- The causes of varicose veins and risk factors
- Varicose veins of lower extremities: symptoms
- Complications of varicose veins
- Classification of varicose veins
- Varicose veins of lower extremities: diagnosis
- Varicose veins of lower extremities: treatment
- Prevention of varicose veins
This is due, above all, the difference in blood pressure to the walls from the inside.
The middle layer of the arteries is represented by dense collagen fibers, preventing the rupture of the vessel.
On the average, however, the vein layer is dominated by smooth-muscle fibers located spirally. In addition, single muscle fibers are present in the inner layer of the vein, forming together with the endothelium special folds - valves. Valves are mainly defined in the veins of the lower extremities.
The peculiarity of the structure of the veins helps to redistribute blood during physical exertion and not to reverse the flow of blood.
The loss of the elasticity of the venous vessel wall, with the widening of its lumen, with the development of vascular valve insufficiency, leading to a disturbance in normal blood flow, has received a separate nosological unit in the form of a disease called varicose veins or varicose from the Latin varix (tortuosity).
In the walls of the affected vessels, sclerotic-degenerative changes develop due to their stretching, thinning, and subsequent formation of spherical extensions (knots) along their length. Valve valves at the initial stages of the disease are still preserved, but the complete closure of the lumen of the vessel with their help is no longer happening. In the future, with the addition of local inflammation and thrombosis, the valves disappear, exacerbating the clinical picture of venous insufficiency.
The disease is quite common: the average "coverage" of the population is 10-18%, with predominance in female persons (2-3 times more often).
The veins of the lower extremities are most affected by varicose veins. However, varicosity can be observed in the vessels of the walls of the large and small pelvis. Practically this disease does not occur in the vessels of the upper extremities.
Expansion of the lumen of the veins, as a manifestation and complication of other diseases of the internal organs, can be observed in the submucosal veins of the esophagus with diseases of the liver, rectal mucosa in hemorrhoids, in the veins of the seminiferous tubule and testicle with varicocele . Overlapping the lumen of a large venous vessel with a growing tumor from neighboring organs, can also cause varicose veins, with a localization uncharacteristic for this disease.
The causes of varicose veins and risk factors
It is observed with the genetically conditioned, transmitted in the genus, the functional immaturity of the valve veins apparatus and the underdevelopment of the connective tissue component of the vessel wall. This leads to increased pressure inside the vessels and the development of varicose veins already in early childhood, with the appearance of the first physical exertion.
2. Violations of blood coagulation.
This group includes congenital factors associated with hypercoagulability. Formed in these cases, thrombi, create obstacles to the normal flow of blood, with the subsequent expansion of the lumen of the vessel.
3. Changing the hormonal background.
This factor is most evident in women due to changes in the level of sex hormones during pregnancy and during menopause. Decreased estrogen with a simultaneous increase in progesterone, with physiological and dysfunctional conditions, increase the production of clotting factors. In addition, such a hormonal background leads to changes in protein-lipid metabolism with a decrease in the synthesis of elastic and collagen fibers, followed by a decrease in the tone of the wall of the venous vessel. The overall result is a decrease in blood flow with the formation of thrombi and insufficiency of the valvular apparatus.
4. Increased body weight.
General obesity has a mechanical effect on the wall of the veins, especially this is observed with its abdominal type, causing an increase in venous pressure below the squeezing zone. In addition, ongoing dysmetabolic and dyshormonal changes at extreme degrees of obesity, distort the normal rheological properties of the blood. This again leads to mechanical obstruction of the vessels from the inside (thrombosis). A sedentary lifestyle with obesity also helps to slow the circulation.
5. Diabetes mellitus.
As a result of complex metabolic disorders, due to hyperglycemia, with relative insulin deficiency, the vein wall elasticity decreases, followed by the widening of its lumen.
Constant dehydration, observed with alcoholism, increases the coagulability of the blood with subsequent violation of the blood flow.
7. Professional factors associated with increased physical activity and a prolonged vertical position.
This includes movers, conductors, sellers, surgeons, hairdressers, maintenance workers for production lines, etc. The risk of developing varicose veins in these people is due to stagnation of blood in the lower extremities due to the constant high intra-abdominal pressure that prevents the delivery of blood to the heart.
8. Mechanical compression of veins in tight linen .
It is observed with the constant wearing of this type of clothing.
9. Frequent constipation.
They lead to an increase in intra-abdominal pressure during straining, followed by a logical chain of development of varicose veins.
