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PubMed2003

[Comparative assessment of different methods of treatment of chronic critical ischemia of lower extremities in elderly and senile patients].

Results of using different methods of treatment of chronic critical ischemia of lower extremities were analyzed in 267 elderly and senile patients. Ischemia of the lower extremities of the III degree was noted in 83% of the patients, the IV degree ischemia--in 17%. In 86 patients who underwent primary high amputation of the lower extremity 2 years survival was noted in 33.7%. In 89 patients treated conservatively during 12-14 days good and satisfactory results were obtained in 58.4%, amputations were made in 41.6%. The 2 years survival was 66.3%. In 92 patients primary reconstructive operations resulted in good and satisfactory outcomes in 75 (81.5%) out of them with the 2 years survival in 88.0%.

Aged↗

PubMedDate not supplied

The visible man: three-dimensional interactive musculoskeletal anatomic atlas of the lower extremity.

A personal computer-based interactive musculoskeletal anatomic atlas of the lower extremity has been created by using the Visible Human Male data set. A semiautomatic segmentation program was developed by using an intelligent scissors approach and shape-based interpolation, thus considerably reducing the laborious work of the segmentation and labeling process. Manual contour extractions at 3-mm section intervals and shape-based interpolations of intervening sections of the musculoskeletal structures of the lower extremity were performed. For interactive and realistic three-dimensional display, an efficient binary volume rendering method was developed that introduces the concept of shear-warp factorization and applies a newly developed normal calculation technique. Binary volume rendering reconstructs various structures from a series of two-dimensional sections in a few seconds, thus enabling real-time manipulations of the computerized atlas. All of the muscles, tendons, and bones of the lower extremity have been segmented and labeled. The volume-based three-dimensional interactive atlas supports various interactions including rotation, removal, highlighting with artificial colors, arbitrary cutting operation, transparent view, and descriptive knowledge representation. In addition, browsing through the two-dimensional images of transverse, coronal, and sagittal views with labeling and segmentation information is possible.

Anatomy, Cross-Sectional↗

PubMed2004

Does a standardization tool to direct invasive therapy for symptomatic lower extremity peripheral arterial disease improve outcomes?

OBJECTIVES: While decision analysis and treatment algorithms have repeatedly been shown to improve quality of care in many areas of medicine, no such algorithm has emerged for the invasive management of lower extremity peripheral arterial disease. Using the best available evidence-based outcomes data, our group designed a standardization tool, the Lower Extremity Grading System (LEGS) score, which consistently directs limbs to a specific treatment on the basis of presentation. The purpose of this study was to examine whether use of such a tool improves outcomes by directing treatment of lower extremity peripheral arterial disease. METHODS: Over 18 months (July 2001-December 2002) our group intervened in 673 limbs (angioplasty, open surgery, primary limb amputation) with lower extremity peripheral arterial disease. During this time we developed the LEGS score, and implemented its prospective use for the final 362 limbs. For the purpose of this study, all 673 limbs were retrospectively scored with the LEGS score to determine the LEGS recommended best treatment. Of the 673 limbs, 551 (81.9%) received the same treatment as recommended with LEGS and 122 (18.1%) received treatment contrary to LEGS. Limbs treated contrary to LEGS (cases) were then compared with matched control limbs (treated according to LEGS), with similar angiographic findings, clinical presentation, preoperative functional status, comorbid conditions and operative technical factors. Outcomes measured at 6 months included arterial reconstruction patency, limb salvage, survival, and maintenance of ambulatory status and independent living status. Kaplan-Meier curves were used to assess patency, limb salvage, and survival; associated survival curves were compared with the log-rank test. Functional outcomes were compared with the Fisher exact test. RESULTS: After matching case limbs with control limbs, 9 limbs had no control match. Thus 113 limbs in 100 patients treated contrary to LEGS were compared with 113 limbs in 100 patients treated according to LEGS. Limbs treated contrary to LEGS resulted in significantly inferior outcomes at 6 months for measures of primary patency (57.5% vs 84.3%; P < .001), secondary patency (73.2% vs 96.2%; P < .001), limb salvage (89.7% vs 97.2%; P = .04), and maintenance of ambulatory status (78% vs 92%; P = .02). As an additional finding, 29.6% (92 of 311) of interventions performed before implementation of the algorithm were treated contrary to LEGS, and thus contrary to objectively determined best therapy, compared with 8.3% (30 of 362) after LEGS implementation (P < .001). CONCLUSIONS: Limbs treated according to our standardization tool resulted in better outcomes compared with limbs treated contrary to the algorithm. These data suggest that routine use of an appropriately validated treatment standardization algorithm is capable of improving overall results for invasive treatment of lower extremity peripheral arterial disease.

