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.

The authors have declared no competing interest.

NCT04927234

The study was funded by Firstkind Ltd

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics committee of the Hospital Clinic de Barcelona Spain the Hospital Universitario Vall de Hebron, Spain the West of Scotland Research Ethics Service West of Scotland REC 4 UK and the IRB Western Institutional Review Board part of WCG (WIRB-Copernicus Group) USA all gave ethical approval for this work

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Yes

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Financial Disclosure This research was funded by Firstkind Ltd.

Conflict of Interest Declaration Each author certifies that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article.

All data produced in the present study are available upon reasonable request to the authors