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At least 73 records · Page 4Linked to original sources
PubMed1998

Reliability study of the Leg-O-Meter, an improved tape measure device, in patients with chronic venous insufficiency of the leg. VEINES Group.(Venous Insufficiency Epidemiologic and Economic Study).

The objective of this study was to evaluate the inter-rater reliability of the Leg-O-Meter, an instrument designed to measure the ankle or calf circumference. The Leg-O-Meter consists of a tape measure fixed to a stand attached to a small board on which the patient is in standing position. For this study the tape measure of the Leg-O-Meter was fixed at 10 cm from the board in order to standardize all measurements. Informed consent to participate in the study was obtained from 39 patients consulting the phlebology clinic of Hôpital St-Michel, Paris, France. Participants were asked to enter a closed room where four independent and blinded observers consecutively took measurements of both legs with the Leg-O-Meter. The order of the observers was randomized between patients. Under the assumption of a two-way random effects model an intraclass correlation coefficient (ICC) was used to determine the reliability or reproducibility of a measure with the Leg-O-Meter. The overall reliability coefficient calculated by the ICC for the right and left leg were estimated at 97.09% [95.52%;100%]95% and 97.08% [95.86%;100%]95%, respectively. The authors conclude that the Leg-O-Meter gives a standardized and reliable measure of the circumference of the ankle. Furthermore, it is not invasive or costly.

Analysis of Variance↗
PubMed2005

Assessment of nutritional status in adult patients with cystic fibrosis: whole-body bioimpedance vs body mass index, skinfolds, and leg-to-leg bioimpedance.

OBJECTIVE: To investigate whether body mass index (BMI) or body fat percentage estimated from BMI, skinfolds, or leg-to-leg bioimpedance are good indicators of nutritional status in adult patients with cystic fibrosis. Body fat percentage measured by whole-body bioimpedance was used as the reference method. DESIGN: Cross-sectional study using four methods to estimate body fat percentage. All patients filled out a food frequency and a physical activity questionnaire for assessment of their habitual food intake and energy requirements, respectively. SUBJECTS/SETTING: Thirty-five adult patients (23 men/12 women) with cystic fibrosis, age range 18 to 46 years, were measured during their yearly visit at the outpatient clinic of the Cystic Fibrosis Center in Utrecht, the Netherlands. STATISTICAL ANALYSIS: Mean+/-standard deviation was calculated for all measurements and 95% confidence intervals for differences between methods. Bland-Altman plots were used to assess differences between the measures of body composition and Pearson correlation coefficients were calculated to determine the relationships between them, and between the energy requirements and the energy intakes. RESULTS: For men the whole-body body fat percentage reference was 14.1%+/-3.0, body fat percentage estimated from BMI was 15.8%+/-4.3, body fat percentage estimated from skinfolds was 8.6%+/-4.8, and body fat percentage estimated from leg-to-leg bioimpedance was 13.1%+/-4.9. For women the whole-body body fat percentage reference was 24.0%+/-5.9, body fat percentage estimated from BMI was 25.1%+/-4.0, body fat percentage estimated from skinfolds was 17.0%+/-4.8, and body fat percentage estimated from leg-to-leg bioimpedance was 25.0%+/-6.9. Body fat percentage estimated from BMI and body fat percentage estimated from skinfolds were significantly different from the reference value for body fat percentage (P <.05). The correlation coefficients between the reference body fat percentage and body fat percentage estimated from BMI, from skinfolds, and from leg-to-leg bioimpedance were all more than 0.72. In all but one patient, nutritional status was correctly assessed by BMI: those with a BMI less than 18.5 had body fat percentage less than 10% (men) or less than 20% (women). The mean energy intake of the men was 141% of the Recommended Dietary Allowance as proposed in European and Dutch guidelines. The mean energy intake of the women was 94% of the Recommended Dietary Allowance. CONCLUSIONS: A simple calculation of BMI is adequate to diagnose nutritional status in adult patients with cystic fibrosis. Bioimpedance measurements are only needed when nutritional therapy specifically focuses on lean body mass.