10. Wearing shoes with high heels.
It is dangerous, first of all, to restrict movements in the ankle, and therefore to reduce the muscles of the shin, which help the blood to move up.
11. Climatic factors.
Staying in conditions of high ambient temperature without adequate replenishment of fluid loss - becomes the cause of thrombosis with subsequent violation of venous outflow.
12. Unreasonable prescribing and uncontrolled intake of medicines with the main or side effect in the form of acceleration of blood coagulability.
13. Previously transplanted abdominal surgery.
Dangerous risk of formation of small and large venous thrombi, leading to a violation of outflow of blood from the extremities.
14. Severe cardiovascular diseases with the phenomena of circulatory insufficiency, as a consequence of a decrease in the contractile function of the myocardium.
15. Previously injured limbs and surgical interventions on them.
Here, scar processes, which prevent the outflow of blood, are important.
16. Constitutional features.
There is a predisposition to varicose veins in high people, especially in combination with excessive body weight.
The development of varicose veins is mainly observed in the Caucasoid race.
18. Chronic inflammatory processes of the pelvic cavity organs.
As a rule, this applies to diseases of internal genital organs (prostatitis in men and inflammation of the appendages in women). The mechanism is due to the involvement of small venules in the inflammatory process. The edema of their inner lining arises at the same time, complicates the outflow of blood, forcing the opening of communicative vessels that connect the arterial and venous channel. Blood in the veins comes with a significant increase in intravascular pressure and volume. After this, the previously described mechanism is repeated: the expansion of the lumen of the veins and the inadequacy of the venous valves.
Varicose veins of lower extremities: symptoms
1. External changes of the subcutaneous veins .
The veins acquire a focal uniform or sack-like thickening of the diameter, with the formation of peculiar knots and tangles of vessels. Modified vessels are stained in dark purple or blue. Small, previously unidentified veins, appear contours in the form of intradermal venous "mesh".
Most often such changes are exposed to the veins of the foot and lower leg. As the process progresses, a similar pattern is revealed in the venous vessels of the thighs.
2. Pain .
Patients note early fatigue, heaviness in the legs. There is a dull pain of a bursting character in the calf muscles. Over time, the pain becomes more intense, with the possible occurrence of muscle cramps of the shins. It is noted that after finding some time of the legs in a horizontal position, the described symptomatology subsides for a while, which would then resume (orthostatic crotalgia) upon transition to a vertical state. Pain is worse when the shin is palpated. In the absence of changes from the superficial veins, in this situation, it is necessary to suspect the presence of varicose veins in the veins of the extremity.
3. Swelling of subcutaneous tissue.
Appears edema of the foot (pastoznost) with the spread to the lower third of the shin, accompanied by the itching of the skin in the projection of the lesion. If during the night pastovnost from the subcutaneous tissue at the ankle level of the ankle joint does not go away, then one should think that the phenomena of venous insufficiency have passed to the stage of decompensation. In these situations, the addition of a secondary infection and the debut of the trophic ulcer should also be excluded.
4. Itching of the skin.
It may appear before the manifestation of a bright clinical symptomatology of varicose veins, but most often occurs already with the manifestations of pronounced violations of the outflow of venous blood.
Occurs already with the expanded clinical picture of the disease. The skin becomes darker in the course of the altered veins and perifokalno from them, in places of mechanical damage with bruises. In the future, all the skin in the distal parts of the limb acquires a cyanotic color (induration). The superficial epithelium is thinned, subcutaneous structures atrophy.
6. Hypothermia of the extremity extremities.
When palpation, the skin of the extremities is cold. Patients also feel the constant "freezing" of the limbs.
7. Trophic ulcers.
Part of the clinicians regard this symptom as a complication of varicose veins. Another part considers the appearance of defects in the skin in the form of open ulcers against the background of industrially altered areas - the last stage of the disease.
Complications of varicose veins:
- Thrombophlebitis .
- Accession of secondary infection (most often erysipelas) to existing trophic ulcers and with the development of moist gangrene of the extremity.
- Deep vein thrombosis with subsequent fatal pulmonary venous thromboembolism.
- Eczema (dermatitis).
- Bleeding from damaged varicose veins.
Classification of varicose veins
The changes relate primarily to superficial veins. Violation of the structure of deep veins and a change in the performance of the functions assigned to them are initially absent.
It develops as a complication of the primary diseases of the deep veins, after which changes occur in the superficial veins of the lower extremities. This occurs in the presence of congenital defects in the development of the venous system (vascular dysplasia, fistula), as well as the outcome of previous deep venous phlebothrombosis. The reasons for the formation of thrombi in the veins were discussed above.
