title: Venous insufficiency and foot dysmorphism: effectiveness of visco-elastic rehabilitation systems on veno-muscle system of the foot and of the calf.
abstract: Chronic venous disease is very common and widespread. Chronic Venous Insufficiency (CVI) is a condition characterized by hypertension of the venous system of the lower limbs which manifests itself through a large range of symptoms. The main cause of CVI is hypertension of the venous system of lower limbs, which in most cases is due to reflux for the incontinence of the valvar system of veins. Other causes are related to obstruction of the venous outflow, or at a reduced venous emptying due to inefficiency of the system of the veno-muscular pumps of the calf and of the foot. The purpose of this study was to evaluate if the use of a non-invasive rehabilitative mode to improve the efficiency of the veno-muscular pumps of the foot and of the calf using photoplethysmography in reflected light. Fifty (50) patients suffering from flatfoot and ped cavus, were studied doing a stabilometric and baropodometric test to evaluate the angle of the foot and the podalic angle. Patients were evaluated by examining vascular examination and venous reography in basal condition, using corrective visco-elastic insoles for the correction of dysmorphisms that we were studying. An improvement of the angle of the Right and Left axis (p<0.05) and the podalic angle (p<0.001), using the right insole both in the flatfoot and cavus foot, was shown by the podobarographic examination. A not important tendency to improvement was also shown by the use of non-specific insole in both pathologies. The vascular examination showed an improvement of 38 percent in venous emptying capacity of the foot/calf veno-muscular pump in cavus foot with the specific B insole (p<0.002). An important improvement of 24 percent, using the specific A insole (p<0.05), was documented in flatfoot. The photoplethysmography examination documented a significant improvement of the venous emptying capacity of foot-calf veno-muscular system due to the use of specific insoles for the studied dysmorphism, with an improving tendency even with the use of non-specific insoles. The hemodynamic improvement is correlated with the improvement of the analyzed biomechanical parameters: contact time, lenght of the halfstep, podalic angle and angle of the foot. The partial normalization of biomechanical parameters allows a reorganization of relationships of forces between ground and foot, as well as the improvement of the function of the subtalar joint, causing a partial recovery of the complex physiological mechanism of activation of the veno-muscular pumps of the foot and of the calf.
authors.affiliation: Department of Basic Medical and Applied Sciences, University of Chieti-Pescara, Chieti 66013, Italy. saggini@unich.it
authors.forename: R
authors.initials: R
authors.lastname: Saggini
authors.forename: R G
authors.initials: RG
authors.lastname: Bellomo
authors.forename: P
authors.initials: P
authors.lastname: Iodice
authors.forename: G
authors.initials: G
authors.lastname: Lessiani
mesh_terms: D000328:Adult; D000842:Ankle / Q000098:blood supply; D005413:Flatfoot / Q000503:physiopathology / Q000534:rehabilitation*; D005528:Foot / Q000098:blood supply*; D005530:Foot Deformities / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D018482:Muscle, Skeletal / Q000503:physiopathology; D017156:Photoplethysmography; D014680:Veins / Q000503:physiopathology; D014689:Venous Insufficiency / Q000503:physiopathology / Q000534:rehabilitation*; D016138:Walking