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Formenti P, Sabbatini G, Brenna G, Galimberti A, Mattei L, Umbrello M, Iezzi M, Uldedaj E, Pezzi A, Gotti M. Foot drop in critically ill patients: a narrative review of an elusive complication with intricate implications for recovery and rehabilitation. Minerva Anestesiol 2024; 90:539-549. [PMID: 38551615 DOI: 10.23736/s0375-9393.24.17912-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Foot drop is a condition characterized by the inability to lift the foot upwards towards the shin bone. This condition may affect a proportion of critically ill patients, impacting on their recovery after the acute phase of the illness. The occurrence of foot drop in critical care patients may result from various underlying causes, including neurological injuries, muscular dysfunction, nerve compression, or vascular compromise. Understanding the etiology and assessing the severity of foot drop in these patients is essential for implementing appropriate management strategies and ensuring better patient outcomes. In this comprehensive review, we explore the complexities of foot drop in critically ill patients. We search for the potential risk factors that contribute to its development during critical illness, the impact it has on patients' functional abilities, and the various diagnostic techniques adopted to evaluate its severity. Additionally, we discuss current treatment approaches, rehabilitation strategies, and preventive measures to mitigate the adverse effects of foot drop in the critical care setting. Furthermore, we explore the roles of critical care physical therapists, neurologists, and other healthcare professionals in the comprehensive care of patients with foot drop syndrome and in such highlighting the importance of a multidisciplinary approach.
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Affiliation(s)
- Paolo Formenti
- Unit of Anesthesia and Resuscitation, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo, Milan, Italy -
| | - Giovanni Sabbatini
- Unit of Anesthesia and Resuscitation, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - Giovanni Brenna
- Unit of Anesthesia and Resuscitation, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - Andrea Galimberti
- Unit of Anesthesia and Resuscitation, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - Luca Mattei
- Department of Neurosurgery, C. Besta IRCCS National Neurologic Institute Foundation, Milan, Italy
| | - Michele Umbrello
- Department of Intensive Care, New Hospital of Legnano, Legnano, Milan, Italy
| | - Massimiliano Iezzi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ersil Uldedaj
- Unit of Anesthesia, Resuscitation and Intensive Therapy, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Angelo Pezzi
- Unit of Anesthesia and Resuscitation, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - Miriam Gotti
- Unit of Anesthesia and Resuscitation, ASST Nord Milano, Bassini Hospital, Cinisello Balsamo, Milan, Italy
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Factors Associated With Peripheral Nerve Injury After Pelvic Laparoscopy: The Importance of Surgical Positioning. THE JOURNAL OF NURSING RESEARCH : JNR 2023; 31:e259. [PMID: 36692838 DOI: 10.1097/jnr.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Nerve damage after abdominal and pelvic surgery is rare but potentially serious. The incidence of peripheral nerve injury is difficult to assess, and rates of between 0.02% and 21% have been cited in the literature. Signs and symptoms of this type of injury may appear immediately after surgery or a few days later. PURPOSE This study was developed to assess the rate of peripheral nerve injury after pelvic laparoscopy and to identify associated risk factors. METHODS A pilot prospective cohort study was conducted between March 2018 and April 2019 on 101 patients with a 1-month follow-up using two semistructured clinical interviews. We carried out a descriptive analysis followed by univariable and multivariable logistic regression analyses. RESULTS Thirteen patients were found to have peripheral nerve injuries, representing a rate of 12.9%. Overall, 14 injuries (five severe and nine mild) were detected. One patient had two mild injuries. In this study, the risk of injury was found to increase 1.77-fold (OR = 1.77, 95% CI [1.13, 2.76], p = .007) for each hour the patient was in the Trendelenburg position. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The longer the patient is in the Trendelenburg position, the greater the risk of peripheral nerve damage. Patients aged 60 years or less also face a higher risk of nerve injury.
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Rabe E, Partsch H, Morrison N, Meissner MH, Mosti G, Lattimer CR, Carpentier PH, Gaillard S, Jünger M, Urbanek T, Hafner J, Patel M, Wu S, Caprini J, Lurie F, Hirsch T. Risks and contraindications of medical compression treatment - A critical reappraisal. An international consensus statement. Phlebology 2020; 35:447-460. [PMID: 32122269 PMCID: PMC7383414 DOI: 10.1177/0268355520909066] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives Medical compression therapy is used for non-invasive treatment of venous and lymphatic diseases. Medical compression therapy-associated adverse events and contraindications have been reported, although some contraindications are theoretically based. This consensus statement provides recommendations on medical compression therapy risks and contraindications. Methods A systematic literature search of medical compression therapy publications reporting adverse events up until November 2017 was performed. A consensus panel comprising 15 international experts critically reviewed the publications and formulated the recommendations. Results Sixty-two publications reporting medical compression therapy adverse events were identified. The consensus panel issued 21 recommendations on medical compression therapy contraindications and adverse event risk mitigation, in addition to reviewing medical compression therapy use in borderline indications. The most frequently reported non-severe medical compression therapy-associated adverse events included skin irritation, discomfort and pain. Very rare but severe adverse events, including soft tissue and nerve injury, were also identified. Conclusion This consensus statement summarises published medical compression therapy-associated adverse events and contraindications, and provides guidance on medical compression therapy. Severe medical compression therapy-associated adverse events are very rarely encountered if compression is used correctly and contraindications are considered.
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Affiliation(s)
- Eberhard Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
| | - Hugo Partsch
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Mark H Meissner
- Department of Surgery, Harborview Medical Center, Seattle, WA, USA
| | - Giovanni Mosti
- Angiology Department, Clinica MD Barbantini, Lucca, Italy
| | - Christopher R Lattimer
- Josef Pflug Vascular Laboratory, West London Vascular and Interventional Centre, Ealing Hospital & Imperial College, London, UK
| | - Patrick H Carpentier
- Centre de Recherche Universitaire de La Léchère, Equipe THEMAS, Université Joseph Fourier, Grenoble, France
| | | | - Michael Jünger
- Department of Dermatology, University of Greifswald, Greifswald, Germany
| | - Tomasz Urbanek
- Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Medical University of Silesia, Katowice, Poland
| | - Juerg Hafner
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Malay Patel
- First Choice Vascular, Swastik Society, Ahmedabad, India
| | - Stephanie Wu
- Department of Podiatric Surgery & Applied Biomechanics, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Joseph Caprini
- Department of Vascular Surgery, The University of Chicago, Chicago, IL, USA
| | - Fedor Lurie
- Department of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Tobias Hirsch
- Practice for Internal Medicine and Vascular Diseases, Halle, Germany
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