Heel Raises and Calf Stretches Exercises Versus Medication Only in Ischemic Intermittent Claudication: A Randomized Controlled Trial

Mohammed Alsagheer Alhewy; Abdelhfeez Moshrif; Abdelaziz Ahmed Abdelhafez; Mohamed Hamza Metwaly; Ehab Abd Elmoneim Ghazala; Hassan Gado; Hany M Aly; Badr Al-Amir Hassan; Ahmed Abdelmoniem Negm; Ahmed Atef Khamis; Wael Abdo Abdo Abd-Elgawad; Abdullah Elsayed; Nehal Farouk

doi:10.1177/15347346241294017

Heel Raises and Calf Stretches Exercises Versus Medication Only in Ischemic Intermittent Claudication: A Randomized Controlled Trial

Int J Low Extrem Wounds. 2024 Oct 29:15347346241294017. doi: 10.1177/15347346241294017. Online ahead of print.

Affiliations

¹ Vascular and Endovascular Surgery department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
² Department of Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
³ Vascular and Endovascular Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
⁴ Department of Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
⁵ Department of Physical Therapy for Internal Medicine, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt.
⁶ Vascular and Endovascular Surgery Department, Faculty of Medicine (girls), Al-Azhar university, Cairo, Egypt.

PMID: 39469950
DOI: 10.1177/15347346241294017

Abstract

Intermittent claudication is a primary symptom of peripheral artery disease (PAD). a chronic progressive disease caused primarily by atherosclerosis. It is usually characterized by leg pain, aches, cramps, or fatigue when walking, which improves with rest. Physical therapy, including a supervised exercise program, is often recommended as the first treatment for sprains. This study aims to evaluate the short-term effects of incorporating heel raise and calf stretch exercises with standard medical therapy compared to medical therapy alone in managing intermittent claudication. From May 2022 to November 2023, 160 patients with Stage II Fontaine PAD were randomly assigned to two equal groups. Group A (80 patients) received heel raise and calf stretch exercises in addition to medical treatment, while Group B (80 patients) received only medical treatment. Both groups underwent treadmill walking tests before and after three months to measure absolute walking distance (ACD), peak walking time (PWT), and Walking Impairment Questionnaire (WIQ) scores, including distance, speed, and symptom severity. At baseline, there were no significant differences between the groups in terms of ACD, peak walking time, ankle-brachial index, distance, speed, and symptoms. At follow-up, Group A showed significantly greater improvements in ACD (312.00 ± 45.43 m), peak walking time (8.54 ± 1.55 min), distance (29.46 ± 4.63 km), speed (20.01 ± 3.13 kph), and WIQ symptoms (22.10 ± 1.02) compared to Group B, which had ACD (276.55 ± 29.07 m), peak walking time (6.72 ± 1.70 min), distance (23.68 ± 3.89 km), speed (15.71 ± 2.71 kph), and WIQ symptoms (20.80 ± 1.47) (P < .001). The ankle-brachial index remained similar between the groups (P > .05). We concluded that integrating standard physical therapy exercises, such as calf raises and leg stretches, with medical therapy significantly enhances walking function in patients with ischemic intermittent claudication.

Keywords: atherosclerosis; calf stretch; heel raise up exercise; intermittent claudication; peripheral arterial disease; physiotherapy.