Congestive syndrome arthrogenes I87.2-

Arthrogenic congestion syndrome

Chronic venous insufficiency with/without degenerative skin changes of the lower extremity due to a varying degree of movement restriction of the upper ankle joint.

Movement restrictions of the ankle joint up to complete stiffening (e.g. in the pointed foot position) lead to an incomplete or complete failure of the muscle pump functions (foot muscle pump, ankle muscle pump, calf muscle pump) and thus to a failure of the distal driving forces of venous haemodynamics.

Regarding pathophysiology, 2 forms of the arthrogenic congestive heart failure syndrome can be distinguished.

a) The arthrogenic congestion syndrome, which occurs as a consequence of severe chronic venous insufficiency. In advanced venous disease (from clinical stage 4), there are changes in the skin and subcutaneous fatty tissue. It is a progressive inflammatory reaction that turns into a sclerosing process. In the further course of the disease, the fasciae become involved, leading to dermatolipofasciosclerosis. As a consequence, the ligamentous apparatus of the upper ankle joint is also affected. The degenerative remodelling of the joint structures and the Achilles tendon can lead to the increasing restriction of movement and even to complete fixation of the upper ankle joint in the toe position. In addition, the presence of a painful leg ulcer itself contributes to the formation of a fixed pointed foot by keeping the foot in plantar flexion. In the worst case, joint motility in the upper ankle joint is 0 - 40 - 40° (dorsal extension - 0 - plantar flexion). As the upper ankle joint stiffens, the calf muscles atrophy. This results in the loss of the functionality of the most important venous pump, namely the crural venous pump. The ankle pump as well as the muscle pump of the powerful M. triceps surae from the superficial flexor box and the muscle pumps of the deep flexors (M. tibialis posterior, M. flexor digitorum longus, M. flexor hallucis longus) lose their function. The fixed pointed foot also causes a recurvature of the knee joint in an upright and walking patient. The recurvation presses the veins at the level of the knee joint against the head of the tibia and constricts them. This additionally impairs the venous outflow. As a result of the increasing venous congestion, the disease situation worsens and further tissue damage occurs, which promotes the development, maintenance and expansion of chronic ulcerations. This vicious circle, in which venous congestion on the one hand and joint motility - especially in the upper ankle joint - on the other hand influence each other unfavourably as pathophysiological processes, was already aptly described by Schmeller in 1990. Characteristically, cuff ulcers and necroses form in the course of the disease.

b) The arthrogenic congestion syndrome, which occurs in primarily venous healthy patients as functional venous insufficiency in disorders of the venom-muscle pump of the leg. The mobility in the upper ankle joint seems to be of particular importance here. However, movement disorders of the knee, the lower ankle joint as well as hollow and flat foot also have an influence on the venous outflow.

1. Doerler M, Altmeyer P, Stücker M (2013). Venous leg ulcer caused by obesity-associated dependency syndrome Case report and discussion of the pathogenesis and treatment. Phlebology 2013; 42: 205-208.

2. Gallenkemper G et al (1995) Venous function in dorsal extension and plantar flexion of the foot - a photoplethysmographic series of studies. Phlebology 24: 139-43.

3. Gallenkemper G et al. (1996) Rabe E, Kreysel HW. Venous outflow during passive compression of various regions of the foot and lower leg as well as during active and passive dorsal extension in the ankle joint. Phlebology 25: 89-94.

4. Hach W (2003) The arthrogenic congestion syndrome. Vascular surgery 8: 227-233

5. Hach W et al. 1983. Arthrogenic congestion syndrome. Vasa 12: 109-16.

6. Hach W (2006). Venous surgery. Stuttgart: Schattauer, 2nd edition 304-306.

7. Kugler C et al (1999) Strunk M, Rudofsky G. Effect of impaired joint mobility on venous pump function of the healthy lower limb, a phlebodynamometric analysis. Phlebology 28(1): 16-22.

8. Lentner A (1994) Mobility in the upper and lower ankle joint in advanced chronic venous insufficiency. Phlebology 23: 149-55.

9. Ludwig M et al (2010) Vascular medicine in clinic and practice - guideline-oriented angiology, vascular surgery and interventional radiology. Stuttgart: Thieme, 2nd edition, 283-284.
10. Nüllen H et al (2010) Arthrogenic congestion syndrome In: T Noppeney, H Nüllen Diagnosis and therapy of varicosis. Springer Medicine Publishing House Heidelberg S 213 -214
11. Schmeller W (1990) The arthrogenic congestion syndrome. Ankle joint changes in chronic venous insufficiency, Berlin: Diesbach Verlag

12. Uhl JF et al (2012) Static foot disorders: a major risk factor for chronic venous disease? Phlebology 27:13-18.