In addition, there is a separation of varicose veins in clinical forms.
- Varicose veins of the lateral (lateral) veins of the thigh and lower leg.
- Reticular varicose veins.
- Varicose telangiectasia.
Varicose disease of laterally located veins of the lower limb occurs both independently and when combined with other clinical varieties. Reverse discharge of venous blood is carried out in the deep vein of the thigh through the subcutaneous and surrounding veins.
Reticular (reticulate) and in the form of telangiectasias (nodules of intradermal capillary vessels), varicosity, in isolated variants, does not lead to the development of venous insufficiency. These forms of varicose veins deliver only cosmetic discomfort.
Recently, angio-surgeons have started to allocate also idiopathic venous insufficiency (IVN). The veins in this disease, in contrast to other forms of the disease, have an initially elevated venous tone for no apparent reason. The symptomatology with IVN does not differ from the classical manifestations of varicose veins.
A wide distribution of the assessment of the stage of varicose disease was classified according to VS. Saveliev.
Compensation stage .
Pain is minimal or nonexistent. The discomfort in the legs is determined with a long sitting or vertical position. In the superficial areas of the skin, small vascular asterisks are identified. Periodically there are minor swelling of the feet and ankles. They quickly pass after accepting the finiteness of the horizontal position.
Stage of subcompensation.
Even with a superficial glance at the limbs, the presence of veins with an enlarged lumen attracts attention.
Complaints of patients at the same time are more specific: pain in the legs of a raspberry character, increased fatigue. At night, convulsions of the calf muscles occur suddenly or against the background of a sensation of "goose bumps" (paresthesia). Edema in the lower third of the shin and on the feet is more pronounced, but after a night's sleep they disappear.
The stage of decompensation.
The clinical picture is aggravated by local changes in the skin: it takes the form of a dry and smooth surface, hair loss, hyperpigmentation of the skin followed by induration of the underlying fiber.
Edema takes the character of permanent, rise higher.
Frequent small intradermal hemorrhages make the pigmentation more saturated due to the loss of hemosiderin (the pigment of the blood). Minor wounds and abrasions heal very long, gradually turning into ulcerative defects.
In 2000, Russian phlebologists proposed a pathogenetic classification of varicose veins. And she also received wide recognition.
- Partial (segmental) changes in the subcutaneous and intradermal veins of the limb without reverse flow (reflux).
- Segmental expansion of veins with reflux on communicative and / or surface vessels.
- Total varicose with reflux of blood in the superficial and communicative veins.
- Varicose veins with reflux of blood through the deep veins of the extremities.
Degree of chronic venous insufficiency
0 - no manifestations were detected.
I - edema that occurs with symptoms of fatigue of the legs.
II - permanent edema with signs of skin pigmentation, thickening of the consistence of subcutaneous fat, the appearance of eczema.
III - the formation of ulcerative defects in the skin of a trophic genesis.
The same classification requires a separate mention of the complications that have arisen.
CEAR classification, used throughout the world, takes into account the clinical indicators of the stage of the disease (C), its causes (E), anatomical lesions (A), the development mechanism (P).
C - clinic.
C0 - when examining the skin, no changes were detected.
C1 - changes in the intradermal veins, expressed in the formation of vascular "stars" (telangiectasia), capillary "mesh" (reticular type) are determined.
C2 - expansion of the lumen of deeper, subcutaneous veins is determined, with the formation of large nodes.
C3 - the symptomatology is associated with hypodermic hypodermia.
C4a - hyperpigmentation of the skin around the altered vessels with changes in the characteristics of its surface: dry cracks accompanied by an obsessive itch (otherwise: venous eczema).
C4b - discoloration of the skin around the vessels, with simultaneous compaction of the underlying subcutaneous tissue (in other words: lipodermatosclerosis, white skin atrophy).
C5 - along with the described changes in the skin, a healed ulcer is determined.
C6 - available ulcers without signs of healing.
E - etiology (origin).
Ep - a primary varicose disease, which occurred without any apparent cause and prior thrombosis of the veins.
Ec - congenital varicose veins.
Es is a secondary varicose vein after a previous phlebothrombosis.
En - the reason can not be clarified due to insufficient anamnestic data.
A - localization of varicose veins.
An - changes in venous vessels were not detected.
As - changes observed in the superficial veins.
As1 - capillary (reticular) intradermal veins are affected.
As2 - varicosity of the large subcutaneous femoral vein.