Adipose Tissue↗
PubMed2001

Restless Legs Syndrome: scoring criteria for leg movements recorded during the suggested immobilization test.

Objective: To evaluate the characteristics of leg movements experienced by patients with the restless legs syndrome (RLS) during wakefulness using the suggested immobilization test (SIT).Methods: Forty patients with primary RLS who showed an index of leg movements greater than 40 during the SIT were selected for these analyses.Results: In general, Coleman's criteria for scoring PLMS were appropriate for scoring leg movements during the SIT. However, a substantial number of leg movements lasted between 5 and 10 s, exceeding Coleman's maximum duration criterion. The other criteria used to score PLMS (i.e. movements separated by 4-90 s and occurring in series of four consecutive movements) allowed detection of more than 90% of all leg movements recorded during the SIT. The distribution of inter-movement intervals (IMI) suggests that a great majority of leg movements recorded during the SIT are periodic, with a modal value of IMI between 11-12 s.Conclusion: Considering that leg movements recorded during the SIT last longer than those occurring during sleep, we recommend using a duration criterion of 0.5-10 s for scoring the former. We also recommend using the same periodicity criteria for the SIT as those used for scoring PLMS.

Journal Article↗
PubMed2005

Is leg-to-leg BIA valid for predicting minimum weight in wrestlers?

BACKGROUND: The National Collegiate Athletic Association (NCAA) and several state associations require prediction of minimum weight (MW) for collegiate and high school wrestlers. The rule requires assessment of body composition before the competitive season to minimize unhealthy weight-loss practices. Leg-to-leg bioelectrical impedance analysis (BIA) has been suggested for use with wrestlers. PURPOSE: To evaluate leg-to-leg BIA against a four-component (4C) criterion to determine whether leg-to-leg BIA predicted MW within acceptable limits for the sport of wrestling. METHODS: Criterion MW was calculated by the 4C equation of Lohman (19) using independent measurement of body density (BD) by hydrostatic weighing, bone mineral content (BMC) by dual x-ray absorptiometry (DXA), and total body water (TBW) by deuterium dilution. Subjects were 57 wrestlers (mean +/- SD; age = 19.7 +/- 1.3 yr, height = 176.6 +/- 7.3 cm, weight = 77.7 +/- 12.4 kg). Hydration was confirmed by the NCAA guidelines. Accuracy, precision, and systematic bias were examined. RESULTS: Comparable mean values (72.2 +/- 9.7 vs 72.2 +/- 10.3 kg), a high correlation (r = 0.94), and a regression line similar to the line of identity were found between BIA and 4C. However, large individual differences and systematic bias were seen across the range of MW. BIA predicted MW within 3.5 kg 68% of the time and within 7.0 kg 95% of the time. MW residuals ranged from -10.4 kg to +6.9 kg. When using 2.0 kg as an acceptable cutoff for error, only 40% of the BIA values were within 2.0 kg of the criterion. CONCLUSION: Large individual variation was seen, and, by definition, the precision was poor when estimating MW for individuals. In practical terms, the prediction error may span multiple weight classes, thus making leg-to-leg BIA unacceptable for prediction of MW in this sample under the conditions of the study.

Absorptiometry, Photon↗
PubMed2000

Leg ulcers in peripheral arterial disease (arterial leg ulcers): impaired wound healing above the threshold of chronic critical limb ischemia.

