A relative has chronic venous leg ulcers, one on each leg. Elevation
is apparently highly recommended. I am looking for information on ways
to elevate the limb(s), bearing in mind that these wounds are painful,
and that my relative's general mobility is poor, due to other
complaints, and to being overweight.

The three positions where elevation might be useful are:

a) When seated, e.g. at the kitchen table, on an ordinary chair on
    "raisers" (if that's the correct term - things that increase the
    effective seat height). Possible elevation of foot to hip level.

b) When seated in an arm chair watching TV - the chair has with a
    thick foam cushion to raise the effective seat height. Possible
    elevation of foot or feet to hip level.

c) In bed. Possible elevation of foot to heart level or above.

Lying on the floor without some means of help getting up again is
out of the question.

In what ways might this elevation be easily (and comfortably!!)
achieved? Are there any devices available (or that could be made)
that would do the job, or help? Are (for instance) any low pressure
inflatable cushions, mattresses, or similar, available that could
be used to (for instance) position under the foot of a bed mattress,
or on the end of a couch? Any mechanical means to do the job?

Any help, advice, or pointers to further sources of information
will be much appreciated.

"Chris Bacon"  wrote ...
>A relative has chronic venous leg ulcers, one on each leg. Elevation
> is apparently highly recommended. I am looking for information on
> ways to elevate the limb(s), bearing in mind that these wounds are
> painful, and that my relative's general mobility is poor, due to other
> complaints, and to being overweight.

While it's good to see an assessment that extends beyond the wound, I still 
think that elevation is much too narrow a solution.

Full assessment to determine the nature of the vascular problem is 
essential, but from what you are saying, dietary advice and an exercise 
program would be much better than an assumption of 'putting the feet up'.

It would also be useful to further extend that assessment to eliminate other 
conditions that might have an impact, including endocrine issues (eg 
diabetes and thyroid), cardiovascular, respiratory and autoimmune, if these 
have not already been investigated.

To get back on topic, there are plenty of proprietary cushions available, 
but I'd wait for the outcome of assessments; a 'common sense' solution might 
be all that's needed for limb elevation - and you could save a fortune.
-- 
Andrew Heenan
http://www.realnurse.net/

"Chris Bacon" wrote:
>A relative has chronic venous leg ulcers, one on each leg. Elevation
> is apparently highly recommended. I am looking for information on ways
> to elevate the limb(s), bearing in mind that these wounds are painful,
> and that my relative's general mobility is poor, due to other
> complaints, and to being overweight.
>
> The three positions where elevation might be useful are:
>
> a) When seated, e.g. at the kitchen table, on an ordinary chair on
>    "raisers" (if that's the correct term - things that increase the
>    effective seat height). Possible elevation of foot to hip level.
>
> b) When seated in an arm chair watching TV - the chair has with a
>    thick foam cushion to raise the effective seat height. Possible
>    elevation of foot or feet to hip level.
>
> c) In bed. Possible elevation of foot to heart level or above.

=============  snipped for brevity  ============

Further to Andrew's excellent advice, Google found these using 'leg 
elevation leg ulcers'.



Leg elevation encourages venous return and may reduce pain and leg swelling 
[Royal College of Nursing, 2000a]. Raising the legs above hip level for 30 
minutes three to four times a day will allow swelling to subside and improve 
microcirculation in people with venous insufficiency. Placing several 
pillows under the bed mattress will assist leg elevation at night. However, 
there is insufficient evidence to recommend regular leg elevation as a 
routine intervention.

Source: http://www.prodigy.nhs.uk/guidance.asp?gt=Leg%20ulcer%20-%20venous



Elevation and activity

When you are resting, if possible, try and keep your leg elevated (raised) 
higher than your hip. This is particularly important if your leg is swollen. 
The aim is to let gravity help to pull fluid and blood in the right 
direction - towards the heart. This reduces swelling in the leg, and reduces 
the pressure of blood in the leg veins.

Try to set 3 or 4 periods per day of about 30 minutes to lie down with your 
leg raised. For example, lie on a bed or sofa with your foot on a couple of 
pillows. However, do not spend all your time in bed or resting. For the rest 
of the time, keep as active as you can, and do normal activities. If 
possible, regular walks are good, but do not stand for long periods.

When you sleep overnight, if possible, try to keep your leg raised. You can 
do this by putting some pillows under the bottom of the mattress. (It may 
not be possible to sleep like this if you have certain other medical 
problems or disabilities.)

Source: http://www.patient.co.uk/showdoc/23068777/



The higher the leg, the lower the pressure in the leg veins! If the foot is 
elevated above the heart then the pressure in the foot drops to a normal 
level. Put your legs up whenever you can and as high as you are able-the arm 
of the sofa is good. Elevate the lower end of your bed (6 inches or so) so 
that when in bed your feet are a little higher than your head. You can use 
some old books for this.

Source; http://www.vascularsociety.org.uk/patient/legulcer.html



I don't understand why the doctor(s) or nurse(s) looking after your relative 
haven't advised on this aspect of care. In my experience, patients can only 
tolerate leg elevation for short periods when sitting because of the 
discomfort caused by the hip joint being flexed. Elevating the lower leg 
above the level of the heart, even when lying in bed, is neither practical 
nor well tolerated!

On Tue, 03 Jan 2006 23:00:23 +0000, Chris Bacon
 wrote:

>A relative has chronic venous leg ulcers, one on each leg. Elevation
>is apparently highly recommended. I am looking for information on ways
>to elevate the limb(s), bearing in mind that these wounds are painful,
>and that my relative's general mobility is poor, due to other
>complaints, and to being overweight.

The local Occupational Therapists should have access to a variety of
devices to help.  For "made to measure" solutions try contacting your
local REMAP Panel (www.remap.org.uk).


-- 
Peter Parry
www.remapsherts.org.uk

"Chris Bacon" wrote:
>A relative has chronic venous leg ulcers, one on each leg. Elevation
> is apparently highly recommended. I am looking for information on ways
> to elevate the limb(s), bearing in mind that these wounds are painful,
> and that my relative's general mobility is poor, due to other
> complaints, and to being overweight.

=============  snipped for brevity  =============

Reduced mobility and "other complaints" are factors that can delay wound 
healing. If your relative is elderly, then advanced age is another factor 
that can delay wound healing. You say that your relative is overweight; it 
can still be the case that an overweight person has some nutritional 
deficiences which can include a deficit in the essential factors needed for 
wound healing, such as proteins, vitamins and minerals. Nutritional 
assessment can determine this, and from that attempts can be made to correct 
any nutritional deficiences. As Andrew says, a full assessment is needed. 
Obviously I don't know the full circumstances but in a worse-case scenario 
it is possible that complete healing of both these ulcers is not a realistic 
goal in this particular case. I hope that isn't the case!

"Peter Parry" wrote:
> The local Occupational Therapists should have access to a variety of
> devices to help.  For "made to measure" solutions try contacting your
> local REMAP Panel (www.remap.org.uk).
>
>
> -- 
> Peter Parry
> www.remapsherts.org.uk

Also, your local primary care or community NHS Trust should have an 
equipment store and facilities for loaning equipment free of charge to 
patients at home or in community settings. The nurse at your local GP 
surgery should have a list of equipment available and be able to write a 
requisition form. For example, devices to raise the foot of the bed.