How to help leg ulcers heal

Combination of heel raises, walking and compression bandages works best

Prescribing resistance and aerobic exercise to patients with venous leg ulcers increases the chances of wound healing, according to a New Zealand study published in the Journal of the American Medical Association.

The meta-analysis of five randomised controlled trials involving 190 participants shows that healing rates are higher when patients are prescribed exercise in addition to compression bandaging, compared with bandages alone.

The five studies explore a range of exercises — either alone or in combination with compression bandaging, including heel raises, calf raises and partial squats (progressive resistance exercises), walking and using a treadmill or cycling.

Overall, exercise combined with compression bandaging is associated with increased venous leg ulcer healing at 12 weeks, with an additional 14 cases healed per 100 patients compared with bandaging alone.

Combining resistance exercises with aerobic activity appears to be the most effective, with an additional 27 cases healed per 100 patients.

The evidence may now be “sufficiently suggestive” for doctors to consider recommending simple, progressive resistance, such as heel raises, and 30 minutes of walking at least three time a week to suitable patients while further research is produced, the authors write.

“Adherence to such a regime suggests that for every four patients treated with prescribed exercise plus compression, one more patient might heal than if using compression alone,” say the researchers from the University of Auckland.

The study is the first to focus on complete ulcer healing and to attempt to summarise the evidence by exercise type.

Simply walking 10,000 steps a day or just doing heel raises does not lead to improvement over control, the authors note.

A trial on ankle dorsiflexion exercises could not be included in the meta-analysis, but it shows a statistically significant reduction in ulcer size in the dorsiflexion compared with the control group, they add.

Increased ulcer healing as a result of exercise is also associated with annual cost savings of around $1500 for health services and $110 for the participants, the study authors report.

More information: JAMA Dermatology 2018; online.