Activation of the Venous Muscle Pump by Neuromuscular Stimulation of the Common Peroneal Nerve Reduces Postoperative Edema in the Foot and Ankle

Edema after foot and ankle surgery is associated with unsatisfactory outcomes. It impairs postoperative mobilization, range of motion, pain, wound healing, and risk of venous thrombosis. The aim of this study is to determine if activation of the venous muscle pump by neuromuscular stimulation of the common peroneal nerve reduces postoperative edema in the foot and ankle. 80 patients having forefoot or hindfoot surgery were randomized to receive standard care following surgery, or a wearable self-adhesive neuromuscular stimulation device applied to the skin below the knee laterally at the head of fibula. This provided intermittent (1 hertz) stimulation of the common peroneal nerve, eliciting a twitch of the muscles of the leg. Edema was measured as the difference between the involved and uninvolved limb, measured by figure-of-eight method of the foot and ankle. Baseline was measured preoperatively and then 14 days following surgery. Figure-of-eight measurement in patients receiving standard care increased relative to baseline by 4.9% (95% CI 4.3%-5.4%) 14 days post-surgery, whereas patients receiving neuromuscular stimulation increased by 3.3% (95%CI 2.7%-3.6%). Patients receiving neuromuscular stimulation had 33% less edema (p<0.05) than those receiving standard care.