As3 - changes in the large saphenous vein.
As4 - short subcutaneous vein is affected.
As5 - a large, but not a trunk, vein is affected.
Ad - varicose veins (cavities of the body and lower limbs): lower hollow, iliac, pelvic (including uterine and gonadal), femoral and the muscles of the lower leg and foot.
Ap - varicose veins of the perforating (communicative) veins of the thigh and lower leg.
P - by the mechanism of pathophysiological changes.
Pn - changes in the blood flow are not revealed.
Po - Obturation (occlusion) of the vein by a thrombus.
Pr - detection of the reverse blood flow (reflux) due to the failure of the valve veins.
Pr, o - a combination of reflux and thrombosis. This occurs with long-existing venous thrombi, when, as a result of inflammatory-sclerotic processes, small through vessels appear that connect the lumen of the vein before and after occlusion.
In addition, the methods of diagnosis of varicose veins with the help of the index L
LI - the external examination and / or the produced dopplerography of venous vessels became the basis.
LII - the basis for the diagnosis was inspection and ultrasonic duplex scanning.
Varicose veins of lower extremities: diagnosis
1. Inspection with the detection of external signs.
2. Interrogation with specification of subjective sensations, previous diseases and conditions that could contribute to the development of the disease.
It should also clarify the presence of concomitant bone diseases (osteochondrosis, heel spurs, arthrosoarthritis, flat feet), as well as connective tissue system (systemic collagenoses, panniculitis). They can not only cause such complaints and local changes, but also indirectly, due to a decrease in motor activity and other mechanisms, contribute to the occurrence of varicose veins.
3. Functional tests.
The Brody-Troyanov-Trendelenburg test. With its help determine the functional state of the valve veins. The patient lies on a couch with a raised leg. After a while, when the venous blood leaves the limb, a large subcutaneous vein is squeezed in the upper third of the thigh. You can use your finger, or you can apply a tight, venous tourniquet. Then the patient is offered to stand up. The tourniquet relaxes. In the presence of insufficient venous valves, you can clearly observe the flow of blood waves in the veins in the direction of the distal parts of the limb.
A number of samples allow assessing the patency of the deep veins of the limb.
The patient in the lying position slowly lifts the straightened leg upwards. As a rule, before the angle reaches 45 °, the contour of veins decreases. It is necessary to remember this indicator. Further, already in the vertical position of the examined, after filling the veins, a venous tourniquet is placed on the border of the upper and middle thirds of the thigh for clamping the lumen of the superficial veins. The patient is again offered to occupy a horizontal position and slowly raise his leg. If the deep veins are sufficiently conducted, the subcutaneous and intradermal veins will subside at about the same level as the angle.
Trial Delier - Pertesa.
In the standing position, in the upper third of the thigh, a venous tourniquet or a cuff from the tonometer with a small air injection is applied to the patient. After this, the patient is invited to walk on the ground or around the room. In the case of normal patency of deep and communicative veins - after a while, the enlarged superficial veins will subside.
The Mayo-Pratt test. The elastic bandage is applied to the entire limb with rather dense tours. For sufficient permeability of deep veins is the fact that there are no complaints of rasporyuschuyu pain and signs of swelling of subcutaneous tissue for 30 minutes. At this time, the patient should be in a vertical position, making the usual load or walk.
To identify the insufficiency of communicative veins and determine their localization will help the three-jaw test of VI Sheinis.
Harnesses are superimposed on the thigh in the upper and middle third. The last tourniquet is fixed in the popliteal region. After that, the patient is invited to stand up and walk around the room. With the successive removal of the tourniquets, one can determine the lack of communication by characteristic protrusion of the veins below the clamping zones. The exit of the affected large communicative veins can be determined palpably, if the patient is offered to stretch the muscles of the shin (to become "on tiptoe").
4. Ultrasound diagnosis.
They are used in two variations: Doppler phlebography and duplex scanning.
Ultrasonic Doppler phlebography allows to specify:
- The patency of the deep veins of the limb;
- Functional value of the valves;
- Presence of affected communicative veins and clarify their location;
- The possibility of reflux in the superficial vein;
- Insufficiency of the ostial valve (in the place of anastomosis of the large femoral and subcutaneous veins).
Under normal conditions, you can confine yourself to this study to determine the level of surgery.
Ultrasound duplex scanning allows you to obtain more detailed information about the valves of the femoral vein (localization, form). In addition, you can get information about changes in the vascular wall of the femoral vein, the diameter of its lumen, the possible presence of thrombi. The special value of this study in obtaining accurate parameters of hemodynamics: the rate of retrograde wave and the duration of retrograde blood flow, linear and volumetric flow velocity.
