The effect of ankle joint immobilization on lower limb venous flow

Foot Ankle Int. 2015 Jan;36(1):18-23. doi: 10.1177/1071100714552823. Epub 2014 Sep 23.


Background: Below-knee cast immobilization is associated with an increased risk of developing deep vein thrombosis secondary to venous stasis. We investigated the effect of weight-bearing in a below-knee cast or pneumatic walking boot on lower limb venous blood flow.

Methods: Duplex ultrasonography was used to measure venous blood flow in the popliteal vein of 10 healthy volunteers. Venous blood flow was measured while at rest, ambulating non-weight-bearing, partial weight-bearing, and full weight-bearing. Measurements were performed without ankle joint immobilization, with the ankle immobilized in a neutral cast, and with the ankle immobilized in a pneumatic walking boot in both neutral and equinus.

Results: There was no significant reduction in venous blood flow measurements between full weight-bearing without ankle joint immobilization and full weight-bearing in a neutral cast or neutral pneumatic walking boot. However, venous blood flow was reduced when partial weight-bearing (50%) and when full weight-bearing in a pneumatic walking boot in equinus.

Conclusion: These results demonstrate that venous blood flow returned to normal levels when the subjects were permitted to fully bear weight in below-knee casts or walking boots, provided that the ankle joint was not in equinus.

Clinical relevance: Weight-bearing status and ankle joint position should be appreciated during decisions for the provision of chemical thromboprophylaxis.

Keywords: boot; cast; deep vein thrombosis.

MeSH terms

  • Adult
  • Casts, Surgical
  • Female
  • Foot Orthoses
  • Humans
  • Immobilization*
  • Leg / blood supply*
  • Male
  • Middle Aged
  • Popliteal Vein / physiology
  • Regional Blood Flow
  • Weight-Bearing / physiology*