OTA 1997 Posters - Foot & Ankle Fractures

*Facilitating Edema Resolution with a "Foot Pump" after Calcaneus Fracture

David B. Thordarson, MD, Nathan Greene, MD, Mark Perlman, MD

LAC and USC Medical Center, Los Angeles, California, USA

Purpose: The purpose of the study was to determine whether the use of a foot pump (intermittent pneumatic pedal compression device) leads to more rapid resolution of preoperative edema following an acute fracture of the calcaneus in a prospective randomized fashion.

Methods: After obtaining institutional review board approval, 27 patients were enrolled in the study (13 patients in the foot pump group and 14 patients in the control group). The inclusion criteria for this study included a closed, displaced intra-articular calcaneus fracture awaiting surgery with excessive edema precluding operative intervention upon admission (negative wrinkle test). After signing the informed consent, the patient was randomized to the control group or the foot pump group. The patients in the control group were treated with a bulky Jones dressing and elevation. The patients in the foot pump (NuTech®; PlexiPulse®) group had a foot pump applied with a posterior splint applied over the foot pump and the leg elevated. The PlexiPulse device works by intermittently compressing the veins in the foot, facilitating venous drainage. The pump rapidly inflates in less than one second, compresses the foot temporarily, and then deflates. On the standard settings used for this study, the pump compressed the foot approximately three times each minute. The degree of compression was adjusted to the patient's tolerance. The device was used full-time during the period of time awaiting surgery. A baseline volumetric measurement of the injured foot was made by placing it in a container previously filled to capacity and measuring the amount of water displaced by immersing the foot until the sole touched the bottom of the container. Each day following enrollment in the study, the splint and/or foot pump was removed and a repeat volumetric measurement was obtained of the injured extremity. The change in the volume in the foot between day 1 and 2, day 1 and 3, and day 1 and 4 were compared with an unpaired T-test.

Results: All 13 patients tolerated the foot pump. In fact, some patients noted pain relief with the use of the pump. The changes in the foot volume are presented below in a table.

	Day 1-2 (change volume ml)	Day 1-3 (change volume ml)	Day 1-4 (change volume ml)
Foot Pump	-37 (n = 13)	-96 (n = 11)	-276 (n = 8)
Control	+71 (n = 14)	+40 (n = 13)	+45 (n = 10)
Difference (Foot Pump-Control)	108	136	321
p Value	.048	.018	.103

Discussion: Most calcaneus fractures are complicated by significant edema secondary to hemorrhage, soft tissue injury and inflammation. Frequently, operative fixation of calcaneus fractures is delayed until initial edema resolution has begun. In some instances, the patient will spend days in the hospital with their extremity elevated in a compressive dressing awaiting edema resolution in order to proceed safely with surgery. Others will be sent home to await adequate edema resolution in order to proceed with surgery. We demonstrated a significant decrease in edema which progressed in the first 72 hours of treatment with the foot pump. More rapid edema resolution as demonstrated in this study could decrease the typical hospital stay for patients following calcaneus fractures. In addition, this device can be used on outpatients awaiting edema resolution prior to proceeding with surgery. With less edema following this type of fracture, the risk of wound dehiscence could be lowered.

Conclusion: A significant progressive decrease in the foot volume was noted during the first 72 hours following application of a foot pump in patients with severe edema precluding operative fixation of calcaneus fractures. The pump was well-tolerated by all the patients in the study and we believe serves as a useful adjunct in the preoperative edema resolution following these complicated fractures.