PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Lower Extremity”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources
PubMed2006

Return to driving after lower-extremity amputation.

OBJECTIVES: To study driving behaviors after major lower-extremity amputations and to determine which factors influence return to driving after amputation. DESIGN: A cross-sectional study. SETTING: Data were collected from patients attending an outpatient amputee and prosthetics clinic between February 2001 and September 2001. PARTICIPANTS: A convenience sample (N=123). Inclusion criteria were: age greater than 18 years, unilateral or bilateral major lower-extremity amputation, minimum 1 year since prosthetic fitting, and active automobile driver within 6 months prior to amputation. Subjects had an average age of 63.4+/-12.1 years and were on average 6.8+/-8.3 years since amputation. Common causes for amputation were peripheral vascular disease (73.2%), trauma (13.8%), and tumor (12.2%). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Driving habits after lower-extremity amputation. RESULTS: Overall, 80.5% of participants were able to return to driving an average of 3.8 months after amputation, although the majority reported a decreased driving frequency. Female sex (odds ratio [OR]=.08; 95% confidence interval [CI], .02-.34), age of 60 years or greater (OR=.16; 95% CI, .03-.74), right-sided amputation (OR=.13; 95% CI, .03-.52), and preamputation driving frequency of less than every day (OR=.18; 95% CI, .05-.69) were all significantly related to a reduced likelihood of return to driving postamputation. Items that did not have a statistically significant association with return to driving included level of amputation, reason for amputation, preamputation automobile transmission, and accessibility to public transit. Subjects with left-sided amputation had significantly fewer concerns about driving, while those with a right amputation frequently required vehicle modifications (40.6%) or switch to a left-foot driving style for braking (81.3%) and accelerating (65.6%). Common barriers to return to driving included preference not to drive, fear and/or lack of confidence, and related medical conditions. CONCLUSIONS: The majority of subjects with major lower-extremity amputation were able to return to driving after major lower-extremity amputation. Major automobile modifications are commonly performed by right-sided amputees. Several predictors of return to driving and barriers preventing return to driving were identified.

Aged↗
PubMed2005

[Color Doppler ultrasound study on pathological changes of lower extremity arteries in patients with metabolic syndrome].

OBJECTIVE: To explore the pathological changes of lower extremity arteries of patients with metabolic syndrome. METHODS: Fifty patients with metabolic syndrome (MS) and 30 normal volunteers were included in this study. The inner diameters, peak systolic velocities and intima-media thicknesses of the lower extremity arteries, and the sizes and numbers of the plaques in the lower extremity arteries were obtained with color Doppler ultrasound (CDU). RESULTS: In the fifty MS patients, the intima-media thicknesses of forty-one were thicker than 1.1 mm and thirty-three had plaques which had brought stenosis in different degrees. The intima-media thicknesses of the common femoral, popliteal and posterior tibial arteries in the MS patients were significantly thicker than those in the normal volunteers (P<0.01 or P<0.05), and a greater number of plaques in the lower extremity arteries were observed in the patients, as compared with the normal volunteers (P<0.01). CONCLUSION: Various pathological changes had taken place in the lower extremity arteries of the MS patients. The sites and degrees of the lower extremity arterial diseases in MS patients can be definitely detected with CDU.

Adult↗
PubMed1994

Pre-existing cutaneous changes in basal cell carcinomas of the lower extremities.

Basal cell carcinomas (BCCs) of the lower extremities are not frequently reported. Some pre-existing or predisposing conditions are thought to be implicated in their development. In this study, we investigated the possible relationships between pre-existing cutaneous changes and the development of BCCs of the lower extremities, possible sex and age differences, and the histologic patterns involved. Among 1053 patients with BSSc, BCCs of the lower extremities were observed in 48 (4.5%): 25 men and 23 women. Lesions appeared on the thighs (16 cases), the lower legs (27 cases), or the feet (5 cases). Histologic patterns were nodular and micronodular (18 cases), superficial (27 cases), or infiltrative (3 cases). No differences were observed between sexes. The relative degree of elastosis was higher in the lower limbs of women than of men (2.25 vs 1.53). Pre-existing cutaneous changes were observed in 7 cases. The frequency of these BCCs of the lower limbs and the higher degree of elastosis observed in the women seem to be related to sun exposure. The histologic pattern seems not to be affected by environmental factors but rather characteristic of body site. Pre-existent cutaneous changes are not thought to be possible etiologic factors.

