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PubMed1987

Lower extremity swelling: computerized tomography following negative venography.

In 21 patients who had lower extremity swelling and negative venography, radiographic evaluation was extended to include computerized tomography (CT) of the lower extremity, which we have termed venography-CT, or VCT. All patients were referred with the diagnosis of deep vein thrombosis (DVT) and no patient had a history of trauma. CT was effective in demonstrating two occult mechanisms of lower extremity swelling: knee joint effusion (three patients) and intramuscular hemorrhage (five patients). Selective utilization of CT in the evaluation of lower extremity swelling is effective in directing the clinical management of these patients.

Adult↗

PubMed2005

The risk of child abuse in infants and toddlers with lower extremity injuries.

PURPOSE: The aim of this study was to assess the risk of child abuse in children younger than 18 months admitted to a pediatric trauma service with lower extremity injuries. METHODS: An Institutional Review Board-approved retrospective case series of children admitted to a regional pediatric trauma center with lower extremity injuries from 1998 to 2002 (n = 5497) was performed. Factors analyzed included age, injuries, and injury mechanism. RESULTS: Among 5497 trauma patients, the incidence of abuse was 104 (2%) of 4942 children 18 months or older and 175(32%) of 555 children younger than 18 months (odds ratio [OR], 21.4 +/- 2.9, P < .001). There were 1252 (23%) patients with lower extremity injuries in the entire sample, and 66 of these were younger than 18 months. In the extremity trauma group, for patients 18 months or older, 16 (1%) of 1186 were abused compared with 44 (67%) of 66 patients younger than 18 months (OR, 146 +/- 53, P < .001). Among all trauma patients younger than 18 months, 41 of 55 lower extremity fractures were linked to abuse, whereas 134 of 500 other injuries were caused by abuse (OR, 8.0 +/- 2.6, P < .001). Among the 41 abuse-related fractures, femur fracture was the most common (22), followed by tibia fracture (14). CONCLUSIONS: Among children 18 months or older, abuse is an uncommon cause of lower extremity trauma. In children younger than 18 months, lower extremity injuries, particularly fractures, are highly associated with child abuse. Clinicians must thoroughly investigate lower extremity injuries in this age group.

Child Abuse↗

PubMed1987

Assessment and management of the lower extremity in cerebral palsy.

For all lower extremity problems in children with cerebral palsy, early attention to overactive spastic muscle groups can aid in preventing bony deformities under most situations. More severely involved children need more aggressive treatment, with early soft tissue procedures to attempt balance of muscle groups surrounding joints. Early aggressive management of soft tissue problems can avoid long-term bony deformity and more severe posturing problems in the lower extremities of children with cerebral palsy.

Cerebral Palsy↗

PubMed2006

Chronic ergot toxicity presenting with bilateral external iliac artery dissection and lower extremity rest pain.

Chronic use of ergot alkaloids has been recognized as a rare cause of lower extremity ischemia. Most patients with ergot toxicity present with symptoms of lower extremity claudication. Herein we present a woman with bilateral lower extremity rest pain and a history of chronic ergot use for migraine headaches. Arteriography demonstrated extensive pruning of the distal arterial tree along with bilateral external iliac artery dissections - a finding that is not often associated with young, normotensive patients with chronic ergot toxicity. This patient was treated with endovascular stenting of the dissections along with cessation of ergot. Her symptoms improved markedly, and follow-up arteriography 6 weeks later demonstrated resolution of the iliac dissections along with restoration of nearly normal lower extremity runoff vessels. Discontinuation of ergot-containing products and cessation of tobacco and caffeine use is the cornerstone of therapy in chronic ergot toxicity. The association of ergot toxicity and iliac dissection has not been previously described. Endovascular or surgical interventions may be considered in patients with ergot toxicity for specific indications or those whose symptoms progress despite conservative management.

Adult↗

PubMed2002

The relationship between hand-arm vibration and lower extremity clinical manifestations: a review of the literature.

