Treadwell Corporation Blog

Wikipedia’s definition of chronic venous insufficiency cuts to the chase by stating that this condition is sometimes referred to as “impaired musculovenous pump”, thereby illuminating what is the accepted cause/effect relationship that leads to chronic venous insufficiency. Chronic venous insufficiency is the precipitating cause of venous stasis ulcers, or chronic venous ulcers. (Chronic venous ulcers would be my preferred term, as venous stasis ulcers generally aren’t “loners”. When one appears it will usually be followed by more ulcerations, which is why Cullen and Phillips’ 2009 article in the International Wound Journal states that “clinicians describe venous ulcers as “hard to heal” and “frustrating”, and the “presence or absence of healing can be an emotional roller coaster”".

Not only is this  frustrating to patients and clinicians, there is a significant cost to the health care system.  After the near  government shutdown (April 2011) and with the promise of future haggling over budgeting priorities, health care delivery costs become increasingly important. Venous ulcers accounted for estimated annual treatment costs of between 2.5 and 3.5 billion dollars in the United States annually. (McGuckin & Kerstein, Skin and Wound Care, 1994; Lazarus et al, Dermatology 1994) As these estimates are from articles that were published in 1994 and 1998, it is likely that these dated estimates  are below the actual costs today. A breakdown of who is covering these costs among the traditional payment sources of Medicare, Medicaid, Health Insurance carriers, and private pay would be interesting, but beyond the scope of this blog. Another interesting estimate is the prevalence of venous ulcers, estimated to be between 0.06% and 2% with 1% of the population of 60 or older affected at any given time. (Kumar et al-Advances in Wound Care 2004)

These numbers underscore why there is an emphasis on marketing wound care services in long term care facilities. Long term care facilities web sites often specifically list wound care services one of their top four featured services.

Understanding why chronic venous ulcers develop is a key to finding more medically effective and cost effective solutions to current treatment methods (modalities). Venous insufficiency develops primarily from lack of use of the musculovenous pump (walking, cycling, and similar activities engage this bodily function ), which then often leads to a breakdown of skin tissue due to lack of blood flow, i.e. circulation. Subsequently chronic venous ulcers develop in a high percentage of the at risk population. The chronic nature of these ulcers is frustrating to both clinicians and patients and,  as previously noted, carries a great expense to the health care system.

Is the solution simple, as it might appear at first glance? Take these non-ambulatory, especially non-ambulatory 60 plus year olds, and get them walking or put them on an exercycle or bicycle to engage their musculovenous pumps again and heal their ulcers. However, there are many impediments to implementing this solution. The decrease in activity by these folks probably occurred with cause, be it medically due to an arthritic joint or debilitating disease entity, the result of occupational demand, or as a lifestyle choice . As you attempt to increase their activity levels, significant challenges are usually encountered. However, as a physical therapist with over 30 years of experience, I know that you can usually increase a person’s activity level in a graded fashion. In doing so, not only do you have to increase the quantity of their activity level, but of significant importance is the quality of their activity level. What do I mean by this? Let’s go back to the musculovenous pump. This mechanism functions by movement of the ankle (primarily), with downward movement of the foot filling the deep vein of the lower leg with venous blood and upward movement of the foot compressing the deep vein of the lower leg between muscles and “squirting” venous blood back towards the heart (quantity of blood flow). This occurs with each step, provided that the person is walking in a normal heel to toe gait pattern. My experience indicates that  the population suffering from chronic venous ulcers exhibits a flat footed or shuffling type gait (quality of movement). When the motion lacks the quality of normal movement the quantity of blood flow decreases. Thus, an impediment to progress.

How else might we treat venous ulcers and can they be prevented with a different treatment? It is known that it is difficult and inefficient to increase the flow of the stagnant venous blood via compression externally. Current methods use compressive bandaging and compression stockings and sometimes use external compressive devices to facilitate the process. But pause to consider, are compressive bandages a better solution for a part of the body that is already problematic due to lack of movement? Probably not because “…compression bandaging of different types all restrict ankle joint mobility”(Lenter et.al., Phlebotomy 12:25-30). Often the chronic venous ulcers do not heal completely with additional ulcers developing or another ulcer develops soon after the current ulcer heals. The reason this occurs is because current treatment methods fail to sufficiently address the underlying cause, lack of blood flow.

What if engaging the musculovenous pump is a simpler and less costly alternative to current methods of treating chronic venous ulcers? Is there a way to engage the body’s own musculovenous pumping mechanism that does not require the person to be ambulatory, yields the benefits of engaging the musculovenous pump, and is usable multiple times daily, without triggering overuse syndromes? Yes, there is a way! The Treadwell® device engages the body’s musculovenous pumping mechanism. Engaging the musculovenous pumping mechanism increases blood flow in the skin. The increased blood flow promotes healing of existing chronic venous ulcers. Continued use of the Treadwell® device has an ongoing preventative affect as the skin previously succeptible to breaking down due to lack of blood flow now receives the necessary supply of blood to maintain skin integrity. And using the Treadwell® device is a less costly alternative to current methods of treading chronic venous ulcers. There are several reasons for the treatment cost reduction. First, healing is promoted beyond the capacity of current treatment methods to promote healing. Second, the need for expensive repetitive compression bandaging and compression stockings is reduced significantly. Granted, some bandaging costs will be incurred, however, the bandaging will be a less expensive type and the reapplications required will be significantly reduced. Third, continued use of the Treadwell® device provides a preventative affect, often eliminating the chronic nature of venous ulcers and the associated costs.

Using the patented technology of the Treadwell® device works. Anecdotal results of alpha testing has shown that significant healing occurs rapidly when the Treadwell® device is used our . Patients who have demonstrated stagnant venous ulcers for months commence further healing when the Treadwell® device is employed. We are confident that wound healing studies engaging our patented technology will further validate our results to date, and that the Treadwell® device will offer a new and more effective therapy for this pandemic condition.

In conclusion, eliminating the frustration of chronic venous ulcers to patients and clinicians plus huge savings to the health care delivery system is within easy reach. Although studies are needed to validate anecdotal evidence, the best practice for treating chronic venous ulcers is through utilization of the Treadwell® device methodology and migrating to non-compressive bandaging and minimizing the use of compressive stockings.