Age Factors↗
PubMed2005

Patterns of lower extremity innervation in pediatric spinal cord injury.

STUDY DESIGN: Retrospective review. OBJECTIVES: To identify relationships between lower extremity innervation and level of injury, mechanism of injury, and age at injury in a pediatric population with spinal cord injury (SCI). Secondarily, relationships between innervation and completeness of injury, time since injury, race, and sex were evaluated. SETTING: Pediatric orthopedic referral hospital, Philadelphia, Pennsylvania. METHODS: Records of 190 subjects, ages 1-21 years, were reviewed. Data collected from the medical record included lower extremity muscle innervation, American Spinal Injury Association (ASIA) level and class, mechanism of injury, age at injury, time since injury, race, and sex. To determine innervation, lower extremity muscles had been tested using surface electrical stimulation and identified as being innervated or denervated. If a muscle responded weakly, strength duration testing was performed. For analysis via logistic regression, subjects were grouped based upon level and mechanism of injury. RESULTS: A relationship (P<0.0001) was found between ASIA level and lower extremity innervation of all muscles and between length of time since injury and lower extremity innervation for some muscles. Following multiple logistic regression, only ASIA level remained as an independent predictor of lower extremity innervation status. CONCLUSION: Our results show that lower extremity innervation does differ based on the level of the injury. Denervation began to be seen with injuries in the lower thoracic region and more predominantly with injuries in the lumbar region. This supports our hypothesis that the incidence of lower motor neuron injuries would increase as injuries became more caudal. Our hypotheses of a relationship between innervation status and mechanism of injury and age at injury were not supported. This information is important in determining treatment strategies, eligibility for electrical stimulation techniques, and potential regenerative strategies. SPONSORSHIP: This study was funded by Shriners Hospitals for Children, Grant #8530.

Adolescent↗
PubMed2003

Muscle activation patterns of selected lower extremity muscles during stepping and cutting tasks.

Lower extremity muscle activations during crossover and side step cut tasks are hypothesized to play an important role in controlling knee motion, and therefore, impact the design of knee injury prevention and rehabilitation programs. However, the contribution of lower extremity muscles to frontal and transverse plane moments during cutting tasks is unclear. The purpose of this study was to compare the muscle activation patterns of selected lower extremity muscles (vastus lateralis, medial/lateral hamstrings and medial/lateral gastrocnemius) of subjects performing a stepping down and side step cut, a stepping down and crossover cut and an equivalent straight ahead task. Ground reaction force was used to determine the cut angle, stance time and compare the lower limb loading during each task. Electromyography data during all tasks were normalized to the average activation during the straight ahead tasks to determine relative changes in muscle activation between the straight ahead and different cut styles (crossover and side step). There were no differences in the pattern of muscle activation of the vastus lateralis, or lateral hamstring muscles when comparing the cutting tasks to the equivalent straight ahead task. However, the crossover cut task resulted in significantly higher muscle activation of the medial hamstrings and lateral gastrocnemius muscles relative to both the side step cut and straight ahead tasks. These results suggest the medial/lateral hamstrings and medial/lateral gastrocnemius play a role in transverse and frontal plane control during cut tasks.

Adult↗
PubMed1998

Aetiologies and prognosis of Chinese patients with deep vein thrombosis of the lower extremities.

Deep vein thrombosis (DVT) of the lower extremities is not frequently encountered in Oriental patients. We investigated its aetiology and prognosis in 143 patients (65 males, 78 females), presenting to the National Taiwan University Hospital over 4.3 years, diagnosed by colour Doppler ultrasonography. Swelling and pain of the lower extremities were the most frequent presenting symptoms. The left femoropopliteal veins were more frequently involved than other parts of the lower extremities. In these patients, malignancy with or without intravenous catheterization was the most frequent cause (39 patients, 27%). Other common aetiologies included coagulopathy (29 patients, 20%), immobilization (24 patients, 17%) and catheter-related (13 patients, 9%). No definite aetiology could be determined in 37 patients (26%). During follow-up, 27 patients (19%) died, mostly with malignancy. Pulmonary embolism was noted in 16 patients and was not significantly directly related to death. Compared to similar studies in Caucasian patients, there were significant differences in the aetiology of DVT, with malignancy and coagulopathy more common in these Chinese patients.

