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Reversal of Lower Limb Edema by Calf Muscle Pump Stimulation

Goddard, Ayana A. MS; Pierce, Carolyn S. DSN, RN; McLeod, Kenneth J. PhD

Journal of Cardiopulmonary Rehabilitation and Prevention: May-June 2008 - Volume 28 - Issue 3 - p 174–179
doi: 10.1097/01.HCR.0000320067.58599.ac
Cardiac Rehabilitation

BACKGROUND Peripheral edema (PE) is commonly coupled with heart failure, restrictive cardiomyopathy, nephrotic syndrome, renal failure, and hypoproteinemia. Diuretics and/or limb elevation, although commonly prescribed to treat PE, are often insufficient to remove sufficient fluid to prevent complications. We assessed the ability of the calf muscle pump (CMP) stimulation to reverse PE.

METHODS Fluid volume was evaluated by air plethysmography in the right legs of 54 adult women (mean age 46.7 ± 1.5 years) following venous status assessment. Change in calf volume was assessed during 30 minutes of quiet sitting, followed by 30 minutes of sitting with CMP stimulation via micromechanical stimulation of the plantar surface.

RESULTS Leg volume changes demonstrated a bimodal distribution. Leg volume decreased during quiet sitting in 56% of the study group, whereas in 44% of the group, significant lower leg fluid pooling was evident (increase in calf volume of 14.0 ± 0.3 mL/h). CMP stimulation reversed the fluid pooling in the edematous group (−2.7 ± 0.1 mL/h) and was able to accelerate fluid removal in the nonedematous group.

CONCLUSIONS Approximately two fifths of adult women experience substantial pooling when their lower limbs are maintained in a dependent position. Lower-extremity edema exhibited by these women may primarily be due to inadequate calf muscle tone because exogenous stimulation of the CMP was sufficient to halt and reverse fluid pooling. Whether CMP stimulation would provide a means to treat PE in individuals with edema-related health complications, such as congestive heart failure, merits further investigation.

Forty percent of women develop peripheral edema (PE) during quiet sitting. Stimulation of the calf muscle pump (CMP) reversed lower limb fluid pooling, implicating loss of calf muscle tone in the etiology of PE. CMP stimulation may be useful in the treatment of patients with cardiovascular diseases associated with PE.

Program in Biomedical Engineering (Ms Goddard), Decker School of Nursing (Dr Pierce), and Department of Bioengineering (Drs Pierce and McLeod), Binghamton University, Binghamton, New York.

Corresponding Author: Kenneth J. McLeod, PhD, Department of Bioengineering, Biotechnology Bldg, Binghamton University, Binghamton, NY 13902 (kmcleod@binghamton.edu)

© 2008 Lippincott Williams & Wilkins, Inc.