The effect of active toe movement (AToM) on calf pump function and deep vein thrombosis in patients with acute foot and ankle trauma treated with cast - A prospective randomized study

Foot Ankle Surg. 2017 Sep;23(3):183-188. doi: 10.1016/j.fas.2016.04.007. Epub 2016 May 10.

Abstract

Background: Patients with foot and ankle trauma treated with cast are advised to perform toe movements to prevent venous thromboembolism (VTE). Our aim was to determine the effect of active toe movement on asymptomatic deep vein thrombosis (DVT) and venous calf pump function.

Methods: Patients aged 18-60 years with acute foot and ankle trauma requiring below knee non weight bearing cast were randomized to intervention (regular active toe movement) or control groups (n=100). Patients had bilateral lower limb venous ultrasound to assess for DVT on discharge from clinic. Patients requiring chemical thromboprophylaxis were excluded.

Results: 78 completed the study. 27% sustained asymptomatic DVT, with no statistically significant difference in calf pump function or DVT incidence between groups. All DVT's occurred in the injured lower limb.

Conclusion: Active toe movement is not a viable strategy for thromboprophylaxis in patients with acute foot and ankle trauma treated with cast.

Keywords: Deep vein thrombosis; Thromboprophylaxis; Venous thrombosis.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Ankle Injuries / therapy*
  • Casts, Surgical / adverse effects*
  • Female
  • Foot Injuries / therapy*
  • Fracture Fixation / adverse effects*
  • Fracture Fixation / methods
  • Humans
  • Male
  • Middle Aged
  • Movement
  • Muscle, Skeletal
  • Physical Therapy Modalities*
  • Prospective Studies
  • Regional Blood Flow
  • Toe Joint
  • Venous Thrombosis / diagnostic imaging
  • Venous Thrombosis / etiology
  • Venous Thrombosis / prevention & control*
  • Young Adult