The effectiveness of calf muscle electro-stimulation on lower extremity arterial perfusion in patients living with diabetes mellitus and peripheral artery disease

Abstract

Aim: To investigate whether calf muscle electro-stimulation improves arterial inflow and walking capacity in claudicants with peripheral artery disease and diabetes mellitus. Methods: A prospective, one-group, pretest-posttest study design was employed on forty participants (n=40) with bilateral limb ischemia (ABPI <0.90), diabetes mellitus and calf muscle claudication. All participants received a program of calf muscle electrical stimulation with varying frequency (1-250Hz) on both limbs (N=80) for 1 hour per day for 12 weeks. Spectral Doppler waveforms of pedal arteries; ankle brachial pressure index (ABPI); absolute claudication distance (ACD); and thermographic temperature patterns across four specified regions of interest (hallux; medial forefoot; lateral forefoot; heel) at rest and after exercise, were recorded at baseline and following intervention to evaluate for therapeutic outcomes. Results: Significant increases were registered in mean ACD (137 meters; p=0.000) and mean ABPI (0.04; p=0.001) in response to the intervention. Resting foot temperatures across all regions of interest increased significantly (p= 0.000) while the post-exercise temperature drops were halved across all regions at follow-up, with two of four regions reaching statistical significance (hallux, p=0.005; lateral forefoot, p=0.038). Spectral Doppler waveforms did not change (p=0.304) between both serial assessments. Conclusion: Electrical stimulation of varying frequency for 1 hour per day for 12 consecutive weeks registered statistically significant improvement in outcome measures that assess arterial inflow and walking capacity in claudicants with diabetes mellitus. These results favor the use of ES as a therapeutic measure in this vulnerable population in order to reduce symptoms and potentially reverse derangements associated with the limb ischemia.