Adolescent↗
PubMed2006

Transitions to mobility difficulty associated with lower extremity osteoarthritis in high functioning older women: longitudinal data from the Women's Health and Aging Study II.

OBJECTIVE: To assess the impact of lower extremity osteoarthritis (OA) on transitions to mobility difficulty, and to assess the influence of pain, excess weight, and quadriceps strength on these transitions. METHODS: We analyzed longitudinal data acquired from 199 participants in the Women's Health and Aging Study II (ages 70-79 years) who initially reported no lower extremity limitation (e.g., difficulty walking one-quarter mile) or difficulty in activities of daily living (ADL; e.g., transferring). Prevalent lower extremity OA was determined from validated algorithms encompassing multiple data sources. Markov transition models were created to analyze the first transition from no difficulty at baseline to lower extremity limitations, ADL difficulty, or both 18, 36, and 72 months later. RESULTS: Compared with women without OA (n = 140), a higher proportion of women with lower extremity OA (n = 59) initially reported pain on most days and more severe pain while walking (P < 0.05). Women with OA were also heavier, with a higher proportion being obese or overweight (P < 0.001). Lower extremity OA, higher body mass index, and lower knee extensor strength independently increased the risk of transition to combined lower extremity and ADL difficulty first over 72 months. CONCLUSION: Lower extremity OA increased the likelihood of developing difficulty in both lower extremity tasks and ADL over 72 months in a cohort of initially high functioning older women. Two modifiable factors, higher relative weight and lower knee extensor strength, substantially impacted these transitions, and therefore warrant increased attention in the management of lower extremity OA.

Activities of Daily Living↗
PubMed2006

A prospective cohort study of lower-extremity pressure ulcer risk among bedfast older adults.

OBJECTIVE: To estimate the incidence and identify risk factors for lower-extremity pressure ulcers in bedfast older adult patients. DESIGN: Prospective cohort study. SETTING: A 500-bed long-term-care facility in Japan. PATIENTS: A total of 259 patients who were aged 65 years or older, confined to bed, and without lower-extremity pressure ulcers at enrollment participated in the study. MAIN OUTCOME MEASURES: Incidence of occurrence, wound characteristics, and risk factors for lower-extremity pressure ulcers. The incidence of lower-extremity pressure ulcers per 100 person-years was 16.8 (n = 33). The most common sites of lesions were the toes and heels. Cox regression analysis indicated that 3 factors were independently related to new lower-extremity pressure ulcer risk: low ankle-brachial index value (hazards ratio 0.075; 95% confidence interval [CI], 0.023-0.242), length of bedfast period (hazards ratio 1.010; 95% CI, 1.004-1.015), and male gender (hazards ratio 2.951; 95% CI, 1.450-6.009). Receiver operating characteristic curve analysis showed the area under the curve was 0.760 (95% CI, 0.675-0.844) for the ankle-brachial index. Therefore, an ankle-brachial index cutoff level of 0.8 provided high sensitivity and adequate specificity. CONCLUSION: Lower-extremity pressure ulcers are a significant problem in bedfast older adult patients aged 65 years or older. Bedfast older adult patients who developed lower-extremity pressure ulcers in this study were believed to have arteriosclerosis; the patients' ulcers exhibited features of ischemic ulcers. The findings of the present study suggest that bedfast older adult patients with a low ankle-brachial index value, a long bedfast period, or male gender should be closely monitored for lower-extremity pressure ulcer development on admission to long-term-care facilities. In particular, the ankle-brachial index is recommended as a screening tool in this practice setting.

Age Distribution↗
PubMed1997

Selective use of preoperative lower extremity arteriography in free flap reconstruction.

