Effect of foot stato-dynamic disorders on hemodynamics of the lower limb using strain-gauge plethysmography

Background: The plantar venous pump (PVP), composed of deep plantar veins, is the most distal contributor to venous return from the lower limbs. A pressing need still exists to assess how plantar muscle contraction and gait affect PVP function, how foot stato-dynamic disorders (FSDs) can contribute to venous insufficiency, and how venous return can be optimally stimulated. Our first objective is to compare the venous blood hemodynamics in lower limbs between healthy subjects with a FSD and healthy subjects without a FSD to understand the influence of foot morphology in the performance of the PVP. Our second objective is to evaluate whether PVP function varies with different plantar pressures. Methods: A total of 52 healthy volunteers (26 feet with a normal arch as the control group and 26 feet with dysmorphism [13 flat feet and 13 hollow feet]) were included. Strain-gauge plethysmography was performed 8 cm above the medial malleolus at different conditions of PVP stimulation: (1) toe flexion, (2) intermittent pneumatic compression (IPC) with and without an insole, and (3) 3-km/h speed walking on a treadmill barefoot, with shoes, and with shoes and insoles. From the strain-gauge plethysmography, we measured the venous blood ejection fraction (EF). From the pressure sensor placed at the midfoot on the plantar arch during IPC, we obtained the maximal pressure (N/cm²). Results: Toe flexion allowed for ejection of an average of 20% of the total venous volume in both groups. IPC and gait generated a mean EF superior to 100% of the available venous volume. The maximal pressure applied at the midfoot during IPC was lower than the pressure set. No significant differences in the EF or maximal pressure were observed between the two groups. The mean EF was not significantly affected for the pronator and supinator walkers compared with those with normal walking dynamics. Wearing shoes did not significantly affect the mean EF. However, wearing insoles during gait significantly increased the venous return in feet with plantar dysmorphism. Conclusions: To the best of our knowledge, this clinical study is the first to assess the PVP function in 52 healthy volunteers with and without FSDs. We found that wearing shoes did not significantly affect PVP efficiency but that wearing morphologically adapted insoles significantly improved the venous return in the dysmorphic feet. In our sample of healthy volunteers, the differences observed between the control group and feet with FSDs were not statistically significant.