic leg ulcers.
The NHS (2017) recommends that you see your GP if your varicose veins are causing you pain or discomfort, the skin over your veins is sore and irritated, and/or the aching in your legs is causing irritation at night and disturbing your sleep. Your GP can diagnose varicose veins based on these symptoms, although further tests may be carried out. Clinical commissioning groups (CCGs) have set different criteria to grant access to surgical treatment for varicose veins within the NHS, mainly including varicose eczema, varico-phlebitis or bleeding; interestingly, pain is rarely considered a valid indication.
Reaching out to our own nursing and healthcare colleagues is paramount and we need all to be involved in promoting and maintaining the health of our legs. This editorial does not address in full the complex assessment and management of chronic venous insufficiency (CVI); however, to make a start, ask yourselves the following questions:
- Do you experience aching, throbbing and tired legs and/or have varicose veins?
- Are you at risk of developing varicose veins later in life, due to pregnancy, family history, being overweight, having a sedentary lifestyle, or standing/working for long hours on your legs?
If the answer is yes to one or more of the above, read below and contact your local GP practice or pharmacy for further information on what to do next.
We cannot assume, as for any other medical condition, that people are always sufficiently informed. For example, a student nurse in her early 20s was working as a healthcare assistant on the hospital bank for the first time in our vascular, leg ulcer clinic. After working all day removing dressings, washing legs and supporting the team, she came up to me and said, ‘I never understood why my legs burned and hurt so much; myself and my mother have tried everything: ointments, creams and yet they have been hurting for so long. Will this happen to me too, will I get ulcers?’ At that, she rolled-up her uniform trousers to display a number of large varicose veins. I reassured her that we could work to prevent this and she was advised to buy compression hosiery and see her GP. This story is not unique, and we need to reach out and contact as many people as we can in a campaign to raise awareness and promote appropriate assessment, treatment and prevention within the healthcare system.
The Tissue Viability Society
As a trustee of the Tissue Viability Society (TVS), I am part of a coalition of organisations and societies called ‘Legs Matter’. This collaboration came from a national response to raise awareness and understanding of conditions affecting the lower limb and foot, with the view of ensuring timely and effective treatment. Patients and the public are at the centre of this campaign, which includes men and women
of every age, from young pregnant women to older adults. We also want to make commissioners and policymakers aware of the campaign and the impact of lower limb and foot conditions on the public, highlighting the socioeconomic burden associated with them (Guest et al, 2015).
Lower leg and foot awareness is everybody’s business and we need to start by looking at the health and condition of our own hard-working legs, of those we care for and of those around us. Personally, I will continue to wear compression hosiery for life; not only does this bring physical benefits, but it also reassures me that I am playing my part in preventing the likelihood of varicose veins. It also sets an example when treating patients, showing how compression hosiery is comfortable, wearable and gives results.
About the author
Andersons I (2008) Understanding chronic venous hypertension. Wounds Essentials 3: 20–32. Available online: www.wounds-uk.com/pdf/content_9420.pdf www.circulationfoundation.org.uk/help-advice/veins
Circulation Foundation (2018) Veins: General information — varicose veins. Available online: www.circulationfoundation.org.uk/help-advice/veins (last accessed 26 January, 2018)
Guest JF, Ayoub N, McIlwraithT, Uchegbu, I, Gerrish A, Weidlich D, Vowden K, Vowden P (2015) Health economic burden that wounds impose on the National Health Service in the UK.
Br Med J 5(12). Available online: http://bmjopen.bmj.com/content/bmjopen/5/12/e009283.full.pdf (last accessed 26 January, 2018)
NHS Choices (2017) Varicose veins. Overview. Available online: www.nhs.uk/conditions/varicose-veins/#when-to-see-your-gp (last accessed 26 January, 2018)
Royal College of Nursing (2017) Nine in 10 largest NHS hospitals short of nurses. RCN, London. Available online: www.rcn.org.uk/news-and-events/news/nine-in-10-largest-nhs-hospitals-short-of-nurses (last accessed 26 January, 2018)
The original article featured in Journal of General Practice Nursing 2018, Vol 4, No1