Spa treatment by condition
Spa treatment for poor leg circulation
When the calf starts burning after two hundred metres and you have to stop to be able to walk on, that is intermittent claudication. The Czech indication list places arterial disease of the limbs, conditions after thrombosis and chronic lymphoedema in the circulatory disease group — and Marienbad treats them with carbon dioxide baths and guided walking training.
What is treated here
- Arterial disease of the limbs of atherosclerotic origin at stage IIb, that is, with intermittent claudication
- Arterial disease of the limbs of inflammatory origin
- Functional disorders of the peripheral vessels
- Condition after a thrombosis, once the acute phase is over
- Chronic lymphoedema of the legs
- Condition after reconstructive and revascularising surgery on the vascular system outside the heart and thoracic aorta, and after percutaneous angioplasty
How the cure works
Initial examination on arrival day
The spa physician takes the vascular findings, checks pulses, skin condition and leg circumference, and asks about the pain-free walking distance — it is the yardstick against which progress can be measured. Bring the findings from your angiologist or vascular surgeon.
First week: circulation and walking distance
Carbon dioxide baths and dry gas baths are used daily, together with guided walking training on level paths up to just below the pain threshold — that is the level of exertion that matters for walking training.
Second week: extending the distance
Walking distances become longer, and gradients are added. For lymphoedema, manual lymphatic drainage and machine-assisted drainage take priority instead, supplemented by exercises that support the return flow.
Final examination and a plan for home
The pain-free walking distance is measured again and compared with the starting value; the finding goes into the final report. You receive a walking programme for home — without continuing regularly, the gain is lost again.
Treatments used
- Carbon dioxide bath in mineral water
- A bath in the local mineral water at around 34°C; the carbon dioxide absorbed through the skin is the central treatment for circulatory problems in the limbs.
- Dry gas bath in Mariengas
- Application of the natural carbon dioxide from the Marien Spring without water and without the strain of heat — suitable also where warm baths are not an option.
- Guided walking training and terrain cure
- Graded paths in the spa forest, walking up to just below the pain threshold followed by a rest, in gradually longer stages.
- Manual lymphatic drainage
- For chronic lymphoedema: hand techniques that support the drainage of lymph fluid from the legs.
- Machine-assisted lymphatic drainage
- Devices such as Lymfoven and Lymfopress supplement the manual treatment of lymphoedema.
- Group exercise and exercise therapy in the pool
- Exercises for endurance and calf muscles, in water with less strain on the joints.
- Nutrition counselling
- Individual sessions on blood lipids, weight and glucose metabolism, that is, on the risk factors underlying the vascular findings.
How long, and when
Three positions on the Czech indication list apply here. Arterial disease of the limbs of atherosclerotic origin at stage IIb, or of inflammatory origin (II/4), provides for an initial stay of 21 days of comprehensive or 21 days of contributory care, with the repeat stay the same, in certain cases 14 days of contributory care. Functional disorders of the peripheral vessels, conditions after thrombosis and chronic lymphoedema (II/5) run to 21 days of comprehensive or contributory care, with a repeat stay of 21 or 14 days of contributory care. Conditions after vascular surgery and after percutaneous angioplasty (II/8) provide for 21 days of comprehensive or contributory care. Self-paying guests agree the length with the spa physician; the professional minimum is at least 10 treatments over at least 10 days.
What the studies show
For circulatory problems in the legs, the evidence base for carbon dioxide treatments is comparatively the strongest. In a randomised study, foot baths in carbonated water (1000 mg CO₂ per kilogram, 33°C, 30 minutes, five times weekly over four weeks) increased peak arterial flow, tissue oxygen and the pain-free walking distance, while plain water did not change these values (Hartmann et al., 1997, Angiology; small cohort, artificially carbonated water, effect size not given in the abstract). A crossover study by the same research group with 18 patients found that immersing the feet in carbonated water increased laser-Doppler skin flow and tissue oxygen, while plain water did not (Hartmann et al., 1997, Angiology; single bath, surrogate parameters). After twenty minutes of exposing the skin to spa carbon dioxide gas, flow in the femoral artery, pressure at the posterior tibial artery and tissue oxygen in the foot increased, while water vapour of the same temperature had no effect (Savin et al., 1995, Angiology; very small cohort, single application). For the exercise component, strong evidence exists: a Cochrane review of walking training for intermittent claudication found, compared with usual care, a pain-free walking distance longer by an average of 82 metres and a maximum walking distance longer by 120 metres, with an effect lasting up to two years (Lane et al., 2017, Cochrane Database Syst Rev; outpatient exercise programmes, not spa treatment, most individual studies small). An older review notes that controlled evidence for CO₂ balneotherapy exists specifically for peripheral arterial disease, trophic ulcers and microangiopathies (Resch and Just, 1994, Wien Med Wochenschr). None of these papers shows that the cure replaces vascular surgery or vascular medical treatment.