Preoperative angiography is commonly utilized prior to free flap reconstruction of the lower extremity. The charts and radiographs of 38 patients who underwent free flap reconstruction, after acute posttraumatic lower extremity injuries, were studied. Patients were categorized according to the presence or absence of vascular abnormality based on pulse examination alone. Specific vascular abnormalities were recorded in each group. Of the 38 patients who had preoperative lower extremity arteriography, 23 were found to have normal dorsalis pedis and posterior tibial pulses. Only 1 of these patients had an angiographic abnormality. Of the 15 patients with abnormal pulse examinations, all were found to have angiographic abnormalities. Cost analysis of the lower extremity angiogram revealed a total additional expense of $2,957. Pulse examination was found to be a sensitive and effective predictor of lower extremity vascular integrity. Although lower extremity angiography is encouraged when distal pulse examination is abnormal, the use of preoperative arteriography for lower extremity microvascular free flap reconstruction is probably unnecessary in most patients with normal distal pulses.

Adolescent↗
PubMed2004

Leg strength in peripheral arterial disease: associations with disease severity and lower-extremity performance.

OBJECTIVE: The purpose of this study was to determine relationships between lower-extremity arterial obstruction, leg strength, and lower-extremity functioning. DESIGN: The study design was cross-sectional. A total of 514 outpatients (269 with ankle-brachial index [ABI] <0.90), aged 55 and older, were identified from three Chicago-area hospitals. Individuals with history of lower-extremity revascularization were excluded. Main outcome measures Strength in each leg, 6-minute walk, 4-meter walking velocity, accelerometer-measured physical activity, and a summary performance score were measured. The summary performance score is a composite measure of lower-extremity functioning, ranging from 0 to 12 (12 = best). The leg with the lower ABI was defined as the "index" leg, and the leg with higher ABI was defined as the "contralateral" leg. RESULTS: Index leg ABI levels were associated linearly and significantly with strength for hip extension (P <.001), hip flexion (P <.001), knee extension (P =.066), and knee flexion (P =.003), adjusting for known and potential confounders. In adjusted analyses, the index ABI was also associated linearly and significantly with strength in the contralateral leg. Adjusting for confounders, including ABI, knee extension strength, was associated independently with functional measures. CONCLUSION: Among patients without prior leg revascularization, strength in each leg is highly correlated with the lower-leg ABI. Leg strength is associated independently with functional performance. Further study is needed to determine whether lower-extremity resistance training improves functioning in patients with peripheral arterial disease.

Aged↗
PubMed2002

Reliability of primary vein grafts in lower extremity free tissue transfers.

Free flaps transferred to the lower extremity have a higher risk of failure, which may be expected to increase further with the use of vein grafts. The results of 103 consecutive free flaps to the lower extremities of 98 patients who were operated from March 1994 to December 1999 were evaluated to assess the reliability of vein grafts in lower extremity reconstruction. Five flaps were lost and the overall success rate was 95.1%. Eighty-four free tissue transfers in 79 patients were performed for the reconstruction of traumatic cases, and 81 of these flaps were performed in a delayed manner, between 1 week and 4 months after the injury. Interpositional vein grafts were used primarily in 22 flaps--all in traumatic cases--and 21 of them survived completely (95.4%). Primary vein grafts were used both for arteries and veins in 15 flaps and for arteries only in 7 flaps. The most common cause of tissue loss in these patients was a crush injury in earthquake survivors, followed by electrical injuries, gunshot injuries, motor vehicle accidents, and chronic infections. Free muscle flaps in 13 patients, skin flaps in 4 patients, osseous flaps in 2 patients, and temporal fascial flaps in 2 patients were the flaps of choice in vein graft reconstructions. Although a higher incidence of flap loss has been reported with the use of interpositional vein grafts than with regular transfers, and the technical and pathophysiological problems in flap transfers are also high in the lower extremity, the success rate in vein-grafted free flaps did not differ from that of the simple free flap transfers in the current series. This appears to be the result of meticulous preoperative planning and proper selection of recipient vessels during optimal operative conditions.

Adolescent↗
PubMed1990

Increased limb salvage. Distal tibial/peroneal artery thrombectomy/embolectomy in acute lower extremity ischemia.