OBJECTIVE: To assess the current literature supporting a relationship between hand-arm vibration (HAV) and lower extremity clinical effects. METHODS: An initial review of the literature identified lower extremity vascular and neurological effects reported in association with HAV. A second literature review was performed with explicit search and evaluation strategies. It focused on analytical studies and looked for epidemiological evidence supporting the relationship between HAV and lower extremity effects. RESULTS: Eight analytical studies which met all of the initial inclusion/exclusion criteria were identified. All of these had serious validity deficiencies with respect to selection bias, response rates and lack of examination of confounders. CONCLUSIONS: There was consistency with respect to an association between those exposed who were diagnosed with hand-arm vibration syndrome (HAVS) and vascular symptoms in the lower extremities. There was no evidence that hand-held vibration exposure independent of the diagnosis of HAVS was associated with lower extremity vascular symptoms. There was no evidence to suggest that HAV was associated with clinically significant lower extremity neurological symptoms.

Arm↗

PubMed1982

Legg-Calvé-Perthes disease: a study of lower extremity length discrepancies and skeletal maturation.

Lower extremity length discrepancies and skeletal maturation have been studied in 147 patients with unilateral Legg-Calvé-Perthes disease followed by orthoroentgenograms for 5 or more years. At the time of initial assessment there was a marked delay in skeletal age as related to chronologic age in 83 percent of the patients. Standing height in the majority of patients both at disease presentation and at skeletal maturation was less than the mean. The average maximum total femoral and tibial discrepancy during the course of the disease was 2.14 cm. The maximum femoral discrepancy averaged 1.38 cm and the maximum tibial discrepancy averaged 0.93 cm. (The time of maximum discrepancy differed in the two major lower extremity bones). The extent of tibial discrepancy correlated well with the time of immobilization in the unilateral abduction ischial weight-bearing brace. The discrepancies did not invariably increase with time and many corrected with the repair process. Four developmental patterns of the discrepancy were detected and classified. Epiphyseal arrest was resorted to in 21 percent of the patients.

Adolescent↗

PubMed1997

Role of nitric oxide and tumor necrosis factor on lung injury caused by ischemia/reperfusion of the lower extremities.

PURPOSE: Acute aortic occlusion with subsequent ischemia/reperfusion (I/R) of the lower extremities is known to predispose to lung injury. The pathophysiologic mechanisms of this injury are not clear. In the present study, we studied the role of tumor necrosis factor (TNF) and nitric oxide (NO) in lung injury caused by lower extremity I/R. METHODS: A rat model in which the infrarenal aorta was cross-clamped for 3 hours followed by 1 hour of reperfusion was used. The rats were randomized into five groups: group 1, aorta exposed but not clamped; group 2, aorta clamped for 3 hours, followed by 1 hour of reperfusion; group 3, 1 mg/kg dexamethasone administered before the aorta was clamped; group 4, 25 mg aminoguanidine, a specific inducible NO synthase (iNOS) inhibitor, administered before the aorta was clamped; and group 5, 2 mg/kg TNFbp, a PEG-ylated dimeric form of the high-affinity p55 TNF receptor I (RI), administered before the aorta was clamped. NO concentration in the exhaled gas (ENO) was measured, as an index of NO production by the lung, in 30 minute intervals during I/R. Serial arterial blood samples for TNF assay were obtained during the course of the experiment. At the end of the experiment, the lungs were removed and histologically examined for evidence of injury. RESULTS: ENO in group 2 increased from 0.7 +/- 0.3 ppb at baseline to 54.3 +/- 7.5 ppb at the end of ischemia and remained stable during reperfusion (54.6 +/- 8.5 ppb at the end of reperfusion). ENO production was blocked by aminoguanidine, by dexamethasone, and by TNFbp given before aortic occlusion. Serum TNF in groups 2, 3 and 4 increased rapidly during early ischemia, reaching its peak value 60 minutes after occlusion of the aorta, then gradually declined to baseline levels at the end of ischemia, and remained low during reperfusion. TNFbp decreased serum TNF concentration significantly when it was given before aortic occlusion. Histologic examination of the lungs at the end of the experiment revealed that aminoguanidine, dexamethasone, and TNFbp had a protective effect on the lungs. CONCLUSIONS: Serum TNF increases rapidly during lower extremity ischemia and causes increased production of NO from the lung by upregulating iNOS. Increased NO is associated with more severe lung injury, and iNOS blockade has beneficial effects on the lung. TNF blockade before ischemia decreases NO production by the lung and attenuates lung injury. ENO can be used as an early marker of lung injury caused by lower extremity I/R.

