Two Cases of Transcutaneous Electrical Nerve Stimulation of the Common Peroneal Nerve Successfully Treating Refractory, Multifactorial Leg Edema

Abstract

The treatment of leg edema often involves promoting venous blood flow but can be difficult in patients with comorbidities that prevent traditional management strategies such as limb elevation or mechanical compression devices. The geko device is a self-contained neuromuscular stimulation device that adheres to skin over the common peroneal nerve and delivers a low-voltage stimulus that activates the lower-leg musculature resulting in enhanced superficial femoral vein blood flow and velocity. Here we report 2 cases of multifactorial and refractory leg edema successfully treated with the geko device over a period of 4 to 16 weeks. The device also improved pain and chronic wound healing. Although the geko device is costly, it was well tolerated and may provide another treatment strategy for resistant leg swelling.

Does Neuromuscular Electrical Stimulation Improve Recovery Following Acute Ankle Sprain? A Pilot Randomised Controlled Trial

“…In addition to activation via the bodies’ nervous system, muscles can be contracted by the application of electrical stimulation to the common peroneal nerve. Neuromuscular electrical stimulation (NMES) devices are reported to reduce oedema by compressing venous and lymphatic vessels and inducing an increase in venous return and lymphatic flow; 9 however, they are not currently used during routine treatment following an ankle sprain. Preliminary work has found NMES to facilitate a reduction in oedema in other populations, 10,11 and therefore, this pilot study aims to assess the feasibility of a larger trial to determine whether NMES (firefly™ manufactured by Firstkind Ltd., High Wycombe, UK) could help to reduce oedema in ankle sprain patients when used in addition to standard care.…”

“…The firefly device 12 was chosen because it is a small and unobtrusive (149 mm × 42 mm × 11 mm), lightweight (18 g), self-adhesive, disposable, internally powered, NMES device, using technology and stimulation settings which have previously been proven to increase blood flow and reduce oedema. 9 It has seven stimulation modes with selectable pulse widths of 70, 100, 140, 200, 280, 400, and 560 µs (±5% + 20 µs). The repetition rate is 1 Hz (±5%), with a maximum charge of 20 µC per pulse.…”

The effects of knee joint angle on neuromuscular activity during electrostimulation in healthy older adults

“…9 Clinically, stimulating lower limb venous circulation with electrostimulation can also reduce limb volume oedema in orthopaedic, 10 diabetic and cardiovascular disease patients. 11 During electrostimulation, the activated tibialis anterior becomes an agonist, and the medial gastrocnemius an antagonist. Force and EMG recordings indicate that electrostimulation intensity relates directly to ankle dorsiflexion (and muscle-pump) force.…”

Refractory venous leg ulcers: observational evaluation of innovative new technology

“…Initially developed to prevent postoperative deep vein thrombosis (DVT), it stimulates 50–70% of the blood flow generated by 10 consecutive full dorsiflexions (considered to equivalent that achieved by walking) measured by photophlesmography (PPG) ( P = 0·0004) in the dorsal veins of the foot and by strain gauge phlesmography (SPG) in changes to mid‐calf circumference measured ( P < 0·001) . The geko™ device increases venous, arterial and microcirculatory blood flow in the lower limb in people with chronic venous insufficiency and intermittent claudication , reduces chronic leg oedema in some individuals , acts as a calf‐muscle pump and maintains TCpO2 , promoting conditions suitable for wound healing.…”