Fifty-five acutely ischemic lower extremities, in 35 patients, which remained ischemic after standard thrombectomy/embolectomy techniques were further treated with distal tibial/peroneal thrombectomy/embolectomy by ankle level arteriotomy to increase limb salvage. A total of 84 infrapopliteal arteries were explored and thromboembolectomy performed in 79. The precipitating ischemic event was arterial embolus in 38 per cent, arterial thrombus in 60 per cent, and trauma in 2 per cent of the cases. There were 16 female and 19 male patients. Additional bypass grafting was used in 18 per cent of extremities. The limb salvage rate was 91 per cent in this select "tibial/peroneal" group. This technique salvaged 50 limbs that otherwise would have required major amputation. The addition of this technique changed the potential limb salvage rate from 76 per cent of the entire 199 lower extremities treated during this period to an actual limb salvage rate of 97 per cent. Operative mortality was 16 per cent in this selected group with an overall mortality of 6 per cent for all patients with acutely ischemic lower limbs. A mean patient follow-up of 32 months (range 12 to 72 months) identified only three late amputations, demonstrating that distal tibial/peroneal thrombectomy/embolectomy is a durable procedure. It is a technically easy means of promoting limb salvage in the acutely ischemic limb which either 1) remains ischemic after standard transinguinal iliofemoral thromboembolectomy, or 2) is secondary to infrapopliteal artery occlusion. It allows successful thromboembolectomy of acutely occluded infrapopliteal arteries without distal popliteal arteriotomy. These techniques should be within the armamentarium of all surgeons dealing with acute lower extremity ischemia.

Adult↗
PubMed1993

Prevalence and correlates of lower extremity arterial disease in elderly women.

Although lower extremity arterial disease occurs in 15-20% of the population over the age of 75 years, little is known about the etiology of the disease in women. In this cross-sectional study involving 1,601 healthy elderly women (mean age, 71 years; range, 65-93 years), the occurrence of lower extremity arterial disease was assessed noninvasively by measuring brachial and ankle pressures bilaterally. Disease prevalence ranged from 2.9% in those aged 65-69 years to 15.5% in those aged 80 years or older. Approximately 20% of those with disease had symptoms of claudication. Age, systolic blood pressure, and current smoking status were strong independent risk factors for arterial disease; a history of arthritis, use of nonthiazide diuretics, current coffee drinking, and upper body obesity were also independent correlates. The number of pack-years in current and former smokers and the number of cigarettes per day used by current smokers showed a dose-response relation with disease. The population attributable risk for current smoking was 26%. The major correlates for symptomatic arterial disease were current smoking and systolic blood pressure. It is concluded that the major risk factors for lower extremity arterial disease in elderly women are similar to those in men. Preventive efforts should focus on smoking cessation and management of hypertension.

Aged↗
PubMed2002

Can custom-made biomechanic shoe orthoses prevent problems in the back and lower extremities? A randomized, controlled intervention trial of 146 military conscripts.

BACKGROUND: Shock-absorbing and biomechanic shoe orthoses are frequently used in the prevention and treatment of back and lower extremity problems. One review concludes that the former is clinically effective in relation to prevention, whereas the latter has been tested in only 1 randomized clinical trial, concluding that stress fractures could be prevented. OBJECTIVES: To investigate if biomechanic shoe orthoses can prevent problems in the back and lower extremities and if reducing the number of days off-duty because of back or lower extremity problems is possible. DESIGN: Prospective, randomized, controlled intervention trial. STUDY SUBJECTS: One female and 145 male military conscripts (aged 18 to 24 years), representing 25% of all new conscripts in a Danish regiment. METHOD: Health data were collected by questionnaires at initiation of the study and 3 months later. Custom-made biomechanic shoe orthoses to be worn in military boots were provided to all in the study group during the 3-month intervention period. No intervention was provided for the control group. Differences between the 2 groups were tested with the chi-square test, and statistical significance was accepted at P <.05. Risk ratio (RR), risk difference (ARR), numbers needed to prevent (NNP), and cost per successfully prevented case were calculated. OUTCOME VARIABLES: Outcome variables included self-reported back and/or lower extremity problems; specific problems in the back or knees or shin splints, Achilles tendonitis, sprained ankle, or other problems in the lower extremity; number of subjects with at least 1 day off-duty because of back or lower extremity problems and total number of days off-duty within the first 3 months of military service because of back or lower extremity problems. RESULTS: Results were significantly better in an actual-use analysis in the intervention group for total number of subjects with back or lower extremity problems (RR 0.7, ARR 19%, NNP 5, cost 98 US dollars); number of subjects with shin splints (RR 0.2, ARR 19%, NNP 5, cost 101 US dollars); number of off-duty days because of back or lower extremity problems (RR 0.6, ARR < 1%, NNP 200, cost 3750 US dollars). In an intention-to-treat analysis, a significant difference was found for only number of subjects with shin splints (RR 0.3, ARR 18%, NNP 6 cost 105 US dollars), whereas a worst-case analysis revealed no significant differences between the study groups. CONCLUSIONS: This study shows that it may be possible to prevent certain musculoskeletal problems in the back or lower extremities among military conscripts by using custom-made biomechanic shoe orthoses. However, because care-seeking for lower extremity problems is rare, using this method of prevention in military conscripts would be too costly. We also noted that the choice of statistical approach determined the outcome.