Animals↗

PubMed2001

Peripheral neuropathy in the hands of diabetic patients with lower extremity amputations.

One hundred unilateral ambulatory lower extremity amputees underwent sensibility testing of their remaining foot and right hands to determine if the magnitude of peripheral neuropathy present in the feet of patients with diabetes was of greater magnitude than that in their hands. Testing was performed with a series of Semmes-Weinstein monofilaments. Ninety-one of the subjects were male, and 9 were female. Sixty-five were diabetic, 40 required insulin. The magnitude of peripheral neuropathy was compared between the hands and feet of patients with and without diabetes, and between insulin-dependent and non-insulin-dependent diabetics. There was a slight trend to a more severe degree of insensitivity in the feet as compared with the hands in each of the individual groups. There was no statistically significant difference when comparing hand and foot sensibility in any of the comparison groupings. The quantitative amount of peripheral neuropathy appears to affect the hands and feet of diabetics in a similar "stocking-glove" fashion. The results of this screening gives further support to the concept of prophylactic foot care programs in diabetics with peripheral neuropathy to decrease the risk for the development of foot ulcers, which are often the precursor of eventual lower extremity amputation.

Aged↗

PubMed2025

Screening of the key single nucleotide polymorphisms in type 2 diabetes mellitus complicated with lower extremity arterial disease by machine learning.

OBJECTIVES: Diabetic lower extremity arterial disease (LEAD) is a manifestation of diabetic lower extremity vascular complications. This study aimed to screen the key single nucleotide polymorphism (SNP) gene signature in patients with type 2 diabetes mellitus (T2DM) and LEAD. METHODS: A total of 147 patients with T2DM complicated by LEAD and 144 patients with T2DM without LEAD were enrolled for transcriptome sequencing. The Plink software was used to preprocess the data. Five machine learning methods were adopted to build the SNP diagnosis models. The receiver operating characteristic (ROC) curve was used to quantify the predicted probabilities of the model. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed using the cluster Profiler package. Finally, regression statistical analysis was used to correlate the key SNPs with clinical information and biochemical indicators. RESULTS: A total of 24 SNPs were retained and 10 SNPs were risk allele genes. Nine SNPs (rs7412, rs1800629, rs699947, rs3918242, rs668, rs1800470, rs1800449, rs1800469, and rs1024611) were identified as the key SNPs sites. GO and KEGG pathway analyses revealed that these genes are mainly enriched in fluid shear stress and atherosclerosis. Finally, rs1800449 was associated with low-density lipoprotein cholesterol (LDL-C). With high density lipoprotein cholesterol (HDL-C), related site was rs1024611. The sites associated with total cholesterol (CHOL) were rs1800449 and rs7412.The site associated with apolipoprotein B (APOB) and apolipoprotein A1 (APOA1) were rs1800470 and rs1800469. CONCLUSION: This study authenticated nine SNPs for the diagnosis of T2DM patients with LEAD, which will be of great significance in the development of diagnostic molecular biomarkers for T2DM patients.

Humans↗

PubMed2006

Higher and lower extremity vein color duplex sonography in highly qualified football players and wrestlers.

