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Foot Ankle Int. 2014 May;35(5):429-33. doi: 10.1177/1071100714530884. Epub 2014 Apr 9.

The effect of lower limb cast immobilization on calf muscle pump function: a simple strategy of exercises can maintain flow.

Author information

1
University Hospital of Wales, Cardiff, Wales, UK.

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.

KEYWORDS:

calf pump; cast; immobilization; mechanical thromboprophylaxis

PMID:
24719402
DOI:
10.1177/1071100714530884
[Indexed for MEDLINE]

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