Amputation, Surgical↗

PubMed2005

Angiographic imaging of the lower extremities with multidetector CT.

Multidetector CT (MDCT) has improved imaging of the arteries in the lower extremities. The main advantages of this novel technology are the exceptionally fast scan times, high spatial resolution, increased anatomic coverage, and capability to generate high-quality multiplanar reformations and three-dimensional (3-D) renderings from raw data that can be reprocessed easily and quickly. The applications of MDCT in imaging the lower extremities are multiple and varied. They include the evaluation of peripheral arterial occlusive and aneurysmal disease, the patency and integrity of bypass grafts, and arterial injury owing to trauma. This article describes the techniques of lower extremity MDCT angiography and its use in a few clinical applications.

Angiography↗

PubMed1989

Resting ankle-arm pressure index in vascular diseases of the lower extremities.

The authors calculated 442 values of resting ankle-arm indices in 222 patients, of whom 114 reported exercise pain of the lower extremities (51.3%) and 34 reported rest pain (15.3%). Tissue necrosis was diagnosed in 55 patients (24.8%) and other disorders in 19 (8.6%). Obliterating atherosclerosis was found in 186 patients (83.8%), Buerger's disease in 16 (7.2%), and other vascular diseases in 20 patients (9%). The studied index value in 262 examined lower extremities was 1.3-1.0 in 54, 0.9-0.8 in 29, 0.7-0.6 in 66, 0.5-0.4 in 55, and 0.3-0.0 in 58 lower extremities. Respective values for contralateral lower extremities (180) were the following: 69, 54, 33, 14, and 10.

Adult↗

PubMed2005

The effect of arm swing on lower extremities in vertical jumping.

Although it is known that an arm swing can enhance the performance in vertical jumping, the mechanisms through which this enhancement occurs are not yet clearly described. The purpose of this study was to examine how arm swing affects the lower extremity torque, power and work in vertical jumping and to gain an insight into the mechanisms that enable the arm swing to increase jump height. Five subjects maximally performed two types of vertical squat jumps with (SJA) and without (SJ) an arm swing from a force platform. All performances were videotaped with a high-speed video camera (200 Hz). The jump heights, joint torques, power and work were calculated by combining kinematic and kinetic data. It was confirmed that arm swing enhanced the jump height significantly (p<0.01). The work by the hip and by the ankle was significantly augmented by arm swing (p<0.05 and p<0.01, respectively). However, the work by the knee was significantly smaller in SJA (p<0.05). The total work by the three lower extremity joints (ankle, knee and hip) was significantly larger in SJA (p<0.05). The increase of the lower extremity work by the arm swing (31.4 J) was about twice as large as the work done by the shoulder and elbow in SJA (16.3 J). It was concluded that the increment of jump height resulted mainly from the increase of the lower extremity work, which is considered to have been brought about by the additional load on the lower extremity due to the arm swing.

Adult↗

PubMed1994

Lower-extremity motor neuropathy associated with surgery performed on patients in a lithotomy position.