It is recognized that due to muscle exercises cardio-vascular system undergoes various morphologic and functional changes among highly qualified sportsmen. Healthy vascular system is needed to meet successfully great physical load. Aim of the search was to study higher and lower extremity venous system functional condition during physical exercise and rest among highly qualified football players and wrestlers. Highly qualified 30 wrestlers and 25 football players of age 18-25 years were studied. Olympic, World and Europe champions were included among wrestlers. Apparatus Acuson 128 X P/10 performed color duplex sonography examinations, transducers 7.5 MHz lineal. Higher and lower extremity venous screening in B regime was simultaneously performed by blood stream color cartogram and blood stream spectral analysis. Study revealed no pathology and documented about even rates among football players and wrestlers for higher and lower extremities by color duplex sonography. B-regime revealed same echonegativity of lower extremity veins among wrestlers and football players. Target veins were distinguished by echopositive vessel wall lineal structure. In color duplex regime venous lumen were evenly filled with color. Sportsmen post--physical exercise color duplex sonography examination revealed higher extremity venous lumen diameter and blood stream parameters twice exceeded among wrestlers than football players. However, time needed for the venous lumen diameter and blood stream changes was equal for both groups of sportsmen. The study revealed that football player lower extremity medial and wide calibre venous diameter 2.5-3 fold increased during post-exercise examination; lower extremity venous diameter and blood stream restores to primary parameters 30 min earlier in soccer players than in wrestlers. Thus, higher and lower extremity veins react in different ways among sportsmen of different kinds. For example lower extremity vein diameter and blood stream increases in football players more than in wrestlers, while, higher extremity veins reach higher rates in wrestlers to compare to soccer players. These evidences conclude different adaptation resources among sportsmen of different physical trainings. That is why during physical load blood circulation in down to up direction is facilitated because of lower extremity muscle contraction support in football players.

Adolescent↗

PubMedDate not supplied

Incidence and distribution of lower extremity deep vein thrombosis in rehabilitation patients: implications for screening.

Patients admitted to in-patient rehabilitation programs have an increased risk for developing deep venous thrombosis (DVT). However, the utility of screening for lower extremity DVT using duplex ultrasound in this high-risk population is not well characterized. The purpose of this study is to identify whether or not screening lower-extremity duplex exams are indicated in this high-risk population. Screening lower extremity duplex exams were performed on all patients admitted to the rehabilitation center at Mt. Sinai Hospital over a 3-year period. Charts were reviewed for patient age, gender, diagnosis, date of screening and follow-up duplex exams, presence and location of venous thrombosis at each duplex exam, history of anticoagulation, and medical DVT prophylaxis. The presence of DVT at screening, the location of DVT along the lower extremity, and the outcome of calf DVT were analyzed in terms of gender, underlying diagnosis, and history of DVT prophylaxis. Lower extremity DVT was detected in 34% of patients. Twenty-three percent of patients had isolated calf vein thrombosis. Men were more likely than women to have DVT. Calf DVTs progressed in 3% of patients over an average follow-up of 2 weeks. The presence of DVT, its location along the lower extremity, and the outcome of calf vein DVT had no significant relationship to underlying diagnosis or history of prophylaxis. Screening duplex exams to detect lower extremity DVT in rehabilitation patients is useful. Screening altered management in 26% of patients, prompting either anticoagulation or repeat duplex exam.

Aged↗

PubMed2003

Impairment level SumScore for lower extremity Complex Regional Pain Syndrome type I.

OBJECTIVES: To construct a single indicator on impairment level for lower extremity Complex Regional Pain syndrome type I (CRPS I). DESIGN: The Impairment level SumScore (ISS) for upper extremity CRPS I was adapted to be used for lower extremity evaluation. Medline literature search and research findings were used to adapt the upper extremity version of the ISS, with emphasis on reliability, responsiveness and validity of measurement instruments. Where needed, additional patient data was gathered to evaluate these aspects for different measurement instruments. SETTING: An outpatient clinic of a university hospital in the Netherlands. PARTICIPANTS: Two groups consisting of 17 and 26 healthy volunteers, and two groups of respectively 40 and 18 lower extremity CRPS I patients according to Veldman's criteria. MAIN OUTCOME MEASURES: VAS and McGill pain scores, water displacement volumeter values, and physicians' and patients' assessment of CRPS I severity. RESULTS: A combination of measurements, incorporating pain (VAS and McGill), temperature (infrared thermometer), volume (water displacement volumeter) and active range of motion (universal goniometer), was converted in a single score ranging from 5 to 50. The reliability, as well as the responsiveness was adequate. CONCLUSIONS: The lower extremity ISS permits evaluation of the most prominent symptoms in CRPS I, and can be used to monitor changes in CRPS I.

Adult↗

PubMedDate not supplied

Long-term incidence of lower-extremity amputations in a diabetic population.

