The Venous Foot Pump

NewsBot · Dec 4, 2009

Members do not see these Ads. Sign Up.
The Anatomy and Physiology of the Venous Foot Pump.
Corley GJ, Broderick BJ, Nestor SM, Breen PP, Grace PA, Quondamatteo F, Olaighin G.
Anat Rec (Hoboken). 2009 Dec 2. [Epub ahead of print]

The presence of a venous pumping mechanism in the foot may be significant for venous return in the lower extremities. However, there has been a lack of conclusive research in the area to date and controversy still exists over the detailed anatomy and physiologic mechanism of the venous foot pump. A full understanding of the anatomy and physiology of the venous foot pump is essential for designing effective interventions for the prevention, treatment, and management of venous disease in the lower limbs. This article highlights and discusses the relevant literature relating to the anatomy and physiology of the venous foot pump. In addition, the plantar aspects of 10 cadaveric feet were dissected. These dissections revealed the presence of a previously unreported secondary deep plantar arch and/or deep system of venous connections in the foot and facilitated a more detailed description of the patterns of doubling and branching of the primary veins of the foot. The results of these dissections are discussed within the context of previous work in the field with the aid of detailed diagrams of the dissected feet and may provide a backdrop for the physiology of the venous foot pump and its potential role in lower limb circulation. This is discussed in the last section of the article, which also highlights existing controversy regarding the role of weight bearing and muscular contraction as the dominant mechanisms for venous pumping in the foot
Click to expand...

NewsBot · Aug 14, 2010

Venous Emptying from the Foot. Influences of Weight-bearing, Toe-curls, Electrical Stimulation, Passive Compression and Posture.
Broderick BJ, Corley GJ, Quondamatteo F, Breen PP, Serrador JM, Olaighin G.
J Appl Physiol. 2010 Aug 12. [Epub ahead of print]

This paper investigates the hemodynamic properties of the plantar venous plexus (PVP), a peripheral venous pump in the human foot, using Doppler ultrasound. We investigated how different ways of introducing mechanical changes vary in effectiveness of displacing blood volume from the PVP. The contribution of the PVP was analysed during both natural and device elicited compressions. Natural compressions consisted of weight-bearing on the foot and toe-curl exercises. Device elicited compressions consisted of intermittent pneumatic compression (IPC) of the foot and electrically elicited foot muscle contractions. Ten healthy participants had their posterior tibial, peroneal, anterior tibial and popliteal vein blood flow monitored while performing these natural and device elicited compression of the PVP while supine and in an upright position. Results indicated that: 1) natural compression of the PVP, weight-bearing and toe-curls, expelled a significantly larger volume of blood than device elicited PVP compression, IPC and electrical stimulation; 2) there was no difference between the venous volume elicited by weight-bearing and by toe-curls; 3) expelled venous volume recorded at the popliteal vein due to all test conditions was significantly greater than that recorded from the posterior tibial and peroneal veins; 4) there was no significant differences between the volume in the posterior tibial and peroneal veins; 5) ejected venous volume, recorded when in the upright position was significantly higher than those recorded when supine. Our study shows that weight-bearing and toe-curls make similar contributions to venous emptying of the foot.
Click to expand...

NewsBot · Aug 1, 2012

Anatomy of the foot venous pump: physiology and influence on chronic venous disease.
Uhl JF, Gillot C.
Phlebology. 2012 Jul 30.

The aim of this paper is to demonstrate the location of the venous foot pump using an anatomical study. Four hundred cadaveric feet were injected with green neoprene latex followed by a dissection. A coloured segmentation of the venous system was achieved. The Lejars' concept of the venous sole of the foot is incorrect: the true blood venous reservoir of the foot is located deeply in the plantar veins, between the plantar muscles. The medial and mostly lateral plantar veins converge into the plexus shaped calcaneal crossroad, where the blood is ejected upwards into the two posterior tibial veins. In addition, the several medial perforators of the foot directly connect the deep system (medial plantar veins) to the superficial venous system (medial marginal vein). This forms a true 'medial functional unit' which is unique in the limb given its directional flow is from deep to superficial. In conclusion, the plantar veins play an important role in the physiology of the venous return since a venous reservoir of 25 mL of blood is mobilized upwards with each step during walking. Therefore, the impairment of the foot pump by a static foot disorder should be considered as an important risk factor for chronic venous disease, and should be evaluated and corrected in any patient with venous insufficiency.
Click to expand...

Craig Payne · Aug 1, 2012

NewsBot said: ↑

the impairment of the foot pump by a static foot disorder should be considered as an important risk factor for chronic venous disease, and should be evaluated and corrected in any patient with venous insufficiency
Click to expand...

