The efficacy of forceful ankle and toe exercises to increase venous return: A comprehensive Doppler ultrasound study

Phlebology. 2018 Jun;33(5):330-337. doi: 10.1177/0268355517706042. Epub 2017 May 7.

Abstract

Objective Venous stasis is a risk factor for venous thromboembolism. We aimed to determine the efficacy of forceful foot exercises for actuation of the calf muscle pump to counteract stasis. Methods We examined 20 seated healthy subjects. The peak systolic velocity at the level of the popliteal vein was assessed by Doppler ultrasound. Results The mean peak systolic velocity measurements (in cm/s) were as follows: baseline = 5.6; ankle plantar flexion with toe flexion = 91.0; toe touch heel lift = 107.4; ankle dorsiflexion with toe extension = 193.6; isolated flexion of all toes = 118.8; ankle plantarflexion with 100 and 250 Newton forefoot force = 89.9 and 154.5, respectively. Conclusion All exercises achieved significant increases in peak systolic velocity compared to baseline. Ranking showed that forceful ankle dorsiflexion, plantarflexion with 250 Newtons and forceful flexion of all toes yielded the highest mean peak systolic velocity values (193.6, 154.5, and 118.8 cm/s, respectively).

Keywords: Active foot dorsiflexion (more precisely: forceful ankle and toe exercises); Duplex ultrasound; calf muscle pump function; venous stasis; venous thromboembolism prophylaxis.

MeSH terms

  • Adult
  • Aged
  • Ankle / diagnostic imaging
  • Ankle / physiopathology*
  • Ankle Joint / diagnostic imaging
  • Exercise
  • Female
  • Foot / diagnostic imaging
  • Healthy Volunteers
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Models, Cardiovascular
  • Muscle, Skeletal / diagnostic imaging
  • Muscle, Skeletal / physiopathology*
  • Popliteal Vein / diagnostic imaging
  • Popliteal Vein / physiopathology*
  • Range of Motion, Articular
  • Toes / diagnostic imaging
  • Toes / physiopathology*
  • Ultrasonography, Doppler*
  • Young Adult