OBJECTIVE: To describe the 10-year cumulative incidence of and risk factors for lower-extremity amputations in diabetics. DESIGN: Cohort study. SETTING: Primary care. PARTICIPANTS: Population-based sample (N = 879) of younger-onset diabetic persons (in whom diabetes was diagnosed before 30 years of age and who were taking insulin) and a stratified random sample (N = 956) of older-onset diabetic persons (diagnosis at or after 30 years of age) participating in baseline, 4-year, and 10-year examinations. MAIN OUTCOME MEASURE: Amputations of the lower extremities as reported by the participants. RESULTS: The 10-year cumulative incidence of lower-extremity amputation was 5.4% in younger-onset and 7.3% in older-onset persons. Multivariate analyses were performed by logistic regression. In younger-onset persons, age (odds ratio [OR] for 10 years, 2.0; 95% confidence interval [CI], 1.5-2.8), history of ulcers (OR,4.8; 95% CI, 2.3-9.9), diastolic blood pressure (OR, 2.1 for 10 mm Hg; 95% CI, 1.5-3.0), glycosylated hemoglobin level (OR, 1.4 for 1%; 95% CI, 1.2-1.6), sex (OR, 5.2 for men; 95% CI, 2.2-12.3), and retinopathy (OR, 1.2 for 2 steps; 95% CI, 1.1-1.4) were significantly associated with incidence of lower-extremity amputation. In older-onset persons, history of ulcers (OR, 3.3; 95% CI, 1.6-6.8), glycosylated hemoglobin level (OR, 1.3 for 1%; 95% CI, 1.1-1.5), duration of diabetes (OR, 1.6 for 10 years; 95% CI, 1.1-2.5), sex (OR, 2.6 for men; 95% CI, 1.3-4.9), diastolic blood pressure (OR, 0.7 for 10 mm Hg; 95% CI, 0.5-1.0), and proteinuria (OR, 2.4; 95% CI, 1.0-5.7) were significantly associated with incidence of lower-extremity amputation. CONCLUSION: These data show there are several risk factors for lower-extremity amputation with potential for modification and preventive strategies.

Adolescent↗

PubMed2005

Review of epidemiologic studies on occupational factors and lower extremity musculoskeletal and vascular disorders and symptoms.

The epidemiologic literature on lower extremity musculoskeletal disorders (MSDs), vascular disorders, and occupational mechanical factors is relatively sparse, compared to the low back and upper extremities. The present literature review aims to summarize and evaluate the current literature on lower extremity vascular disorders, MSDs, and symptoms, and to update previous literature reviews. A search was conducted in PubMed. Articles were included if they had a lower extremity musculoskeletal outcome, and a workplace factor(s). They were evaluated based upon their generalizability, exposure, and outcome assessments, study design, and controlling of confounders. Most of the literature has focused on osteoarthritis of the hip and knee, whereas not much research has been done examining the feet/ankles and lower legs. Overall, better exposure assessment is needed to examine the causal pathway between occupational factors and MSDs.

Epidemiologic Studies↗

PubMed2002

The relationship between clinical measurements of lower extremity posture and tibial translation.

OBJECTIVE: The purpose of this investigation was to determine if postures of the lower extremity were related to the amount of anterior tibial translation. DESIGN: Regression model of lower extremity postural measures used to predict the amount of tibial translation for a sample of convenience. BACKGROUND: Retrospective studies have indicated a link between certain lower extremity postures and prediction of anterior cruciate ligament injury status. What is not clear is whether these lower extremity postures cause, or occur as a result of anterior cruciate ligament injury. METHODS: Genu recurvatum, the thigh-foot angle, and navicular drop measures were obtained from the right leg of 43 uninjured college-aged subjects. Tibial translation was determined using a KT-1000 arthrometer. Gender related differences were determined with independent t-tests. Step-wise regression was performed to assess the relationship between postural measures and subject gender, and tibial translation. RESULTS: Very good to excellent inter- and intra-rater reliability was found for the postural measures. There was greater tibial translation (P=0.01) in females. The final regression model indicated a moderate relationship between sex of the subject, navicular drop and tibial translation (r=0.551). Genu recurvatum and thigh-foot angle were not significant predictors of tibial translation. CONCLUSIONS; We concluded that foot pronation has a greater impact on the amount of tibial translation than genu recurvatum and torsion of the lower leg in anterior cruciate intact subjects. RELEVANCE: Static clinical measures of lower extremity posture are commonly taken as predictors of outcome (both performance and injury). There may be little association between these static measures and dynamic performance.