This caught my attention!, esp in the context of: Foot disorders as a risk factor for venous disease and Insoles for venous insufficiency

NewsBot · Jan 1, 2014

The Foot Venous System: Anatomy, Physiology and Relevance to Clinical Practice.
Ricci S, Moro L, Antonelli Incalzi R.
Dermatol Surg. 2013 Dec 23.

OBJECTIVE:
This review aims to summarize present knowledge of foot venous return, with a special interest in clinical and research implications.
METHODS:
It is based on the latest available publications on foot anatomy and hemodynamics.
MATERIALS: ANATOMY:
Five systems are described: the superficial veins of the sole, the deep veins of the sole (with particular attention to the lateral plantar vein), the superficial dorsal plexus, the marginal veins and the dorsal arch and the perforating system. The Foot Pump: The physiology of venous return is briefly described, with an emphasis on the differences between standing and walking and the interplay of the foot and calf venous systems.
RESULTS:
The hypothesis that the foot and calf venous systems may be in conflict in several clinical conditions (localization of leg ulcers, corona phlebectatica, foot vein dilatation, arteriovenous fistulas of the foot, foot-free bandaging) is presented, briefly discussed, and mechanistically interpreted.
CONCLUSIONS:
Foot venous return could be more important than is commonly thought. Certain clinical conditions could be explained by a conflict between the mechanisms of the foot pump and the leg pumps most proximal to the foot, rather than by generic pump insufficiency, with possible effects on treatment and compression strategies.
Click to expand...

NewsBot · Jan 15, 2014

Anatomy of the veno-muscular pumps of the lower limb.
Uhl JF, Gillot C.
Phlebology. 2014 Jan 10.

OBJECTIVE:
To study the anatomy of the veno-muscular pumps of the lower limb, particularly the calf pump, the most powerful of the lower limb, and to confirm its crucial importance in venous return.
METHODS:
In all, 400 cadaveric limbs were injected with green Neoprene latex followed by an anatomical dissection.
RESULTS:
The foot pump is the starter of the venous return. The calf pump can be divided into two anatomical parts: the leg pump located in the veins of the soleus muscle and the popliteal pump ending in the popliteal vein with the unique above-knee collector of the medial gastrocnemial veins. At the leg level, the lateral veins of the soleus are the bigger ones. They drain vertically into the fibular veins. The medial veins of the soleus, smaller, join the posterior tibial veins horizontally. At the popliteal level, medial gastrocnemial veins are the largest veins, which end uniquely as a large collector into the popliteal vein above the knee joint. This explains the power of the gastrocnemial pump: during walking, the high speed of the blood ejection during each muscular systole acts like a nozzle creating a powerful jet into the popliteal vein. This also explains the aspiration (Venturi) effect on the deep veins below. Finally, the thigh pump of the semimembranosus muscles pushes the blood of the deep femoral vein together with the quadriceps veins into the common femoral vein.
CONCLUSION:
The veno-muscular pumps of the lower limb create a chain of events by their successive activation during walking. They play the role of a peripheral heart, which combined with venous valves serve to avoid gravitational reflux during muscular diastole. A stiffness of the ankle or/and the dispersion of the collectors inside the gastrocnemius could impair this powerful pump and so worsen venous return, causing development of severe chronic venous insufficiency.
Click to expand...

NewsBot · Jan 18, 2014

Calf Pump Activity Influencing Venous Hemodynamics in the Lower Extremity.
Recek C.
Int J Angiol. 2013 Mar;22(1):23-30.

Calf muscle pump is the motive force enhancing return of venous blood from the lower extremity to the heart. It causes displacement of venous blood in both vertical and horizontal directions, generates ambulatory pressure gradient between thigh and lower leg veins, and bidirectional streaming within calf perforators. Ambulatory pressure gradient triggers venous reflux in incompetent veins, which induces ambulatory venous hypertension in the lower leg and foot. Bidirectional flow in calf perforators enables quick pressure equalization between deep and superficial veins of the lower leg; the outward (into the superficial veins) oriented component of the bidirectional flow taking place during calf muscle contraction is no pathological reflux but a physiological centripetal flow streaming via great saphenous vein into the femoral vein. Calf perforators are communicating channels between both systems making them conjoined vessels; they are not involved in the generation of pathological hemodynamic situations, nor do they cause ambulatory venous hypertension. The real cause why recurrences develop has not as yet been cleared. Pressure gradient arising during calf pump activity between the femoral vein and the saphenous remnant after abolition of saphenous reflux triggers biophysical and biochemical events, which might induce recurrence. Thus, abolition of saphenous reflux removes the hemodynamic disturbance, but at the same time it generates precondition for reflux recurrence and for the comeback of the previous pathological situation; this chain of events has been called hemodynamic paradox.
Click to expand...