BACKGROUND: Peripheral arterial disease is the only identifiable etiology in approximately 10% of leg ulcers. Clinical data on the management of these chronic wounds are scarce. OBJECTIVE: We attempted to outline the threshold of systolic ankle pressure and ankle-brachial-index (ABI) below which arterial leg ulcers can occur and to outline the indication for revascularization in arterial leg ulcers. METHODS: Diagnostic and outcome analysis was performed for 26 consecutive patients with arterial leg ulcers. We calculated sensitivities, specificities, and receiver operating characteristic (ROC) curves for the identification of arterial leg ulcers among all 223 consecutive leg ulcer patients within a 3-year period, as well as the ROC curve for patients who required revascularization. RESULTS: The systolic ankle pressure was 88 (18-130) mm Hg (median; 95% confidence interval) and the ABI was 0.60 (0.15-0.86), respectively. Eighteen patients (69%) were subjected to revascularization. By the end of the study, 24 patients (92%) healed completely, 1 improved (90% wound closure), and 1 patient had to undergo below-knee amputation for chronic osteomyelitis. During this study, the ankle pressure and ABI were poor in distinguishing those patients who required revascularization from those who healed without revascularization. CONCLUSION: Most arterial leg ulcers do not meet the criteria of chronic critical limb ischemia, but they do not heal under conservative measures, either. A majority of these patients benefit from revascularization and should, therefore, be referred for arterial duplex ultrasound investigation or angiography. In our study, an ankle pressure below 110 mm Hg identified all patients (100%) who were subjected to revascularization procedures. However, controlled clinical studies are required to find the systolic ankle pressure and ABI below which revascularization can be recommended to speed up the healing time.

Aged↗
PubMed1998

Effect of pergolide on restless legs and leg movements in sleep in uremic patients.

Restless legs syndrome (RLS) and periodic limb movements in sleep (PLMS) are disorders that are common and disturbing to uremic patients. The treatment of these is problematic. Eight patients on chronic hemodialysis and continuous peritoneal dialysis completed a double-blind placebo-controlled crossover study using incremental doses of pergolide up to 0.25 mg at bedtime for treatment of RLS and sleep disruption. Five patients (62.5%) noted subjective improvement in restless legs symptoms and sleep quality. Objective results were improved only slightly by treatment. The percentage of the first hour in bed during which leg movements occurred decreased from 20.5 +/- 6.0 to 11.5 +/- 3.3, p < 0.05. However, findings during sleep were less positive. The following measures were not significant between placebo and treatment: leg movements per hour of sleep [53.7 +/- 22.3 vs 35.8 +/- 11.8 (p = 0.2)]; and percentage of sleep time spent with leg movements [5.5% +/- 3.2 vs 4.4% +/- 1.4 (p = 0.37)]. Patients continued to have very disrupted sleep, and we could not document an objective improvement in sleep architecture. Thus, although pergolide at the dose of 0.25 mg at bedtime provided subjective improvement in symptoms of restless legs and quality of sleep, and objectively decreased leg movements during the first hour in bed, objectively sleep continued to be disrupted. In this small patient group, the response to pergolide was not uniform, and further investigation is required to test effectiveness at higher doses.

Adult↗
PubMed1998

Leg blood flow during slow head-down tilt with and without leg venous congestion.

The effects of slow changes in body position on leg blood flow (LBF) were studied in nine healthy male subjects. Using a tilt table, sitting volunteers were tilted about 60 degrees backwards to a supine position within 40 s. To modify the venous filling in the legs, the tilt manoeuvre was repeated with congestion of the leg veins induced by two thigh cuffs inflated to a subdiastolic pressure of 60 mmHg. Doppler measurements in the femoral artery were used to estimate LBF. Additional Doppler measurements at the aortic root in five of the subjects were taken for the determination of cardiac output. The LBF was influenced by body position. In the control experiment it increased from 500 ml x min(-1) in the upright to 780 ml x min(-1) after 15 min in the supine position. A mean maximal value of 950 ml x min(-1) was observed 20 s after the tilt. Heart rate remained almost constant during the tilt phase, whereas stroke volume increased from 90 ml to 120 ml and it remained at that level after the cessation of the tilt. Congestion of the leg veins had no significant effect on heart rate, stroke volume and mean blood pressure. However, it increased vascular resistance of the leg during and after the tilt. After 15 min in the tilted position LBF amounted to 600 ml x min(-1). The results suggest that the filling of the leg veins is inversely related to leg blood flow. The most likely mechanism underlying this observation is a local effect of venous filling on vasomotor tone.

Adult↗
PubMed1988

[Measuring leg length and leg length difference with the method of real time sonography].