BACKGROUND: Motor neuropathy of a lower extremity is well-recognized as a potential complication of procedures performed on patients in a lithotomy position. Most of this awareness is based on anecdotal reports, however, and the incidence and risk factors for this complication have not been reported. METHODS: We retrospectively reviewed the perioperative courses of 198,461 consecutive patients who underwent 1 of 56 surgical procedures historically performed on patients in a lithotomy position at the Mayo Clinic, Rochester, Minnesota, from 1957 to 1991 inclusive. The medical diagnoses of patients who had procedures in a lithotomy position were scanned for 26 diagnoses associated with neuropathy. Persistent neuropathy of the lower extremity was defined as a motor deficit of at least 3 months' duration. Risk factors anecdotally associated with persistent neuropathy were analyzed by comparing identified cases of neuropathy to controls in a 1:3 case-control study. RESULTS: Persistent neuropathies after procedures performed on patients in a lithotomy position were identified in 55 cases for a rate of 1 per 3,608. Multivariate risk factors for development of a persistent neuropathy of a lower extremity included duration in lithotomy of 4 h or longer, a body mass index (kilograms per squared meter) of 20 or less, and a history of smoking within 30 days of the procedure. Regional anesthetic techniques were not found to be associated with an increased risk of neuropathy. Of the 53 patients who lived at least 1 yr after their procedure, 24 (45%) required either prosthetic or ambulatory support for persistent foot drop or leg weakness. CONCLUSIONS: These data suggest that prolonged duration in lithotomy and patient risk factors, including very thin body habitus and smoking in the preoperative period, are associated with the development of a lower-extremity neuropathy after procedures performed on patients in a lithotomy position. A reduction of time in the lithotomy position may be particularly worthwhile for patients with these risk factors.

Adolescent↗

PubMed1988

Soft-tissue expansion in the lower extremities.

Soft-tissue expansion enjoys ever-wider use, but to date an experience using this technique in the lower extremity has never been presented. We reviewed our first 16 patients to describe the indications and contraindications for the use of tissue expansion in the lower extremity. Guidelines evolved from study of the data. Soft-tissue expansion merits consideration for coverage of problem wounds, in preparation for removal of large benign lesions, and for the repair of contour defects. The operator should know that an open wound below the knee predicts a complication if soft-tissue expansion is attempted in that location. In the thigh, incisions can be confidently placed at the edge of the defect. In every location, large expanders should be chosen so that they are as long as or longer than the adjacent defect. The increase in circumference of the limb should be followed. Simple designs for advancement flaps usually work well. As our experience has grown, reconstruction using soft-tissue expansion in the lower extremity has become safer and the results more predictable through better patient selection and diligent monitoring of intraluminal pressures, even if only by ensuring that the patient is always comfortable. Soft-tissue expansion has a role in reconstruction of the lower extremity.

Adolescent↗

PubMed1989

Lower extremity peripheral neuropathy and ischemic ulcers associated with giant cell arteritis.

A patient with previously treated, temporal artery biopsy proven, giant cell arteritis (GCA) developed lower extremity ulcers and sensory neuropathy. Sural nerve biopsy showed epineural vessels with focal mild chronic inflammation. The lower extremity skin and nerve abnormalities improved after retreatment with prednisone. The rare manifestations of lower extremity skin and peripheral nervous system involvement associated with GCA are discussed. GCA must be considered in lower extremity ischemic processes of the skin and peripheral nervous system.

Foot Diseases↗

PubMedDate not supplied

[Use of nitrendipine in treating patients with obliterative atherosclerosis of arteries in the lower extremities].

Twenty patients with obliterative atherosclerosis in the lower extremities arteries (Fontaine's stage II) were treated with nitrendipine (Bayotensin) given in the dose of 20 mg daily for 6 weeks. This therapy with nitrendipine produced improvement manifested by the prolongation of the distance of intermittent claudication, shortening of pain duration, increase in blood flow in the ischemic extremity, and increase in pressure index. At the same time, nitrendipine decreased ADP-produced platelet aggregation and activated fibrinolytic system. Clinical trials have shown that nitrendipine is effective in the obliterative atherosclerosis in the lower extremities.

Adult↗

PubMed2003

Lower extremity stiffness: implications for performance and injury.