NewsBot · May 23, 2017

Optimizing calf muscle pump function.
Lattimer CR et al
Phlebology. 2017 Jan

Background The tip toe manoeuvre has been promoted as the gold standard plethysmography test for measuring calf muscle pump function. The aim was to compare the tip toe manoeuvre, dorsiflexion manoeuvre and a body weight transfer manoeuvre using the ejection fraction of air-plethysmography and evaluate which has the best pumping effect. Methods Sixty-six archived tracings on 22 legs were retrieved from an air-plethysmography workshop and analysed. Pumping performance was measured using the calf volume reduction after each manoeuvre. Results Expressed as median [inter-quartile range], body weight transfer manoeuvres resulted in a significantly greater ejection fraction (%) than tip toe manoeuvres at 59.7 [53.5-63.9] versus 42.6 [30.5-52.6], P < 0.0005 (Wilcoxon). There was no significant difference in the ejection fraction between the tip toe manoeuvre versus dorsiflexion manoeuvre, P = 0.615. The repeatability (confidence interval: 95%) of 66 ejection fraction tests was excellent: tip toe manoeuvre (±1.2), dorsiflexion manoeuvre (±1.3) and body weight transfer manoeuvre (±1.6). Conclusion The body weight transfer manoeuvre appears to be a better method of measuring the full potential of the calf muscle pump with a 40.1% relative increase in the ejection fraction compared to a tip toe manoeuvre. Exercises which involve body weight transfers from one leg to the other may be more important in optimizing calf muscle pump function than ankle movement exercises.
Click to expand...

NewsBot · Jun 6, 2019

The biomechanical function of the foot pump in venous return from the lower extremity during the human gait cycle: An expansion of the gait model of the foot pump
AndyHorwood
Medical Hypotheses; Volume 129, August 2019, 109220

The gait cycle has been modelled for energetics and musculoskeletal health and disease, but little has been published in relation to the function of gait as a mechanism in maintaining haemodynamic homeostasis through the lower limb. Blood returns from the lower limb drawn to the heart by the low pressure at the vena cava through hydrodynamic forces. Resisting these hydrodynamics forces are gravitational and frictional forces. The deficit between the forces acting for venous return from the lower limb by hydrodynamics and those acting against antegrade flow, is filled by extrinsic mechanical mechanisms including the respiratory pump, skeletal muscle pumps and the foot pump. The efficiency of the lower limb skeletal muscle pump and foot pump are likely linked to gait kinetics and kinematics. A model is proposed that attempts to expand upon previous gait models of the foot pump as part of the kinetic and kinematic events that occur during gait, whilst also developing the argument that the foot pump needs to be divided into passive-pressure phases, and combined active-muscular/passive-pressure phases during gait. This model suggests that non-weightbearing arch profiles will have little influence on the combined active/passive-pressure phases of the foot pump, while the ability to develop compliance and stiffness within the foot at the requisite periods of the gait cycle is likely to influence foot pump efficiency.
Click to expand...

NewsBot · Mar 6, 2022

Plantar Venous Pump Activity, Generalized Joint Hypermobility, and Foot Mobility in Ballerinas: A Case-Control Study
Nilüfer Kablan, Selda Uzun, Fatma Kulalı, Yaşar Tatar
J Sport Rehabil. 2022 Mar 4;1-7

Context: The plantar venous pump (PVP) is a vascular network located between the muscles of the foot arch. It has been suggested foot mobility is critical for PVP activation.

Objective: This study investigates the effect of generalized joint hypermobility (GJH) on foot mobility and PVP activity in ballerinas and to determine how a short-term warm-up exercise impacts these parameters in the presence of GJH.

Design: Prospective study.

Methods: Twelve ballerinas (age = 16.73 [1.8] y) and 15 non-dancer-matched controls (age = 16.31 [2.1] y) were included. When performing weight-bearing activities, venous return parameters (diameter, velocity, and flow volume) from the posterior tibial vein were measured using color and spectral Doppler ultrasonography. Foot mobility was determined using navicular drop test. The participants performed a 10-minute cycling exercise to reveal its effect on reducing tissue stiffness. All measurements were performed synchronously and twice-before and after the cycling exercise.

Results: The results showed the navicular height obtained before and after exercise in the ballerinas was significantly different compared with that obtained in the sitting position, and the values obtained in the 3 measurement positions in the nondancer group were significantly different from each other (P < .05). The difference between the venous diameter values measured before and after exercise and the reference value was significant in both groups (P < .001). There was a significant decrease in venous velocity following exercise in the nondancer group (P = .044). The venous volume values obtained after exercise were significantly different between the groups (P = .039).

Conclusions: The GJH has no distinctive effect on foot mobility and PVP activity in ballerinas. The presence of GJH did not influence the effect of short-term warm-up exercise on foot mobility and PVP activity. We believe that measuring the navicular drop and venous return with a more precise synchronization may provide additional information regarding the link between arch tension and venous return.
Click to expand...

