Compression and Venous Ulcers: Why Consistency Beats Strength.

Venous ulcers heal when the swelling is controlled, and swelling is controlled by compression, worn, correctly, most of the time. That last clause is where treatment fails. Stockings that hurt to put on don't get put on. Wraps applied wrong slide down by lunch. And a drawer full of abandoned compression is one of the most common findings in homes where a venous ulcer has been "being treated" for a year.

The reasons are practical: hand strength, shoulder mobility, fear of cutting off circulation, and nobody ever demonstrating the technique on the actual leg in the actual chair. The fixes are practical too: the right compression class for the person's circulation, donning aids matched to their hands, and teaching whoever helps in the morning, not just the patient. One caveat is not negotiable: compression on a leg with significant arterial disease is dangerous, which is why circulation gets assessed before the first wrap goes on.

At the bedside we see the real routine, not the clinic version of it, and we can adjust the plan until it's one the household can sustain. That is often the difference between a venous ulcer that closes this year and one that doesn't.