A brief presentation of the clinical and radiological methods to measure the leg length and the leg length difference is followed by an outline of the new diagnostic method for measuring the leg length and the leg length difference by means of real-time sonography. Tests conducted on corpses, as well as clinical examples, show that sonography is an ideal method for determining the exact lengths of the femur and tibia. The joint gaps on the hip joint, knee joint and upper ankle joint can be visualised by means of a 5 MHz linear scanner. A 1 mm strong metal bar on the skin and under the scanner are positioned at a right angle to the longitudinal axis of the body so that the bar can be seen in the centre of each joint gap by means of real-time sonography. A measuring device gives the distances of the joint gaps in cm so that the differences correspond to the real length of femur and tibia. This standardised measuring procedure is done by a specially developed bearing and measuring device. The results of the sonographical measurings on 20 corpses and checking after consecutive dissections showed in 75% of the cases a 100% sonographic measuring accuracy of the total leg length. The separately considered results for femur (85%) and tibia (90%) were even better. The maximum sonographic measuring fault was 1.0 cm for the femur (in one case) and 0.5 cm for the tibia, respectively. Thus, sonographic measuring of the leg length offers a reliable, non-invasive and easily performed new method that can be repeated any number of times. It is ideal for the development control of therapeutically influenced as well as spontaneous transformations of leg length differences.

Aged↗
PubMed1988

Leg size and muscle functions associated with leg compliance.

Leg compliance is "causally related with greater susceptibility" to orthostatic stress. Since peak O2 uptake (peak VO2) and muscle strength may be related to leg compliance, we examined the relationships between leg compliance and factors related to muscle size and physical fitness. Ten healthy men, 25-52 yr, underwent tests for determination of vascular compliance of the calf (Whitney mercury strain gauge), peak VO2 (Bruce treadmill), calf muscle strength (Cybex isokinetic dynamometer), body composition (densitometry), and anthropometric measurements of the calf. Cross-sectional areas (CSA) of muscle, fat, and bone in the calf were determined by computed tomography scans. Leg compliance was not significantly correlated with any variables associated with physical fitness per se (peak VO2, calf strength, age, body weight, or composition). Leg compliance correlated with calf CSA (r = -0.72, P less than 0.02) and calculated calf volume (r = -0.67, P less than 0.03). The most dominant contributing factor to the determination of leg compliance was CSA of calf muscle (r = -0.60, P less than 0.06), whereas fat and bone were poor predictors (r = -0.11 and 0.07, respectively). We suggest that leg compliance is less when there is a large muscle mass providing structural support to limit expansion of the veins. This relationship is independent of aerobic and/or strength fitness level of the individual.

Adult↗
PubMed1985

A comparison of one-legged and two-legged countermovement jumps.

Ten well-trained male volleyball players performed one-legged and two-legged vertical countermovement jumps. Ground reaction forces, cinematographic data, and electromyographic data were recorded. Jumping height in one-legged jumps was 58.5% of that reached in two-legged jumps. Mean net torques in hip and ankle joints were higher in one-legged jumps. Net power output in the ankle joint was extremely high in one-legged jumps. This high power output was explained by a higher level of activation in both heads of m. gastrocnemius in the one-legged jump. A higher level of activation was also found in m. vastus medialis. These differences between unilateral and bilateral performance of the complex movement jumping were shown to be in agreement with differences reported in literature based on isometric and isokinetic experiments.

Ankle Joint↗
PubMed2002

[The medial saphenous hetero (cross leg) flap in coverage of soft tissue defects of the leg and foot].