NewsBot · Jul 11, 2022

Pedal Musculovenous Pump Activation Effectively Counteracts Negative Impact of Knee Flexion on Human Popliteal Venous Flow
Christopher W Reb et al
Foot Ankle Spec. 2021 Mar 3

Knee scooters are commonly used for mobility instead of other devices. However, passive popliteal venous flow impedance has been observed with knee scooter usage ostensibly as a result of deep knee flexion. This study aimed to characterize the magnitude of impact knee flexion has on popliteal venous flow in relation to the degree of knee flexion when walking boot immobilized. Furthermore, the countervailing effect of standardized pedal musculovenous pump (PMP) activation was observed. Popliteal venous diameter and flow metrics were assessed with venous ultrasonography in 24 healthy individuals. Straight leg, crutch, and knee scooter positioning while wearing a walking boot and non-weight-bearing were compared. Flow was assessed with muscles at rest and with PMP activation. Of 24 participants, 16 (67%) were female. Twelve limbs (50%) were right sided. The mean age was 21.9 (SD = 3.0) years, and the mean body mass index was 21.9 (SD 1.9) kg/m2. Observer consistencies were excellent (intraclass correlation range = 0.93 to 0.99). No significant differences in mean vessel diameter, time-averaged mean velocity, and total volume flow occurred (all P > .01). Corresponding knee flexion effect sizes were small (range = -0.04 to -0.26). A significant decrease (-24%) in active median time-averaged peak velocity occurred between upright and crutch positions (20.89 vs 15.92 cm/s; P < .001) with a medium effect size (-0.51). PMP activation increased all flow parameters (all P < .001), and effect sizes were comparatively larger (>0.6) across all knee flexion positions.Clinical Significance: Knee flexion has a small to medium impact on popliteal venous return in healthy patients. Active toe motion effectively counters the negative effects of gravity and knee flexion when the ankle is immobilized
Click to expand...

NewsBot · Apr 18, 2023

Calf muscle pump pressure-flow cycle during ambulation
Roman A Tauraginskii et al
J Vasc Surg Venous Lymphat Disord. 2023 Apr 15

Objective: Calf muscle pump (CMP) failure contributes to the severity and progression of chronic venous disease (CVD). Attempts to improve CMP function through resistance exercise have failed to improve CVD severity or quality of life, partially because the selection of the type of exercise was based on the assumption that CMP ejects blood from intramuscular venous sinuses (VS), which has never been tested in humans. This study aimed to investigate real-time changes in the pressure and size of the VS during the entire gait cycle of ambulation.

Methods: Twelve lower extremities of nine healthy volunteers were studied at rest and while walking on a treadmill at three different speeds (60, 90, and 120 steps/min). The changes in VS cross-sectional area and pressure were measured. Myography of the gastrocnemius (GCM) and anterior tibial muscles (ATM) was used to register muscle activity. The relationship between the phases of the gait cycle and the measured parameters was analyzed using video records of all experiments.

Results: The observed timing of events was consistent among all limbs studied. At standing-still position, the VS pressure and cross-section area was 70.3 ± 4.2 mmHg and 23.3 ± 14.6 mm2, respectively. During ambulation, at the first half of stance, the GCM and ATM eccentrically contract, the pressure is low (17 ± 8, 20 ± 12, and 29 ± 13 mmHg at 1, 1.5, and 2 Hz, respectively), and the VS is collapsed. When the heel starts rising (the second half of stance) the GCM concentrically contracts, the pressure increases reaching its maximum values (143 ± 37, 134 ± 46, and 128 ± 41 mm Hg), and the VS opens, reached its maximal size (1.8 ± 1.4 and 2.3 ± 2.2 mm2 at 1 and 1.5 Hz respectively), which is followed by collapse of the VS. During the swing phase, the GCM relaxes, the ATM concentrically contracts resulting in rapid fall in the pressure (2.6 ± 4.7, 1.1 ± 6.2, and -4.7 ± 3.2 mm Hg). VS cross-section remains negligible.

Conclusions: GCM concentric contraction was associated with simultaneous increase in VS pressure and cross-sectional area. GCM relaxation with ATM concentric contraction coincided with a decrease in VS pressure down to negative values. VS do not fill but remain empty during the swing phase of ambulation, acting not as a reservoir, but as a conduit transferring blood from the network of intramuscular veins to the axial deep veins.
Click to expand...

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Craig Payne Moderator

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

The importance of the venous foot pump

Effect of Footwear and Foot Orthotics on Venous Status

Effect of Foot Orthotics on Venous Function

Plantar venous plexus and the intrinsic muscles of the foot

Micromobile Foot Compression Device for Increasing Lower Limb Venous Blood Flow

Foot orthoses and Chronic Venous Insufficiency treatment or prevention ?

Foot disorders as a risk factor for venous disease

Share This Page