Adolescent↗
PubMedDate not supplied

Altered perceptions after upper and lower extremity blocks: an initial investigation.

BACKGROUND AND OBJECTIVES: Nerve blocks frequently produce unusual altered perceptions in the extremities. We examined perceptual changes experienced after peripheral blocks. METHODS: Fifty consecutive patients having an upper or lower extremity block for surgery participated in this prospective study. Patients were divided into 2 groups: upper extremity (n = 20) and lower extremity (n = 30). Each group was asked a list of questions about perceptions of limb sensation, length, weight, and location and given a detailed 2-point discrimination test over the V(1)-V(3) divisions of the trigeminal nerve prior to block and sedation. While the extremity was still blocked, the exam was repeated before postanesthesia care unit discharge. RESULTS: In both groups, 98% of patients described altered limb perception. The perceptions in the upper extremity were: heaviness, 60%; numbness, 50%; warmth, 40%; pain, 30%; full or fat, 20%; floating, 5%; shorter, 0%; or thinner, 10%. The perceptions in the lower extremity were: numbness, 75%; heaviness, 46%; warmth, 33%; pain, 32%; full or fat, 36%; floating, 25%; shorter, 18%, or thinner, 7%. Upper extremity block patients were more likely to describe the limb as lighter (P <.0001); the lower extremity group was more likely to describe the limb as numb (P =.01) or floating (P =.0002). There was no difference in the ability to correctly identify the location of the limb between the groups. There was no difference in 2-point discrimination between each assessment for either group. CONCLUSION: The results of this study confirm and quantify the perceptions experienced by patients undergoing upper and lower extremity blocks. These perceptions are prevalent. This knowledge is helpful in providing patients with accurate preoperative preparation. Further investigation is warranted to determine the neurologic etiology of these observations.

Adult↗
PubMed1992

[Laser puncture in the treatment of diabetic angiopathies of the lower extremities].

Laseropuncture in patients with diabetes mellitus associated with angiopathies of the lower extremities (grade II and III) produced a pronounced clinical effect which was manifested by removing the pain syndrome, improvement of the peripheral circulation and extremity function and function of the lower extremities, improvement of thermographic values. But this positive dynamics was more pronounced in angiopathies of the lower extremities of the stage of functional disorders than obliterating atherosclerosis of the legs. Sterility of the laser beam, possibility of local effect on biologically active points, non-painful procedure, absence of age limits and side effects allow to widely recommend this method for the treatment of Diabetes mellitus associated with angiopathies of the lower extremities.

Acupuncture Points↗
PubMed1976

The use of spermatic cord lymphatics in the relief of surgically created lower extremity edema. A preliminary report of experiments in dogs.

When lower extremity lymphedema is not amenable to control by medical methods, attempts to ameliorate the problem surgically have generally been unsatisfactory. The intact testis and spermatic cord provide a potential bridge that may permit communication between the unobstructed lymphatics of the gonadal system and the obstructed lymphatics of the lower extremity. Preliminary experience in male dogs wherein lower extremity lymphedema is first induced surgically and is treated by testicular implantation into the edematous thigh shows that lympholymphatic communications between the lower extremity and the gonadal system may result.

Animals↗