Calf muscle pump failure in lower limb lymphoedema

Abstract

Abnormal venous haemodynamics and poor calf muscle pump may play a role in lymphoedema by contributing to production of excess interstitial fluid. Using photoplethysmography (PPG), we compared haemodynamic characteristics between normal and lymphoedematous lower limbs. PPG was performed using an automated infrared-based system, while the patient performed 10 active dorsiflexions of the ankle. This gave values for venous refilling time and venous pump power. A total of 62 limbs (normal = 37; lymphoedematous = 25) were studied. Lymphoedematous limbs showed significantly decreased venous pump power and venous refilling time (s) than normal limbs (24.6±14.1 versus 45.4±16 and 23±15.2 versus >45, respectively; P<0.005 for all the results). The haemodynamic values measured in the normal group showed good consistency and reproducibility. These results were consistent with the previous literature and demonstrate an impaired venous system associated with the development of lymphoedema. Poor muscle pump power may reflect physical disability of the ankle joint to perform dorsiflexion. This factor should be considered when treating this incurable condition.