Does the heel-rise test explain functional capacity in venous insufficiency?

Abstract

Introduction Individuals with chronic venous insufficiency (CVI) have muscle pump dysfunction and reduced functionality. However, studies are inconsistent in proving whether a particular test can assess muscle functional capacity. Therefore, the aim of this study was to evaluate whether the heel-rise test (HRT) is able to explain functional capacity in patients with CVI. Materials and methods Subjects with CVI aged between 20 and 59 years old were selected for this study. All participants were classified by means of the Clinical Anatomy Etiology Pathophysiology Classification of Chronic Venous Disease (CEAP). The HRT and the shuttle walk test (SWT) were performed. Descriptive statistics, Spearman correlation, linear models and regression variance analysis (one-way ANOVA) were used for data analysis. Significance was set at alpha ≤ 5%. Results 79 subjects were included in the study (38.79 ± 1.34 years). The HRT was able to explain functional capacity only in individuals aged between 50-59 years (R2 = 0.60, p = 0.0001). The heel-rise test was not sensitive to detect differences between the CEAP classes analyzed (p > 0.05). Conclusion The HRT was able to explain functional capacity in individuals aged between 50-59 years, and it can be applied in clinical practice for the functional evaluation of patients with CVI with mild severity in this age range.

Reference values for the bilateral heel-rise test

“…Several methods have been used to assess the strength and endurance of this muscle, such as dynamometers, isokinetic dynamometers, or functional tests including the heel-rise test (HRT). The HRT is used to quantify clinical conditions that affect the triceps surae, such as peripheral arterial disease (PAD), 9 , 10 , 11 Achilles tendon injury, 12 , 13 stroke, 14 chronic venous insufficiency, 5 , 15 and health conditions related to old age. 16 The HRT evaluates various properties of the triceps surae, such as strength, endurance, fatigue, muscle function, and performance.…”

“… 16 The HRT evaluates various properties of the triceps surae, such as strength, endurance, fatigue, muscle function, and performance. 7 , 15 , 17 It involves repeated concentric-eccentric muscle action 1 , 7 , 8 and has been shown to be clinically relevant in the quantification of triceps surae endurance. 5 , 7 , 8 The test was initially proposed as a unipedal test.…”

Association between heel-rise test performance and clinical severity of chronic venous insufficiency

“…1,2 Although venous reflux is based on several mechanisms, the main factor of CVI is venous hypertension caused by the combination of valvular insufficiency and calf muscle pump dysfunction. [1][2][3][4][5][6] The symptoms and structural alterations are pain, "heavy legs" (especially at the end of the day), telangiectases, reticular veins, varicose veins, a tendency for evening edema, hyperpigmented dermal changes, subcutaneous tissue fibrosis (lipodermatosclerosis), and eventual ulceration. [1][2][3][4][5][6] Two mechanisms contribute to chronic venous hypertension: increased hydrostatic pressure due to venous reflux, and peripheral muscle pump dysfunction.…”

“…[1][2][3][4][5][6] The symptoms and structural alterations are pain, "heavy legs" (especially at the end of the day), telangiectases, reticular veins, varicose veins, a tendency for evening edema, hyperpigmented dermal changes, subcutaneous tissue fibrosis (lipodermatosclerosis), and eventual ulceration. [1][2][3][4][5][6] Two mechanisms contribute to chronic venous hypertension: increased hydrostatic pressure due to venous reflux, and peripheral muscle pump dysfunction. The triceps surae muscle plays an important role in venous return, compressing the deep veins of the calf during contraction and ejecting blood toward the heart.…”

“…This test can be used to evaluate the performance of the calf muscle pump and consists of a muscular (concentric/eccentric) activation test that counts the number of plantar flexion repetitions until fatigued. 4,[14][15][16][17] Although CVI is a socially relevant disease affecting many people, there are no defined strategies for physiotherapeutic follow-up in this population. It is important to define better treatments for individuals with CVI and to investigate the impact of variables such as age, physical activity, and the use of compression stockings in this condition to better understand the association between peripheral muscle pump performance and CVI severity.…”