Implies the introduction of intravenous X-ray contrast substance, after which, with some interval, several radiographic shots are taken.
Yielding to ultrasound, due to the presence of preliminary preparation of the patient and carrying out allergic tests for the contrast agent, phlebography, nevertheless, remains relevant for clarifying the presence:
- Varicose veins of the lower leg (ascending phlebography);
- Failure of the valves of the femoral vein (pelvic venography);
- Diagnosis of congenital hypoplasia and deep vein aplasia (ascending and pelvic phlebography);
- Diagnosis of postthrombophlebitic syndrome (ascending and pelvic phlebography).
Unlike ultrasound, phlebography gives at once a general spatial architectonics of the affected limb varicose.
6. Radionuclide phlebography.
At present, this method has more historical significance, since in comparison with classical phlebography and ultrasound data, there is no fundamentally new information. In the organizational sense (working with radionuclides and staying a patient in a gamma camera), this method also provides certain difficulties. The principle is based on the observation of the passage of an isotope inserted into the vein along the venous limb system. Surface and deep vessels are well visualized, which gives a representation of the venous outflow.
Varicose veins of lower extremities: treatment
Includes medication and compression correction.
1. Wearing compression knits (golfs, tights, stockings).
Distinguish between therapeutic and preventive compression knitwear. Warm clothing is labeled into four classes, where each division indicates a certain level of uniform compression of the limb in mm. Gt; Art. And depends on the clinical stage of the disease:
1 class - discomfort and pain in the limbs without visual manifestations.
2 class - the first visual changes of superficial veins.
3 class - the appearance of vascular plexuses (nodes).
4th grade - stage of complications.
Preventive washing is strongly recommended for people who experience prolonged physical exertion, as well as being in a sitting position for most of the working day. For these purposes use compression tights and stockings.
Uniform compression of the lower extremities with compression linen, helps maintain blood circulation at the level of physiological parameters, helping to drain out. The main principle is the creation of an external framework to maintain the tone of the weakened walls of venous vessels.
Prophylactic compressive knitwear postpones, and even completely neutralizes the risk of varicose veins. In cases where the first clinical manifestations of varicose have already begun to be disturbed, it is recommended that you urgently consult a doctor in a polyclinic or a specialized medical center.
With the already developed disease, curative linen lowers the risk of developing thrombosis and embolism, reduces the manifestations of venous insufficiency, thereby stabilizing the patient's condition.
2. Medicinal preparations.
At present, there is no ideal drug that affects all the pathogenetic links in the development of varicose veins. It is necessary to combine them. Partial suspension of the process in the initial stages with the help of drugs is possible, but the reverse development of already existing nodes with isolated drug treatment is not observed.
Most commonly, doctors prescribe the following drugs: Troxevasin, Troxerutin, Venorutin, Venitane, Flebodia 600, Detralex, Antistax, Lyoton-gel. Their main effect is aimed at bringing the venous wall into a proper tone, removing venous stasis and then improving microcirculation in tissues. Each of the listed products has its clear indication for use and a certain dosage of admission. Their use should be controlled by your health care provider. Self-medication here is unacceptable, since complications in the form of dermatitis and allergic reactions, cause additional suffering and are treated with difficulty.
Other drugs prescribed for varicose veins are aimed at changing the rheological properties of the blood, for the prevention and treatment of thromboses. These are such well-known drugs as Trental, Acetylsalicylic acid, Curantil. In the same Lyoton-gel, Thrombophobia, Venolife enters heparin, perfectly diluting the blood.
With the aim of anesthetizing, removing the swelling and stifling inflammation, non-steroidal anti-inflammatory drugs are used, more often diclofenac in the form of a gel.
Forms of application of preparations are various: tablets, solutions for injections, ointments.
3. Folk remedies in the treatment of varicose veins.
It is important to understand that their use, for the most part, is aimed at removing the symptoms of complications, in particular thrombophlebitis, and not the treatment of the underlying disease. The use of these methods at the current stage should not substitute for drug therapy in the initial stages of development of varicose veins and, moreover, surgical treatment in the unfolded clinical picture.
Consider and list some of the most appropriate folk remedies.