PURPOSE OF THE STUDY: Reconstruction of large areas of soft tissue defects of the lower limb is a major challenge, particularly when the zone involves the lower part of the leg and the foot. The cross-leg flap can be a reliable alternative to free flaps, both in adults and children. We analyzed our experience in a retrospective series of 26 patients who underwent a standardize surgical procedure. MATERIAL AND METHODS: Twenty-six cross-leg flap procedures were performed between 1984 and 2000 using the same technique. Mean patient age was 32 years (range 7-67 years). All patients were trauma victims. Mean delay from trauma to flap reconstruction was 2.5 years (range 18 days-16 years). A free flap or loco-regional flap for coverage had been unsuccessful in 19 patients. The zones involved were: leg (n=7), anterior ankle area (n=3), malleolar area (n=2), dorsal aspect of the foot (n=1), heal (n=11, including 4 in an exclusively non-weight-bearing area). Mean patient follow-up was 3 years (1-10 years). The same surgical technique with external fixation was used for all patients. The flap was harvested according to a standard technique with ratios ranging from 3: 1 to 4: 1. The donor site and the flap pedicle were covered with a thin skin flap, at least during the first operative time. During the first operative time, the recipient site was resected to the exact size of the flap, the remaining coverage was achieved during the weaning process using part of the flap pedicle. Weaning was achieved after a mean 27 days (21-38 days). RESULTS: Complete flap necrosis occurred in one case and partial necrosis in six. Punctual necrosis was observed in five cases requiring revision surgery or local care. One abscess of the donor site occurred two years after flap reconstruction. Coverage was satisfactory for leg and ankle reconstructions, with no recurrent ulcerations or hyperkeratosis at last follow-up. A satisfactory esthetic aspect was achieved in all cases. For foot reconstructions, ulcerations or hyperkeratosis of the plantar skin-flap junction was observed in five cases. All of the patients were however able to wear normal shoes and felt there had been an improvement after surgery. DISCUSSION: The cross-leg flap procedure should, in our opinion, be used in three situations. i) After failure of other techniques: results are very reliable for salvage procedures; 19 of our 26 patients had had failed free or loco-regional flap procedures prior to the cross-leg flap. ii) The reconstruction is large and blood supply contraindicates a free flap procedure (only one intact vascular axis). iii) The entire heal area to be reconstructed would be insufficiently covered by a free flap. Most of the long-term problems are related to heal coverage in weight-bearing areas.

Abscess↗
PubMed2006

Passive leg movements and passive cycling do not alter arterial leg blood flow in subjects with spinal cord injury.

BACKGROUND AND PURPOSE: Subjects with a spinal cord injury (SCI) are at increased risk for cardiovascular disease-related secondary complications, such as pressure ulcers and attenuated wound healing. It has been suggested that passive exercise enhances blood flow via mechanical pump effects or reflex activation. The purpose of this study was to assess the effects of passive leg movements and passive cycling on the arterial circulation in subjects with SCI. SUBJECTS: Eight men with motor complete SCI and 8 male control subjects participated. METHODS: Echo Doppler measurements were obtained to measure leg blood flow at rest, during and after 10 minutes of standardized passive leg movements, and during and after 20 minutes of passive leg cycling. Blood pressure was measured continuously, and total vascular resistance and leg vascular resistance were calculated. RESULTS: In both groups, no changes in leg blood flow, vascular resistance, or blood pressure were observed during or after the 2 interventions. DISCUSSION AND CONCLUSION: The results of the study demonstrate that passive leg movements and passive cycling do not alter the arterial peripheral circulation in subjects with SCI or control subjects. Although the results do not support the use of passive movements or exercise for the prevention of cardiovascular disease-related secondary complications, physical therapists should not be dissuaded from using these techniques to address musculoskeletal concerns.

Adult↗
PubMed2005

Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance.

BACKGROUND: Leg-length inequality is most often divided into two groups: anatomic and functional. Part I of this review analyses data collected on anatomic leg-length inequality relative to prevalence, magnitude, effects and clinical significance. Part II examines the functional "short leg" including anatomic-functional relationships, and provides an outline for clinical decision-making. METHODS: Online database--Medline, CINAHL and MANTIS--and library searches for the time frame of 1970-2005 were done using the term "leg-length inequality". RESULTS AND DISCUSSION: Using data on leg-length inequality obtained by accurate and reliable x-ray methods, the prevalence of anatomic inequality was found to be 90%, the mean magnitude of anatomic inequality was 5.2 mm (SD 4.1). The evidence suggests that, for most people, anatomic leg-length inequality does not appear to be clinically significant until the magnitude reaches approximately 20 mm (approximately 3/4"). CONCLUSION: Anatomic leg-length inequality is near universal, but the average magnitude is small and not likely to be clinically significant.

