title: Does squatting worsen lower limb ischemia in patients with peripheral arterial disease?
abstract: Peripheral arterial disease (PAD) is an important cause of morbidity and mortality in the world affecting up to 20% in people over 70 years of age. The prevalence is increasing in India due to combined effects of increased life expectancy, increased tobacco smoking and increased prevalence of diabetes mellitus. The aim of the study was to examine the hypothesis whether squatting posture reduces blood flow to lower limbs resulting in worsening of symptoms of lower limb ischemia in patients with PAD. 10 patients with arterial disorders due to thromboangiitis obliterans (TAO), atherosclerosis and diabetic macro vascular disease were selected for patients and were compared with 10 healthy volunteers as controls. Clinical examination and duplex scan of posterior tibial artery (PTA) and dorsalis pedis artery (DPA) performed in standing and squatting position in a clinical environment. They were asked about symptoms of numbness, ischemic pain and the results were noted. Results were tabulated and analysed using Microsoft Excel®. Members in the control group complained of numbness of both the limbs after a period of 30 min on an average. In the patients group, members while squatting complained of numbness in the involved limb within 5 min. They complained of ischemic pain in the involved limb within 10 min and developed numbness in the opposite limb in within 15 min. Posterior tibial artery and dorsalis pedis artery pulsations disappeared for the entire duration of squatting in both groups as confirmed by duplex scanning. It may be recommended that patients with established peripheral vascular disease should avoid squatting position, even if it is for a very short period of time. It is desirable to advice such patients to use appropriate structures as supports which will allow them to work without squatting. This may also necessitate a change in occupation.
authors.affiliation: Wansbeck General Hospital, Ashington, NE63 9JJ United Kingdom.
authors.forename: Gargeshwari Krishnamurthy Guru
authors.initials: GK
authors.lastname: Raghavendra
keywords: Ischemia reperfusion injury; Peripheral arterial disease; Squatting
references.citation: Am J Physiol Heart Circ Physiol. 2007 Dec;293(6):H3685-91
references.pmid: 17921328
references.citation: Int J Epidemiol. 1991 Jun;20(2):384-92
references.pmid: 1917239
references.citation: Arterioscler Thromb Vasc Biol. 1998 Feb;18(2):185-92
references.pmid: 9484982
references.citation: Am J Med. 2002 Jan;112(1):49-57
references.pmid: 11812407
references.citation: Atherosclerosis. 2004 Jan;172(1):95-105
references.pmid: 14709362