Hirudotherapy - treatment by applying medical leeches to varicose veins. It is used only with thrombophlebitis. The method is dangerous because of the risk of secondary infections and the development of bleeding from the nodes. An excellent alternative may be the use of a medical analogue - a heparin ointment in the initial stages of the disease. For the prevention of thrombosis, you can use it in the later stages, avoiding getting into trophic ulcers.
Apple cider vinegar .
Used in the form of rubbing or wrapping the legs with a damp cloth or gauze soaked in a solution.
Tincture of horse chestnut .
Use the fruits peeled from the green skin. Preliminarily, they are crumbly, pour vodka from the calculation of 10 gr. (Two teaspoons) of chestnut for 100ml. Of vodka. Infused for two weeks in a dark place and applied about a month 3 times a day for 30 drops.
Tincture of Kalanchoe.
The half-liter can is filled with crushed leaves of the colanchoe until the middle, then in a separate container it is filled with vodka in the volume of half a liter. After 3-4 weeks, the resulting solution is triturated overnight in affected areas.
1. Classical operational benefit.
- With the formation and spread of varicose veins with the involvement of large and small subcutaneous veins;
- When communicable veins are affected by varicose veins and the valvular insufficiency of the deep veins of the thigh and shin is detected in persistent, uncorrectable manifestations of venous insufficiency or in the manifestation of complications of varicose veins (bleeding, thrombophlebitis).
If manifestations of venous insufficiency are minimal, then classical surgical intervention is performed with prophylactic purposes, which the patient should know.
The scope of the operation is determined based on the results of the ultrasound study. In addition to the mechanical removal of varicose veins, the goal is to normalize the circulation of the limb by eliminating the increased venous discharge of blood from the surface vessels into the deep ones. Otherwise, repeated surgical manipulations will be required.
2. Combination of sclerosing therapy with minimal surgical manipulation.
It is used for varicose veins of the lower extremity before the formation of vascular nodes: at the stage of telangiectasias, segmental changes of the veins of the tibia, with reticular varicose, in addition to the surgical treatment of the remaining altered vessels after removal of veins with gigriform changes.
The essence of the technique: the removal of veins from the circulation by completely closing their lumen and then replacing them with connective tissue under the influence of chemical substances (ethoxy sclerol, fibrovein).
3. Isolated phlebosclerosis treatment.
In the altered vessels, a substance is administered by means of various technical approaches, puncture or with the help of venous catheters. Then the limb is bandaged with tight elastic bandages. After a while, the vessel "turns off" from the circulation.
4. Radiofrequency ablation.
With this technology, a thermal "welding" of the vessel takes place with the help of a special intravascular probe emitting radio-frequency waves. Under their action there is an isolated heating of the walls of the vessels and their compression. After the operation, the wearing of compression knit wear continues for some time.
5. Endovenous laser treatment.
The special venous catheter with radiation of energy impulses, which causes "sealing" of the lumen of the vessel, acts on the walls of the vessel.
6. Transluminal phlebectomy.
Removal of the modified vessels with a special suction device under optical control, through a special incision in the skin.
It is necessary to remember and know that any surgical treatment has clear indications. Because, along with recovery, each surgical procedure carries certain risks of a general (complications of anesthesia, secondary infection, etc.) and a specific nature associated with a particular operation.
Prevention of varicose veins
- Wearing compression linen.
- Optimum physical activity in any eventuality, without extreme fatigue.
- Use of compression linen.
- To maintain the venous tone, it is useful to use a contrast shower while keeping the feet hygiene.
- Preventing constipation by normalizing a diet with a high content of foods rich in plant fiber.
- With prolonged static loads with a vertical or seated position, it is recommended to perform an uncomplicated exercise every 1.5 hours: in standing position, transfer the load from the heel to the toes, rising 15-20 times upwards. In this way, a peculiar "muscle pump" is launched, strikingly pushing the stagnant blood in the direction of the heart. In the same situations it is useful to take a horizontal position several times a day. If it is impossible, at least for 15-20 minutes, throw your legs in a sitting position on a nearby chair. In addition to this - a few times poprised.
- Use shoes with high heels less often. Heels should not exceed 5 cm.
- Clothes should be free and do not constrain movements.
- It is recommended during sleep to give the legs an elevated position by placing a roller or raising the edge of the bed.
- It is useful after a dream not to immediately break from the bed, and do a few exercises for the legs: circular movements for feet, imitation of bicycle movements.
- When traveling long distances in airplanes or buses, it is necessary to "knead" your legs - periodically get up, make circular movements in stops. In the same situations, you should avoid drinking alcohol and drink more drinking water. It is useful to put on the road compression hosiery.
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