Does the heel-rise test explain functional capacity in venous insufficiency? / O teste da ponta do pé prediz capacidade funcional na insuficiência venosa?

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. .

Introdução Indivíduos com insuficiência venosa crônica (IVC) podem apresentar disfunção da bomba muscular e redução de sua funcionalidade. Porém, estudos são inconsistentes em afirmar se um teste específico muscular pode avaliar a capacidade funcional. Sendo assim, o objetivo do presente estudo é avaliar se o teste da ponta do pé (TPP) é capaz de predizer a capacidade funcional em indivíduos com IVC. Materiais e métodos Foram selecionados para o estudo indivíduos com IVC com idade entre 20 e 59 anos. Os participantes foram classificados por meio da CEAP (Clinical Etiology Anatomy Pathophysiology Classification of Chronic Venous Desease). Foram realizados o TPP e o teste do deslocamento bidirecional progressivo (TDBP). Estatísticas descritivas, correlação de Spearman, modelos de regressão linear e análise de variância (ANOVA one-way) foram utilizados para a análise dos dados. Para significância estatística, foi usado alfa de 5%. Resultados Foram incluídos 79 indivíduos (38,79 ± 1,34 anos) no estudo. O TPP foi capaz de predizer a capacidade funcional somente em indivíduos de 50 a 59 anos (R2 = 0,60; p = 0,0001). O TPP não foi sensível em detectar diferenças entre as classes CEAP analisadas (p > 0,05). Conclusão O TPP foi capaz de explicar a capacidade funcional em indivíduos de 50 a 59 anos, podendo ser aplicado na prática clínica de forma válida para a avaliação funcional de pacientes com IVC de gravidade leve nessa faixa etária. .

Treinamento de resistência da musculatura da panturrilha em um caso atípico de insuficiência venosa clínica / Training of calf muscle endurance ina case of atypical chronic venous failure

As complicações da insuficiência venosa crônica (IVC) estão relacionadas com a ineficiência da bomba muscular da panturrilha.Permanece incerto, porém, se pacientes que apresentam IVC sintomática, mas função de panturrilha pouco comprometida, poderiam se beneficiar do treino muscular. Apresentarum relato de caso, no qual foi realizado umtreinamento de resistência da musculaturada panturrilha em uma mulher com apresentação não usual da IVC. Mulher, 55 anos,com histórico de cirurgia de varizes, sintomas de queimação e peso na perna esquerda,foi avaliada pelo shuttle walking test (SWT),pelo heel rise test (HRT), pelo questionário SF-36 e pela pletismografia a ar, antes e após 15 semanas de treinamento físico.O treinamento consistiu em exercícios de resistência muscular da panturrilha; treino aeróbio de moderada intensidade (70% a 75%da FC pico do teste ergométrico), exercícios de resistência muscular com os membrosinferiores elevados e exercícios de alongamento estático envolvendo a musculatura treinada. Houve diminuição da fração de volume residual de 31,2% para 24,5%. Houve melhora da distância no SWT, desempenhono HRT e da qualidade de vida relacionada à saúde. A reabilitação pode ser benéfica mesmo em pacientes com apresentação não usual da IVC .

The complications of chronic venous insuficiency (CVI) are related to ineficiencyof the calf muscle pump. However it stillremains uncertain whether patients withCVI but with slightly impaired calf musclefunction could benefit from the calf muscletraining. to present the results of a resistancetraining of the calf muscle in a woman withan unusual presentation of CVI. Woman, 55years, submitted to a varicose vein surgery,with complaints of burning and weight in the left leg was evaluated by shuttle walkingtest (SWT), heel rise test (HRT), SF-36 questionnaire and air plethysmography, beforeand after 15 weeks of training: muscular resistance of the calf; aerobic training at moderate intensity (70-75% HR peak treadmill test) and static stretching exercises. Therewas a decrease in residual volume fractionfrom 31.2% to 24.5%. There was improvement of distance on SWT, performance onHRT and quality of life related to health.The physical therapy rehabilitation may bebeneficial even in patients with an unusualpresentation of CVI.

Heel-rise test in the assessment of individuals with peripheral arterial occlusive disease.

INTRODUCTION: The heel-rise test (HRT) is a clinical instrument relevant to vascular rehabilitation that has been proposed to assess the function of the triceps surae muscle. To use HRT in the assessment of individuals with peripheral arterial occlusive disease (PAOD), its ability to detect differences in the functional performance of patients with PAOD must be verified. AIM: To verify whether the test is sensitive in differentiating between individuals with PAOD with distinct functional capacities. MATERIALS AND METHODS: A transversal study in which individuals with PAOD were assessed using the HRT, the Walking Impairment Questionnaire (WIQ), and the Shuttle Walk Test. The following variables were analyzed: number of plantar flexions performed in the HRT (time in seconds) and velocity (plantar flexions per second) when performing plantar flexions up to the point of volunteer fatigue, maximum distance walked in the Shuttle Walk Test, and scores obtained in each WIQ domain. RESULTS: Twenty-five individuals (14 male) were included in the study, with a mean age of 63.36 ± 9.83 years. The variables number of plantar flexions and time to perform the HRT were sensitive enough to differentiate between distinct functional capacities in individuals with PAOD (P = 0.003 and P = 0.009, respectively). However, this result was not found for the variable of velocity in the HRT. The number of plantar flexions in the HRT was sensitive enough to differentiate individuals of extreme classes on the WIQ domain, stairs (P = 0.008). CONCLUSION: The HRT can be applied in clinical practice as a valid assessment of the distinct function capacities of individuals with PAOD.