Plantar flexion test as first choice for evaluating patients with intermittent claudication
AIM
Stress tests are used to find out if patients have intermittent claudication when they appear normal in rest. The treadmill tests are used as first choice in our department.
One problem with the treadmill test is that the patients has to walk in a fast pace. Not all patients can walk sufficiently, and the treadmill test cannot be made.
Another problem is that the treadmill test including the cardiovascular system. Patients with ischemic heart disease can not make the treadmill test. A second contraindication is chronic obstructive pulmonary disease.
Plantar flexion is an exercise known to use mainly the calf muscles.
In this study, I want to find out, if we can use the plantar flexion test as first choice for patients with intermittent claudication symptoms and a normal rest study.
MATERIALS AND METHODS
There was 27 patients (54 legs) included in this study. All the patients has a normal distal blood pressure (DBP) in rest, and symptoms of intermittent claudication
All the patients had a distal blood pressure (DBP) done before the two tests
Half the patients started with the treadmill test, then rested in 30 min. and after that performed the plantar flexion test. The other half did the plantar flexion test first, and then 30 min. rest, and then the treadmill test.
The ankle index was calculated (DBP/systolic arm blood pressure) for the rest and the stress study. A decrease in the ankle index at least 0,15 compared to the rest study is considered significant and the test is positive.
RESULTS
Our study shows specificity at 100 % and sensitivity at 56%.
CONCLUSION
Our study shows that the plantar flexion tests find all the positive patients. We can conclude that we can use the plantar flexion test as first choice for patients with intermittent claudication symptoms and a normal rest study.
If the plantar flexion test is negative we go on with the treadmill test.