When a spa cure is not an option
- Critical limb ischaemia with pain at rest or impending tissue loss — this belongs in vascular surgery, not a spa cure
- A recent deep leg vein thrombosis in its acute phase
- Unhealed wounds and ulcers on the leg
- Heart failure at NYHA class IV, second- to third-degree AV block and active endocarditis
- Continued smoking: the indication list requires nicotine abstinence for the circulatory group
Whether and to what extent a spa cure is appropriate for your vascular findings is decided by the spa physician at the initial examination, based on the angiological findings. Pain at rest, a non-healing wound on the leg, or a leg that suddenly turns cold and pale, are emergencies and require immediate medical treatment, not spa planning. This page provides information and does not replace medical advice.
Frequently asked questions
Does a spa cure help with intermittent claudication?
Two components of the cure have been studied. For walking training, strong evidence exists: a Cochrane review found, compared with usual care, a pain-free walking distance longer on average by 82 metres and a maximum walking distance longer by 120 metres, with an effect lasting up to two years — though in outpatient programmes, not in spa stays. For foot baths in carbonated water, a randomised study showed an increase in peak arterial flow, tissue oxygen and pain-free walking distance, while plain water had no effect; the cohort was small. In Marienbad, both components come together.
Is a spa cure for circulatory problems covered?
For people insured with a Czech health fund, three positions apply: arterial disease of the limbs at stage IIb or of inflammatory origin (II/4), functional disorders of the peripheral vessels, conditions after thrombosis and chronic lymphoedema (II/5), and conditions after vascular surgery and after angioplasty (II/8). Each provides for 21 days of comprehensive or contributory care. Guests insured outside the Czech Republic should clarify cost coverage with their own insurer in advance.
May I go for a spa cure after a thrombosis?
Once the acute phase is over, yes; the condition after a thrombosis is part of position II/5 on the indication list. A spa cure is excluded during the acute phase. How much time must pass and which treatments are possible is decided by the spa physician based on your own doctor's findings — so bring them with you.
What is done for lymphoedema?
The focus is on manual lymphatic drainage and machine-assisted drainage with devices such as Lymfoven and Lymfopress, supplemented by exercises that support the return flow. Chronic lymphoedema is part of position II/5 of the indication list. Unhealed wounds on the leg rule out a number of treatments, which is why the legs are examined at the initial examination.
Do I have to stop smoking for the cure?
For stays run through the Czech indication list, yes — nicotine abstinence is a requirement for the circulatory disease group, set out in the decree itself. For arterial disease of the legs, smoking is also the factor that most strongly determines the course.
Sources
Studies and official documents this article relies on. Our content does not replace medical advice.
- Czech indication list for spa treatment (Decree No. 2/2015 Coll.), Group II — positions II/4, II/5 and II/8 — Arterial disease of the limbs (II/4), functional disorders of the peripheral vessels, conditions after thrombosis and chronic lymphoedema (II/5), and conditions after vascular surgery and percutaneous angioplasty (II/8): each 21 days of comprehensive or contributory care.
- Decree No. 2/2015 Coll. on the professional criteria for spa medical rehabilitation care — Group II — Full text of the indication list for circulatory diseases, including contraindications (second- to third-degree AV block, NYHA IV, active endocarditis), required nicotine abstinence and initial examinations. Czech-language text.
- Hartmann BR et al. 1997, Angiology — randomised study of repeated carbon dioxide foot baths in intermittent claudication — Foot baths in carbonated water increased peak arterial flow, tissue oxygen and pain-free walking distance; plain water did not. Small cohort, artificially carbonated water, effect size not given in the abstract.
- Hartmann BR et al. 1997, Angiology — crossover study, 18 patients with peripheral arterial disease — In carbonated water, skin blood flow and tissue oxygen increased; not in plain water. Single bath, surrogate parameters.
- Savin E et al. 1995, Angiology — study of transcutaneous CO₂ in stage II peripheral arterial disease — After 20 minutes of exposure to spa CO₂ gas, femoral flow, pressure at the posterior tibial artery and tissue oxygen in the foot increased; water vapour of the same temperature had no effect. Very small cohort, single application.
- Lane R et al. 2017, Cochrane Database Syst Rev — review of walking training in intermittent claudication — Exercise programmes lengthened the pain-free walking distance by an average of 82 m and the maximum by 120 m compared with usual care, with an effect lasting up to 2 years. Outpatient programmes, not spa treatment.
- Resch KL, Just U 1994, Wien Med Wochenschr — review of the possibilities and limits of CO₂ balneotherapy — Controlled evidence only for peripheral arterial disease, trophic ulcers, microangiopathies and mild hypertension. Older review.
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