Journal Article↗
PubMed2002

Associations between symptoms of inattention, hyperactivity, restless legs, and periodic leg movements.

STUDY OBJECTIVES: Attention-deficit/hyperactivity disorder (ADHD) has shown associations with restless legs syndrome (RLS) and periodic leg movements during sleep (PLMS) among small samples of referred children, but whether RLS or PLMS are common more generally among hyperactive children has not been well studied. DESIGN: Cross-sectional survey. SETTING: Two university-affiliated but community-based general pediatrics clinics. PATIENTS: N=866 children (469 boys), aged 2.0 to 13.9 years (mean 6.8+/-3.2 years), with clinic appointments. INTERVENTIONS: N/A. MEASUREMENTS: A validated Pediatric Sleep Questionnaire assessed for PLMS (a 6-item subscale), restless legs, growing pains, and several potential confounds of an association between behavior and PLMS or RLS. Parents also completed two common behavioral measures, a DSM-IV-derived inattention/hyperactivity scale (IHS) and the hyperactivity index (HI, expressed as a t-score) of the Conners' Parent Rating Scale. RESULTS: Restless legs were reported in 17% (95% C.I. [15, 20]) of the subjects. Positive HI scores (>60) were found in 13% [11, 16] of all subjects, 18% [12, 25] of children with restless legs, and 11% [9, 14] of children without restless legs (chi-square p<0.05). Odds ratios between HI>60 and each of the following were: a one-s.d. increase in the overall PLMS score, 1.6 [1.4, 1.9]; restless legs, 1.9 [1.1, 3.2]; and growing pains, 1.9 [0.9, 3.6] (all age and sex-adjusted). Results were similar for high IHS scores (>1.25). The associations between each behavioral measure and the PLMS score retained significance after statistical adjustment for sleepiness, snoring, restless sleep in general, or stimulant use. CONCLUSIONS: Inattention and hyperactivity among general pediatric patients are associated with symptoms of PLMS and RLS. If either condition contributes to hyperactivity, the magnitude of association suggests an important public health problem.

Attention Deficit Disorder with Hyperactivity↗
PubMedDate not supplied

[Results of treatment of lower leg fractures with functional lower leg casts].

INTRODUCTION: Problems, consequences and influence of immobilization on tissue and fracture healing, as well as patient's psyche and entire condition of the organism, are well known. With immobilisation patient looses a part of extremity movement. Healing of fractures and remaining tissues is a natural process, so it is usually said that fractures and tissues heal not because of immobilization, but in spite of it. The theory of treating by functional cast (PTB-patellar tendon bearing), firstly described by Sarmiento, is based on tissues natural capability to heal and on its functional guiding to the final cause. The aim of this study is to analyze our previous expirience in regard to this method. MATERIAL AND METHODS: We have studied patients from 7 to 70 years of age with fracture of one or both lower leg bones. After injury, patients were mobilized using upper leg plaster impregned bandages applied to two thirds of extremity's circumference. After X-ray control and locating the position of broken parts, patients were released with thromboprophylaxis using Acetilsalycil acid (Midol) 3 x 1 tablet per day. In some cases, where reduction of broken fragment was hard, total anesthesia was performed. In cases of oblique and spiral fractures, because of possible redislocation we have waited with application of lower leg functional cast up to 3 weeks. RESULTS: We have studied 59 patients, most of them between the age of 11 and 20. In most cases functional cast was applied after 21 to 30 days, fractures healed after 90 to 99 days and the shortening of extremities was clinically non measureable. Usually it was 24 mm. DISCUSSION: Treatment of lower leg fractures is not simple. We especially point to problems with circulation and skin which have to be controlled over and over. There are reports of rejecting operational method as a method for lower leg fracture treating. Our results are the same as those achieved by other authors. Reposition of bone fragments must be performed with special attention. It is best if it is performed during total anesthesia, because muscles are relaxed and therefore circulation gets better, intensity of pain decreases and there are no skin necroses. In few cases, at the beginning of treatment there were skin blisters which only lengthened the treatment. These problems were prevented by early reposition, retention of bone parts and elevation of extremities. CONCLUSION: Lower leg functional cast gives excellent results in treating diaphyseal lower leg fractures. Early mobilization positively influences the patient's psyche and enables quick resocialization. Physical treatment is usually not necessary.

