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Abstract

Objective

Chronic venous insufficiency (CVI) is a progressive disease, leading to calf muscle pump dysfunction and reduced range of ankle motion (ROAM). A full ROAM increases venous return decreasing venous hypertension. The dysfunction of foot pump in static foot disorder (SFD) further contributes to chronic venous insufficiency. In present study we studied the effect of ROAM and SFD on CVI.

Methods

A prospective observational study was conducted from July 2022 to June 2023, with Institute Ethical clearance (INT/2022/MS-533). A total of 402 legs were included, of which 368 legs of the study group had CVI and 34 legs were in control C0 group. Patients were divided into control C0, mild C1-C3 and advanced C4-C6 disease group based on the severity of CVI. SFD and ROAM were evaluated from X-rays by Djian-Annonier angle and goniometry respectively. The primary objective was to study, impairment of ROAM in patients from C1-C6 and its comparison with control C0 group and impact of static foot disorders on ROAM.

Results

ROAM was highest in controls and decreased towards the lowest value in progression to advanced stages of CEAP classification (87° in C0, 71° in mild CVI and 45° in advanced CVI, p < .001). Controls had just nine % legs afflicted with SFD whereas 62.3% and 68.6% with mild and advanced disease had SFD, p < .001. ROAM was highest in those without SFD (68.9°) and least in hollow feet (58.3°), p < .001. ROAM was lower in the symptomatic C2 disease (80°) than asymptomatic type (69°) (p < .001).

Conclusion

This study showed that poor ROAM is associated with higher rate of advance CVI. In addition patients with SFD had advance CVI and poor ROAM. So, it is important to consider treatment of SFD and physical rehabilitation to improve ROAM and break vicious cycle of progression to severe CVI.

Keywords

Range of ankle mobility chronic venous insufficiency static foot disorder hollow foot flat foot varicose veins

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