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From Aging - Clinical and Experimental Research:

Absent pedal pulse and impaired balance in older people: a cross-sectional and longitudinal study

Velipekka Suominen1, Juha Salenius2, Eino Heikkinen3, Maarit Heikkinen2, and Taina Rantanen3

1Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, 2Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere, 3Finnish Centre for Interdisciplinary Gerontology, University of Jyväskylä, Jyväskylä, Finland

BACKGROUND AND AIMS: The purpose of this study was to determine the relationship between abnormal pedal pulse status and postural balance in older people. METHODS: Prospective, population-based cohort study of older residents in the city of Jyväskylä, Finland. A total of 419 individuals aged 75 or 80 at baseline, with known lower extremity pulse status and balance tests performed on a force platform, were eligible for analysis. RESULTS: Cross-sectionally, persons with both dorsal pedal artery pulses absent were found to sway more (p=0.047 anteroposterior velocity, normal standing eyes-open position). The risk of being unable to do the full tandem stance was twofold (OR=2.20, 95% CI 1.29-3.78) for persons without palpable dorsal pedal arteries compared with those with normal pulse status. Balance deterioration was observed at five years (p<0.001for time) but without group-by-time interaction. At ten years, however, the interaction term became significant for the normal standing eyes-closed position (p=0.025 for anteroposterior velocity and p=0.026 for mediolateral velocity), indicating greater balance deterioration among those with both dorsal pedal artery pulses absent. CONCLUSIONS: According to our study, the absence of both dorsal pedal artery pulses is associated with impaired balance in older people. The association was observed both cross-sectionally and longitudinally. In addition, as diminished pedal pulses are frequently associated with impaired lower extremity circulation, our results have also produced information on the possible pathophysiological mechanisms of balance deterioration in older people, which warrant further study. (Aging Clin Exp Res 2006; 18: 388-393)

Hylton

Could you, or anyone else, try to give me a physiological explanation why this study should be applied to anyone in clinical practice?

Whilst neurological deficits would, and have previously made, perfect sense; a lack of a palpable dorsalis pedis seems to be a difficult one to swallow from a clinical point of view. - if only because the vasculartome for the dorsalis pedis is small, and the relative size of the artery makes it a minor contributor to overall pedal perfusion.

Do you have an opinion on this as a clinical phenomenon?

LL

LL,

I'm still trying to track down the full paper, as the abstract doesn't provide much info. Having said that, presumably their argument is that absent pedal pulses are indicative of peripheral arterial disease (PAD), and we know that older people with PAD have impaired lower limb function. Therefore, absent pulses may be an indicator of poor balance by altering lower limb function.

This is not a new idea - there was a previous (bigger and better) study in the Journal of Gerontology that reported higher rate of self-reported mobility impairment and falls in those with PAD (link). I take your point re the use of pulse palpation - an ABI would have been a better measure. The other potential issue with this paper is that it appears to be a univariate model. Because balance is physiologically complex, all balance studies should factor in other well-known correlates such as vision, lower limb strength, sensation, etc, to see if the association still remains significant.

__________________
Cheers,

Hylton

Hylton B. Menz, PhD
Associate Professor and Reader
NHMRC Australian Clinical Research Fellow
Director, Musculoskeletal Research Centre
La Trobe University