Chronic venous insufficiency (CVI) is a progressive condition affecting the venous system, involving superficial, deep, or both venous networks. The pathophysiology is primarily attributed to valvular incompetence and dysfunction of the calf muscle pump, which includes deficits in lower limb muscle strength. Given the pivotal role of the calf muscles in venous return, their functional assessment should be integrated into the routine clinical evaluation of patients with CVI. The Heel-Raise Test (HRT) has been proposed as a method to evaluate calf muscle function; however, its correlation with other validated strength and functional performance assessments remains underexplored.

To determine the applicability of the HRT in assessing calf muscle strength and endurance in CVI patients through its association with other muscle strength and endurance tests, as well as functional performance measures.

A cross-sectional study was conducted involving 40 patients diagnosed with CVI (mean age 67.4 ± 11.3 years, 37% females). Participants underwent the HRT, where they performed maximal plantar flexion repetitions until exhaustion. The total number of repetitions and the time taken to complete the test were recorded. Additionally, participants were subjected to the Five-Times Sit-to-Stand Test (STS-5), Ten-Times Sit-to-Stand Test (STS-10), 30-Second Sit-to-Stand Test (STS-30), and 1-Minute Sit-to-Stand Test (STS-60), which evaluated lower limb strength (STS-5 and STS-10) and muscular endurance (STS-30 and STS-60). Complementary assessments included handgrip dynamometry and the Human Activity Profile (HAP) questionnaire. Pearson and Spearman correlation analyses were performed to examine associations between the HRT and other measures.

The number of HRT repetitions demonstrated significant correlations with STS-5 (r = -0.751; p < 0.001), STS-10 (r = -0.741; p < 0.001), STS-30 (r = 0.724; p < 0.001), STS-60 (r = 0.765; p < 0.001), handgrip dynamometry (r = 0.325; p = 0.041), maximum HAP score (r = 0.401; p = 0.014), and adjusted HAP score (r = 0.330; p = 0.046). Similarly, the time required to complete the HRT correlated with the STS-5 (r = -0.386; p = 0.005), STS-10 (r = -0.399; p = 0.003), STS-30 (r = 0.347; p = 0.012), STS-60 (r = 0.406; p = 0.003), maximum HAP score (r = 0.427; p = 0.002), and adjusted HAP score (r = 0.360; p = 0.011), but not with handgrip dynamometry (r = 0.236; p = 0.092).

The number of repetitions and time spent in the HRT are indicators of calf muscle strength, endurance, and functional capacity in individuals with CVI. Its inclusion in functional assessments can enhance the clinical evaluation of these patients.

The HRT emerges as a viable, practical tool for complementing clinical and functional assessments, particularly in the early to moderate stages of CVI, facilitating targeted interventions and patient management strategies.