BACKGROUND: Lower extremity stiffness is thought to be an important factor in musculoskeletal performance. However, too little or too much stiffness is believed to increase the risk of musculoskeletal injury. PURPOSE: To provide a current update of the lower extremity stiffness literature as it pertains to both performance and injury. SUMMARY: It appears that increased stiffness is beneficial to performance. As well it appears that there may be an optimal amount of stiffness that allows for injury-free performance. There is some evidence that increased stiffness may be related to bony injuries and decreased stiffness may be associated with soft tissue injuries. Further investigations should evaluate the relationship between stiffness and injury prospectively. Initial reports suggest that stiffness can be modified in response to the external environment or verbal cues. RELEVANCE: A greater understanding of the role of stiffness in both performance and injury will provide a stronger foundation for the development of optimal training intervention programs.

Elasticity↗

PubMed2003

Summary measure of dietary musculoskeletal nutrient (calcium, vitamin D, magnesium, and phosphorus) intakes is associated with lower-extremity physical performance in homebound elderly men and women.

BACKGROUND: Nutritional intake has been overlooked as a possible contributing factor to lower-extremity physical performance, especially in homebound elderly persons. OBJECTIVES: Our objectives were to examine the association of a summary measure of calcium, vitamin D, magnesium, and phosphorus intakes with 1) the inability to perform lower-extremity physical performance tests and 2) declining levels of summary lower-extremity physical performance. DESIGN: Baseline data from the Nutrition and Function Study were used to calculate a summary musculoskeletal nutrient (SMN) score as a measure of nutrient intake (factor analysis) and to examine the association of SMN intake with physical performance (multivariable regression models) among recipients of home-delivered meals who completed an in-home assessment (anthropometric measures and performance-based physical tests) and three 24-h dietary recalls. RESULTS: Among the 321 participants, elderly age, black race, body mass index (in kg/m2) > or = 35, arthritis, frequent fear of falling, and lowest SMN intake were independently associated with being unable to perform functional tests. The lowest SMN intake and the highest BMI were both significantly associated with increasingly worse levels of lower-extremity physical performance, after adjustment for health and demographic characteristics. CONCLUSIONS: Considering the importance of identifying short- and long-term outcomes that help elderly persons maintain adequate nutritional status and remain functionally independent at home, the results of this study suggest the need to identify intervention strategies that target the improvement of dietary intake and physical performance. Further investigation is indicated to identify the manner in which nutritional status contributes to the preservation or deterioration of physical performance in homebound elderly persons.

Activities of Daily Living↗

PubMed1998

A primer on lower extremity outcome measurement instruments.

Tracing the roots of lower extremity outcome scales is an interesting and somewhat bemusing journey. A large number of different grading methods can be found with limited reliability and/or validity testing. The usefulness of these instruments in the assessment of patient outcomes after lower extremity interventions is worrisome. This article focuses on the most commonly used scales and demonstrates an alarming and incestuous pattern of cross-validation with moderate to weak associations between potentially unreliable and crudely validated original instruments.

Activities of Daily Living↗

PubMed2006

A novel exercise for improving lower-extremity functional fitness in the elderly.

BACKGROUND AND AIMS: Many falls in the elderly are caused by tripping. After tripping, a certain level of lower-extremity functional fitness is necessary, in order to make protective responses and to avoid falling. The purpose of this study was to test whether our new exercise program (a square-stepping exercise: SSE) would improve lower-extremity functional fitness in the elderly. METHODS: Fifty-two individuals aged 60-80 years were divided into two groups (non-randomized control design); SSE (n=26) and controls (n=26). Lower-extremity functional fitness was defined as standing up from a lying position (agility), chair-stand in ten seconds (leg power), walking round two cones (locomotion speed), sit-and-reach (flexibility) and single-leg balance with eyes closed (balance). The SSE group participated in a six-month regimen of SSE once a week. SSE was performed on a thin mat of 250 cm by 100 cm, partitioned into 40 small squares (25 cm each side). SSE included not only forward steps but also backward, lateral and oblique steps, and step patterns were progressively made more complicated. Controls maintained their usual lifestyles. RESULTS: In the SSE group, significant improvements were observed in agility, leg power, locomotion speed, flexibility and balance. No significant changes were detected in any tests in the control group. CONCLUSIONS: The SSE program improved lower-extremity functional fitness, lack of which constitutes a risk factor for falls in the elderly. This program should be tested further to determine if it can effectively reduce the incidence of falls in the elderly.

