Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492007000200009
Jornal Vascular Brasileiro
Original Article

Relação entre a mobilidade da articulação talocrural e a úlcera venosa

Relationship between talocrural joint mobility and venous ulcer

Cleusa Ema Quilici Belczak; Gildo Cavalheri Jr.; José Maria Pereira de Godoy; Roberto Augusto Caffaro; Sergio Quilici Belczak

http://dx.doi.org/10.1590/S1677-54492007000200009 J Vasc Bras, vol.6, n2, p.149-155, 2007
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Resumo

CONTEXTO: O presente estudo avalia a mobilidade da articulação talocrural nos seis estágios clínicos da classificação CEAP (clínica, etiológica, anatômica e patofisiológica do International Consensus Committee Reporting Standards on Venous Disease) para doença venosa utilizando a goniometria, e detecta redução da mobilidade articular nos estágios mais avançados da doença, C5 e C6 (úlcera cicatrizada ou ativa). OBJETIVO: Investigar a existência de uma relação entre a severidade clínica da doença venosa crônica dos membros inferiores e a diminuição do grau de mobilidade da articulação talocrural. MÉTODO: Selecionaram-se aleatoriamente 120 membros pertencentes a 88 pacientes brancas, que foram separados com base em sua apresentação clínica de acordo com a categoria C da classificação CEAP, sendo distribuídos em 6 grupos pertencentes às categorias de C0-C1 (grupo controle) até C6, com 20 membros cada um e médias de idade próximas para cada grupo. O grau de mobilidade do tornozelo foi acessado por goniometria de apoio plantar em posição de decúbito supino. RESULTADOS: Os grupos C de CEAP apresentam diferença significativa em relação ao grau de mobilidade da articulação talocrural medida por goniometria (p < 0,001). C6 difere significativamente dos demais grupos (p < 0,05); C5 difere significativamente de C6, C3, C2 e C0-C1 (p < 0,05), mas não apresenta diferença significativa do grupo C4; C4 difere significativamente do grupo C6 (p < 0,05) e não difere dos demais grupos; C0-C1, C2 e C3 não apresentam diferença significativa entre si e em relação a C4, e diferem dos grupos C5 e C6 (p < 0,05). O nível de significância utilizado para os testes foi de 5%. CONCLUSÃO: Existe relação entre a severidade clínica da insuficiência venosa crônica dos membros inferiores e a diminuição do grau de mobilidade da articulação talocrural, e ela se faz mais evidente na presença de úlcera venosa ativa ou cicatrizada.

Palavras-chave

Insuficiência venosa, articulação talocrural, úlcera venosa

Abstract

BACKGROUND: This study assesses talocrural joint mobility considering the six stages of CEAP classification (clinical, etiologic, anatomic and pathophysiologic by the International Consensus Committee reporting standards on venous disease) for venous disease using goniometry, and detects reduction in joint mobility in more advanced stages of the disease, C5 and C6 (healed or active ulcer). OBJECTIVE: Investigate the existence of a relationship between clinical severity of chronic venous disease of the lower limbs and reduction in talocrural joint mobility. METHODS: A total of 120 limbs from 88 Caucasian patients were randomly selected. They were divided based on clinical presentation according to the C clinical category of CEAP, being distributed into six groups belonging to categories from C0-C1 (control group) to C6, with 20 limbs each and similar mean age for each group. Range of ankle mobility was assessed by goniometry in the supine position. RESULTS: C groups on the CEAP classification showed significant difference in relation to talocrural joint mobility measured by goniometry (p < 0.001). C6 was significantly different from the other groups (p < 0.05); C5 was significantly different from C6, C3, C2 and C0-C1 (p < 0.05), but with no significant difference from C4; C4 was significantly different from C6 (p < 0.05) and not different from the other groups; C0-C1, C2 and C3 were not significantly different between themselves and in relation to C4, but were different from C5 and C6 (p < 0.05). Significance level used for tests was 5%. CONCLUSION: There is a relationship between clinical severity of chronic venous insufficiency of the lower limbs and reduction in talocrural joint mobility, which is more evident in the presence of active or healed venous ulcer.

Keywords

Venous insufficiency, talocrural joint, venous ulcer

References

Welkie JF, Comerota AJ, Katz ML, Aldridge SC, Kerr RP, White JV. Hemodynamic deterioration in chronic venous disease. J Vasc Surg. 1992;16:733-40.

Barber RF, Shatara FI. The varicose disease. NY State J Med. 1925;31:574-80.

Pollack AA, Wood EH. The venous pressure in the saphenous vein at the ankle in man, during exercise and changes in posture. J Appl Physiol. 1949;1:649-62.

