Case 35: Rest Pain Relieved and Dependency Reduced

This 75 year old female smoker arrived in a wheelchair complaining of leg pain around the clock. She had an expressive aphasia and symptoms of organic brain disease and gave a poor history. Her companion had heard of the Circulator Boot in the hospital elevator and brought her in for evaluation. She had scars from a femoral-popliteal bypass and a subsequent endarterectomy. She had recently been advised by her vascular surgeon that nothing further could be done and that an amputation was likely. Her initial vascular testing showed an obstructed posterior tibial (unobtainable by Doppler) and a greatly weakened dorsalis pedis (figure below). Her right foot was cyanotic.

Baseline Doppler Velocity Tracings Showing Low Wide Dorsalis Pedis and Absent Posterior Tibial

She was initially treated daily on weekdays for ten treatments with the Long-Boot. Then she was tapered to treatments twice a week and finally weekly. She returned occasionally to a twice a week schedule if discomfort recurred. Her pain disappeared and her companion reported that she not only could walk to the bathroom but was "prancing around the house".

Leg after a Month of Therapy

Foot after a Month of Therapy

The tracings below were taken nine months after her initial treatment. She was ambulatory for seventeen months before dying in her sleep

Restoration of Arterial Sounds in the Dorsalis Pedis (BP 72) and Lower Pitched Sounds in the Posterior Tibial Area

Comments: The quality of life of this lady was vastly improved by her boot therapy. She was relieved of pain. She became independent around her house. She could sleep at night. It is commonly forgotten that the quality of life is likewise greatly improved by the rest of the household. Her companion was grateful also.