The Effect of Lower Limb Cast Immobilization on Calf Muscle Pump Function: A Simple Strategy of Exercises Can Maintain Flow. (May 2014)

• Record Type: Journal Article
• Authors: Hickey, Ben A.; Morgan, Amy; Pugh, Neil; Perera, Anthony
• Is Part Of: Foot & ankle international. Volume 35:Number 5(2014:May)
• Page Start: 429
• Page End: 433
• Publication Date: 2014-05
• Subjects: calf pump -- cast -- immobilization -- mechanical thromboprophylaxis; Foot -- Abnormalities -- Periodicals; Ankle -- Abnormalities -- Periodicals; Orthopedics -- Periodicals; 617.585
• DOI: 10.1177/1071100714530884
• Languages: English
• ISSNs: 1071-1007

Abstract

Background: We have investigated the role of the calf muscle pump in casted patients. An audit of venous thromboembolism (VTE) in casted patients showed that the thrombosis occurred in the casted leg; this has not been previously assessed. We postulated that local factors play a major role, and we set out to assess the calf muscle pump in casted patients and to determine whether this can be optimized despite below-knee cast immobilization. Methods: We measured the flow in the popliteal vein using a validated method of Doppler ultrasound measurement of peak velocity with and without a below-knee plaster cast. Results: We demonstrated that a simple strategy of toe and ankle exercises can maintain venous return despite below-knee cast immobilization. Conclusion: This is the first study to examine the effect of the calf muscle pump in the presence of a plaster cast. Major muscle groups such as the flexor hallucis longus and gastrocsoleus extend beyond the field of control of the cast and can still be recruited. Clinical Relevance: We recommend that all patients treated with a below-knee cast be given a program of exercises that can be comfortably performed with the cast; this could provide a useful, inexpensive, and safe thromboprophylaxis strategy acting at the site of greatest risk and targeting a major cause of VTE.