Nicolaides AN, Hussein MK, Szendro G, Christopoulos D, Vasdekis S, Clarke H. The relation of venous ulceration with ambulatory venous pressure measurements. J Vasc Surg. 1993;17:414-9.

Christopoulos D, Nicolaides AN, Cook A, Irvine A, Galloway JM, Wilkinson A. Pathogenesis of venous ulceration in relation to the calf muscle pump function. Surgery. 1989;106:829-35.

Araki CT, Back TL, Padberg FT. The significance of calf muscle pump function in venous ulceration. J Vasc Surg. 1994;20:872-7.

Back TL, Padberg FT Jr., Araki CT, Thompson PN, Hobson RW 2nd. Limited range of motion of the ankle joint is a significant factor in venous ulceration. J Vasc Surg. 1995;22:519-23.

Dix FP, Brooke R, McCollum CN. Venous disease is associated with an impaired range of ankle movement. Eur J Vasc Endovasc Surg. 2003;25:556-61.

Orsted HL, Radke L, Gorst R. The impact of musculoskeletal changes on the dynamics of the calf muscle pump. Ostomy Wound Manage. 2001;47:18-24.

Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg. 1995;21:635-45.

Tinley P, Taranto M. Clinical and dynamic range of ankle motion techniques in subjects with and without diabetes mellitus. J Am Podiatr Med Assoc. 2002;92:136-42.

Somers DL, Hanson JA, Kedzierski CM, Nestor KL, Quinlivan KY. The influence of experience on the reliability of goniometric and visual measurement of forefoot position. J Orthop Sports Phys Ther. 1997;25:192-202.

Rosner B. Fundamentals of biostatistics. 1986.

Belczak Neto J, Belczak CEQ. A importância da goniometria do tornozelo na insuficiência venosa crônica dos membros inferiores. Tratado de flebologia e linfologia. 2006:459-68.

Loetzke HH. Über die Achlles-sehne mit ihren Faszienverhältnissen beim Menschen und den Subcutanvarizen im Bereich der Wadenmuskulatur. Anat Anz. 1956;103:287-304.

Kramer J, Gudat W. Der Talokrural-Winkel. Z Orthop Ihre Grenzgeb. 1980;118:855-8.

Schmeller W, Steidel G, Borgis KJ. Über den bewegungsumfang im oberen sprunggelenk bei venengesunden und venenkraken: ein beitrag zum arthrogenen staunngssyndrom. Phlebol Proktol. 1990;19:100-10.

Bolliger AA, Borgnis FE. Ein verbesserter Ultraschallströmungsmesser für intravasale Messungen. Mefmethoden in der Venenchirurgie. 1971:137-43.

Roaas A, Andersson GB. Normal range of motion of the hip, knee and ankle joints in male subjects, 30-40 years of age. Acta Orthop Scand. 1982;53:205-8.

Oppel U, Higushi F. Talokrural-Winkel und Sprunggelenksbeweglichkeit bei Deutschen und Japanern. Z Orthop. 1987;125:243-6.

Nigg BM, Fisher V, Allinger TL, Ronsky JR, Engsberg JR. Range of motion of the foot as a function of age. Foot Ankle. 1992;13:336-43.

Grimston SK, Nigg BM, Hanley DA, Engsberg JR. Differences in ankle joint complex range of motion as a function of age. Foot Ankle. 1993;14:215-22.

Wright AD. The treatment of indolent ulcer of the leg. Lancet. 1931;1:457-60.

Ruckley CV, Dale JJ, Callam MJ, Harper DR. Causes of chronic leg ulcer. Lancet. 1982;2:615-6.

Tierney S, Burke P, Fitzgerald P, O'Sullivan T, Grace P, Bouchier-Hayes D. Ankle fracture is associated with prolonged venous dysfunction. Br J Surg. 1993;80:36-8.

Timi JR, Futigami AY, Belczak SQ, Pradella FM. Ankle ankylosis and its importance in chronic venous disease. Int Angiol. 2005;24:148.

Browse NL, Burnand KG, Thomas ML. Síndrome da falência contrátil da panturrilha. Doenças venosas. 2001:433-60.

Kan YM, Delis KT. Hemodynamic effects of supervised calf muscle exercise in patients with venous leg ulceration: a prospective controlled study. Arch Surg. 2001;136:1364-9.

Yang D, Vandongen YK, Stacey MC. Effect of exercise on calf muscle pump function in patients with chronic venous disease. Br J Surg. 1999;86:338-41.

Belczak Neto J, Belczak CEQ. Reabilitação cinesiofisiátrica do flebopata crônico. Tratado de flebologia e linfologia. 2006:460-84.

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