Presented for your enlightenment and amusement today is the case of the “Champagne Bottle Leg.” To many, the idea that someone’s leg could be shaped in such a fashion seems absurd, but to those suffering from this affliction, this is no joke. And we’re not talking about a one in a million condition but a disease affecting one out of twenty Americans.

This is the story of Martha, a retiree 70 years of age, who was employed for years working the register at a busy food store. Her medical history was quite common, moderately overweight with well-controlled high blood pressure. For many years she had a problem with swelling of her legs, but it was quite mild. As is often the case, she thought little of it.

When some brownish discoloration developed on her shins, Martha assumed they were age spots. There was no pain, although her legs were feeling somehow heavier after a busy day. Another change was the swelling. Previously, when she woke up in the morning, her legs would be of normal size, without the distention developing by the evening. That was no longer the case.

This is a fairly common timeline for chronic venous insufficiency, with the enlarging limb occurring earlier in the day and resolving less overnight. As do many with this common condition, symptoms will develop at some point, with Martha experiencing a diffuse, heavy ache at some point in her day. And she noted more prominent varicose veins of various sizes appearing in her legs. But when the skin of her leg became noticeably darker, itchy, and almost hard, she became alarmed. Martha took that big step and finally sought medical care.

Occupations requiring prolonged periods standing upright encourages this condition. A study of healthcare workers found evidence of CVI in nearly 70% of them. Although one might posit they should know better, only 3% wore the protective garments typically prescribed. There are innumerable reasons for this failure to treat, a topic requiring serious consideration because of the frequency of the disease.

The incidence of chronic venous insufficiency increases with age, usually affecting those over 50. The older you get, the greater the risk. As with most ailments, an inherited predisposition to CVI is frequently noted. Obesity is a leading candidate for the occurrence of this problem. A traumatic injury to the lower leg, one which impacts the system of veins in the leg can also lead, with time, to its development.

The brownish discoloration of Martha’s leg was because of a substance from our red blood cells being deposited in the skin. How did it get there and what are the effects? Although this substance has important functions, blood was pooling in Martha’s lower leg (every day). When it is able to leak out of the vein, coming to reside in the skin, this material acts to gradually poison our outermost layer, a process having far-reaching consequences.

One of the more predictable effects of this is a developing fragility of the skin. Even the slightest injury, something as insignificant as scratching one’s leg can lead to an open sore that will not heal. These venous ulcers are the most common type of non-healing wound and can persist for years. Although these open wounds drain profusely, and can be quite odorous, they rarely lead to amputation.

But the thickening of the skin Martha saw can progress, making large areas of the leg tough and unyielding, stiffened. When it worsens sufficiently and encompasses the circumference of the lower leg, the swelling enlarges the upper part of the lower leg, but the thickened skin below is too hard to swell. The result is the “Champagne Bottle Leg” deformity referred to earlier.

Martha didn’t get any specific recommendations other than encouraging her to do some elevation during the day, as well as instructing Martha to buy some compression stockings. She found some at her local pharmacy but experienced only some mild reduction in discomfort. After bumping her shin shortly thereafter, an open, draining ulcer developed that took almost two years to heal. Earlier, appropriate therapies could have prevented this condition.

Many approaches should be taken when CVI is developing. As is usually the case, the sooner the problem is addressed, and effective methods utilized, the better the results and the less damage incurred. Unfortunately, the standard therapy is the use of compression stockings. The track record of these is quite poor, partially because most people who are told to utilize this method purchase a stocking providing inadequate compression to be effective. But some is better than none so these can help to slow progression of the vein disease.

A newer approach is comprised of a sleeve for the lower leg. This “device” is simple to put on, unlike prescription stockings, which can take a team effort to don. More importantly, these provide progressive improvements since the wearer controls the amount of compression. As the limb gets even slightly smaller, stockings create less compression. These sleeves are able to produce the same amount of compression, even as the leg gets skinnier. And this leads to improvements in skin color.

The diseased valves of CVI will not “heal up” and cannot be repaired. But with good compression, the skin can recover and complications avoided. Although not everyone will experience the more dire consequences, prevention is the best course of action.

Chronic venous insufficiency is not a serious health threat for most, since blood clots in the legs, and clots traveling to the lungs are rare complications. But it can be painful, even disabling, and living with one of these chronic wounds will put a damper on your quality of life. Don’t simply accept the chronic swelling you are experiencing, especially if there are color changes. The compression sleeve technology has provided consistently excellent results and is comfortable to wear. At last, a game changer in the treatment of chronic venous insufficiency.

EDITORS NOTE: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.