Accidental Falls↗

PubMed2006

Lower extremity vein digital photoplethysmography in highly qualified football players and wrestlers.

Modern sport, along with the high technical, tactic and psychological readiness, requires good physical preparation achieved by a big physical load during trainings and competitions. Aim of the investigations was to study lower extremity venous system functional condition during physical load in highly qualified football players and wrestlers. Highly qualified 25 football players and 30 wrestlers, of age 18-25 years, were studied. Olympic, World and Europe champions were included among wrestlers. Lower extremity venous system digital photopletismography (D-PPG) was conducted by apparatus: Rheo Dopplex II of Huntleight Diagnostics. The equipment digitally analyses photopletismoghraphic plots. Significant functional parameters: vein restoration time (VRT) and venous pump function (VP) in deep venous system were reported by the apparatus appropriate software. It included parameter interpretation diagram, defining degree of venous system condition as normal, equivocal or pathological. Target sportsmen were examined in siting position with physical loading pedis. Sportsmen lower extremity vein light transducing change registration associated with the degree of vessel filling was studied by digital photopletismography . The study results showed that vein restoration time (VRT) in football players is two times minor to compare to the one of wrestlers, while venous pump (VP) function is about 1.5 times higher in footballers than in wrestlers. Degree of lower extremity venous system condition according to parameter interpretation diagram program showed normal values only in few cases. Slight deviations were observed only in individuals with recent trauma. Further examination after the appropriate treatment revealed normal values in traumatic subjects. The search also showed that digital photopletismography appears to be effective, simple and financialy available diagnostic method, which should be more frequently applied in lower extremity vein function examinations among sportmen of different kinds as well as in estimation of recovery therapy effectiveness in post-trauma period.

Adolescent↗

PubMed2000

A comparison of thinning and conventional free-flap transfers to the lower extremity.

This study compares the application of conventional free flaps and thinning flaps to the lower extremities. Thirty patients whose skin and soft tissue of the lower extremities had been reconstructed were divided into two groups: a conventional flap group, reconstructed using conventional free flaps (15 cases), and a thinning flap group, reconstructed using thinning flaps (15 cases). Postoperative complications, long-term results, and revisional surgery were studied in the two groups. Although survival after surgery was the same in both, in the conventional flap group, 11 patients required secondary revisional surgery, the excessive bulk of the flap resulting in poor aesthetics and difficulty in wearing shoes. The conventional flap group also required longer treatment. In the thinning flap group, only 5 of 15 patients received secondary revisional surgery. As a reconstruction material for the lower extremities, thinning flaps are both aesthetically and functionally superior to conventional bulky flaps.

Adolescent↗

PubMed1975

Thromboembolic complications of cast immobilization for injuries of the lower extremities.

Six cases of thromboembolic complications in patients being treated with plaster cast immobilization for a variety of injuries to the lower extremity were encountered over a four month period on an Air Force orthopaedic service. These injuries, consisting of three ruptures of the tendo achillis, two fractures of the tibia, and a sub-talar dislocation of the foot, resulted in one death from pulmonary emboli and three other serious complications of pulmonary emboli. The literature on thromboembolic complications following lower extremity injuries (including information of pathogenesis, clinical characteristics and epidemiology of venous thromboembolism and the hazards of lowere extremity cast immobilization in an individual susceptible to his complication) suggests that prophylaxis against thrombosis should be instituted in high risk individuals who must undergo case immobilization for injuries to the lower extremity.

Achilles Tendon↗

PubMed1994

A new method of training for the lower extremity using unloading.

Rehabilitation of the patient with lower extremity dysfunction is frequently limited to open kinetic chain exercise due to pain and weakness in weight-bearing positions. Although hydrotherapy has been used in the past as a method of reducing body weight forces, task-specific training is not possible due to the resistance offered by water and the inability to regulate load. This clinical commentary describes a new form of lower extremity rehabilitation through the use of Unloading, a controlled reduction in body weight during task-specific activities. Two case reports of professional basketball players with foot injuries are presented in order to describe this method of therapy, which, in the authors' opinion, has the potential for broad applications in physical rehabilitation and deserves further research.

Basketball↗