Response to 'Re. Improvement of Venous Pumping Function by Double Progressive Compression Stockings: Higher Pressure Over the Calf is More Important Than a Graduated Pressure Profile'

The point raised in this letter is very interesting and deals with the functional association between ankle movement and the calf muscle pump. We agree that venous pumping function will decrease when ankle mobility is reduced. Experiments investigating the influence of artificially restricted mobility of the ankle joint clearly demonstrated a reduction of the blood volume expelled during standardized exercise by foot volumetry. 1 Nevertheless, a high performing compression bandage or a fitting compression stocking of good quality ideally should not impede the mobility of the ankle joint. This is particularly true in acute experiments as reported in all our papers. In the long term, reduced ankle mobility using compression bandages has been always claimed but never proved. In an acute experiment, we are convinced that the improvement of the muscle pump largely overcomes the theoretical concept of reduced impairment of ankle movement because of lower distal compression pressure. In a previous paper we compared an elastic stocking with a strong inelastic bandage. 2 Theoretically, the stiff compression device could impede the ankle movement more than the stocking, but the increase of ejection fraction was significantly better with inelastic bandages confirming the superior role of increased pressure over the calf compared with ankle mobility. In another paper comparing graduated and inversely graduated inelastic bandages exerting the same pressure at ankle level and the same degree of “ankle fixation” ,w e again observed a significantly higher increase of the EF just by increasing the pressure over the calf. 3