Adult↗

PubMed2006

Effects of turn angle and pivot foot on lower extremity kinetics during walk and turn actions.

This study examined lower extremity joint moments during walk and turn with different turn angles and pivot feet. Seven young adults (age 21+/-1.3 yrs) were asked to walk at a self-selected speed (1.35+/-0.15 m/s) and to turn to the right using right (spin turn) and left (step turn) pivot feet at turn angles of 0 degrees (walking straight), 45 degrees, and 90 degrees. Video and forceplate systems were employed for kinematic and kinetic data collection. Inverse dynamics approach was used to compute joint moments using segmental kinematics, ground reaction forces, and moments. The participants decreased their forward speed by increasing the ankle plantar flexion moment as the turn angle increased. The peak ankle plantar flexion moment during the braking phase increased with increasing turn angle for both spin and step turns. Ankle invertor moments were observed only in spin turns, suggesting that more ankle muscles are involved in spin turns than in step turns. The turn angle had a significant effect on the transverse plane moment profiles at the different lower extremity joints. The results suggest that the loading patterns of different anatomical structures in the lower extremity are affected by both turn angle and pivot foot during walk and turn actions.

Adult↗

PubMedDate not supplied

Prospective evaluation of combined upper and lower extremity DVT.

The clinical importance of upper extremity deep venous thrombosis (UEDVT) has been increasingly demonstrated in recent literature. Not only has the risk of pulmonary embolism from isolated upper extremity DVT been demonstrated, but a significant associated mortality has been encountered. Examination of this group of patients has demonstrated the existence of combined upper and lower extremity deep venous thrombosis (DVT) in some patients who exhibit an even higher associated mortality. As a result of this information, it has become the standard practice at this institution to search for lower extremity DVTs in patients found to have acute thrombosis of upper extremity veins. Since January 1999, there have been a total of 227 patients diagnosed with acute UEDVT. Within this group, 211 (93%) patients had lower extremity studies; 45 of these 211 (21%) had acute lower extremity DVTs by duplex examination in addition to the upper extremity DVTs. Overall, there were 145 women, 66 men, and the average age was 70 +/-1.2 (SEM); 22 of these patients had bilateral lower extremity thrombosis (LEDVT), and 8 patients were found to have chronic thrombosis of lower extremity veins. Of the patients with bilateral upper extremity DVTs, there were 3 with bilateral LE acute DVTs. Finally, 8 of the remaining 166 patients (5%) with originally negative lower extremity studies were found to develop a thrombosis at a later date. These data serve to confirm previous studies, on a larger scale, that there should be a high index of suspicion in patients with UEDVT of a coexistent LEDVT.

Aged↗

PubMed1997

Adjuvant therapy: the effects on microvascular lower extremity reconstruction.

Adjuvant therapy and microsurgery have allowed advances in surgical extirpation of lower extremity neoplasms. This retrospective study was designed to evaluate the microvascular transfer for lower extremity reconstruction in patients receiving pre- or post-operative irradiation and chemotherapy alone and in combination. Over a 5-year period, 24 free tissue transfers were performed in 22 patients undergoing surgical resection with adjuvant therapy for lower extremity neoplasms. There were 13 male and 9 female patients with an average age of 51 years. The latissimus dorsi muscle was most commonly transferred (N = 15). Eighteen tumors received pre- and three received postoperative radiotherapy. Two tumors received a combination of radiotherapy and brachytherapy. Pre- and/or postoperative chemotherapy was used in 14 patients. Twelve of these patients had both chemo- and radiation therapy. A total of six complications occurred, with no flap loss. Complications were evenly distributed among adjuvant regimens. All patients who underwent attempted limb salvage were able to ambulate postoperatively, except for 1 patients who had local recurrence. In conclusion, adjuvant therapy did not increase the complication rate for free tissue transfer in the lower extremity. Adjuvant therapy did not require alterations in the free tissue transfer and, similarly, free tissue transfer did not alter adjuvant therapy. We believe that free tissue transfer in complicated wounds allows for better wound healing with adjuvant therapy rather than local or primary wound closure alone.

Adult↗