Adolescent↗
PubMed1996

Chronic critical leg ischaemia must include leg ulcers.

OBJECTIVES: In a previous series on conservative treatment in patients with leg ulcers and severe arterial occlusive disease (systolic digital blood pressure (SDBP) < 30 mmHg) a 70% risk of leg amputation and a negligeable potential for ulcerhealing was found. This series assess the efficacy of arterial reconstruction in such patients. DESIGN: Retrospective study of consecutive patients in a department of vascular surgery and of dermatology in cooperation with the wound healing center. MATERIAL AND METHODS: Thirty-nine patients with 42 ulcerated legs underwent arterial revascularisation. 88% of the procedures were distal to the inguinal ligament. MAIN RESULTS: One patient died postoperatively (3%). Seven (18%) had wound complications, but none had graft infections. After 1 year the cumulative secondary patency was 90%, ulcer healing 70% and the limb salvage 90%. Thus only four legs (10%) had been amputated. CONCLUSIONS: Arterial revascularisation for leg ulcers is indicated when conservative treatment fails. Legs with ulceration and SDBP < 30 mmHg should be included in the concept of chronic critical ischaemia.

Aged↗
PubMed1993

Painless legs and moving toes: a syndrome related to painful legs and moving toes?

The syndrome of painful legs and moving toes consists of continuous or semicontinuous involuntary writhing movements of the toes associated with pain in the affected extremity. We report a 57-year-old man with a 33-year history of painless and semicontinuous involuntary movements of the toes of the left foot similar to those seen in painful legs and moving toes. There was no family history of movement disorder. The history and physical examination were negative for significant trauma, radiculopathy, or peripheral neuropathy. There were no other neurological findings or involuntary movements. It is unlikely that the involuntary movements were precipitated by neuroleptics or psychosis. CT scan of the head; EEG, CT, and MRI scans of the lumbosacral spine; and EMG and nerve conduction studies of the legs showed no significant abnormalities except for a predominant cocontraction of the left foot flexors and extensors at 0.6-1.2 Hz in a pattern sometimes seen in painful legs and moving toes. We conclude that there is a condition clinically and electrophysiologically similar to painful legs and moving toes that we call painless legs and moving toes, the etiology of which remains undetermined.

Diagnosis, Differential↗
PubMed1998

Immobilization tests and periodic leg movements in sleep for the diagnosis of restless leg syndrome.

Patients with restless leg syndrome (RLS) complain of motor restlessness, usually occurring while they rest in the evening. Two immobilization tests have been described to assess leg restlessness in these patients. In the first test, the patient sits in bed with his or her legs outstretched while electromyograms are recorded from right and left anterior tibialis muscles for an hour (Suggested Immobilization Test [SIT]); in the second test, the legs are immobilized in a stretcher (Forced Immobilization Test [FIT]). In the current study, the SIT and the FIT were compared in patients with RLS and normal control subjects matched for age and sex. More leg movements were seen in patients than in controls during immobilization tests, especially the SIT. These movements were periodic, occurring at a frequency of approximately one every 12 seconds. The SIT (index > 40) was found to discriminate between RLS and control subjects better than the FIT (index > 25). Patients were also recorded during two consecutive nights to measure periodic leg movements in sleep (PLMS). A SIT index greater than 40 and a PLMS index greater than 11 (highest PLMS index of 2 consecutive nights) were found to discriminate patients with RLS from control subjects with similar power. With each of these two measures, the clinical diagnosis was correctly predicted in 81% of patients and 81% of the control subjects. The SIT has several advantages over the measure of the PLMS index; it does not require an all-night polygraphic recording and can be administered several times a day to measure circadian fluctuation of motor restlessness.

Adult↗