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Ankle Mobility in Relation to Chronic Venous Insufficiency in HIV-Positive Persons With and Without a History of Injection Drug Use

https://doi.org/10.1016/j.jana.2006.05.003Get rights and content

The purpose of this study was to examine ankle mobility in relation to chronic venous insufficiency (CVI) in HIV-positive persons with and without a history of injection drug use (IDU) and to examine the extent to which peripheral neuropathy further reduced ankle mobility. A cross-sectional, stratified design with quota sampling was used to recruit 27 persons with no history of IDU and 46 with a history of IDU from an infectious diseases clinic. Goniometric measurements of forefoot inversion-eversion and dorsiflexion-plantar flexion were obtained. CVI was assessed on a clinical scale. Peripheral neuropathy was identified from chart review and self-report. Injection drug users had less ankle flexion-extension right, inversion-eversion left and right, and total ankle motion than those who did not inject drugs (p < .05). Neuropathy was not associated with less mobility of the ankle joint (p < .01). A causal model supported the hypothesis of ankle mobility as a mediator of the effect of IDU on CVI.

Section snippets

Review of Literature

Normal ankle mobility and painless calf muscle action are critical components of the lower leg. A delicate relationship exists between the muscle-joint unit and intact venous valves of the leg to facilitate venous return and prevent development of CVI (Kugler, Strunk, & Rudofsky, 2001). From the contracting muscles of the leg, the calf muscle pump leads to an increased deep vein pressure and emptying of the deep veins in a cephalic direction. Dorsiflexion of the upper ankle joint and weight

Sample

The sample consisted of 73 HIV-positive persons who learned about the study from a posting or their clinician in the infectious diseases clinic. Those who were interested telephoned the investigator who determined eligibility for the study. Inclusion criteria were ability to walk, not pregnant, 30 through 65 years of age, and ability to understand and respond in English. If the person was eligible, an appointment was made to meet the nurse researcher, have the study explained in detail, sign

Characteristics of Sample

A total of 73 HIV-positive subjects (36 men and 37 women) with a mean age of 45.8 years (SD = 7.6 years) and 93% African-American participated in this study. The mean HIV positivity was 9.55 years (SD = 4.40 years). A total of 16 persons were identified with neuropathies of the lower extremities. Those who injected drugs (n = 46) did so for a mean of 16.57 years (SD = 10.21 years). Injected drugs included heroin (n = 44), cocaine (n = 32), amphetamines (n = 9), methadone (n = 5), and other

Discussion

Ankle joint mobility and CVI classification were significantly worse for HIV-positive persons who had injected drugs. Peripheral neuropathy of the lower extremities did not significantly affect ankle motion or CVI. Injecting into the lower extremity had the most severe consequences for lower leg function. Although stopping IDU is an important aspect of treatment, CVI changes may develop years after drug use has ceased. CVI typically occurs in injection drug users in the third or fourth decade

Conclusions

Patients with HIV infection are living longer and are more susceptible to many of its complications. Impaired motion of the ankle joint and manifestations of CVI are frequently overlooked as complications in persons who have injected drugs. Limited motion of the ankle joint can lead to social and self-care problems for the HIV-positive person. Assessment of the lower leg in terms of motion and clinical manifestations of CVI needs to be performed. Care strategies such as exercises for the ankle

Acknowledgement

This project was funded in part by Blue Cross Blue Shield of Michigan Foundation, Excellence in Research Award.

Barbara A. Pieper, PhD, RN, CWOCN, CS, FAAN, is a professor and nurse practitioner at the College of Nursing, Wayne State University, Detroit, MI.

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    • Barbara A. Pieper, PhD, RN, CWOCN, CS, FAAN, is a professor and nurse practitioner at the College of Nursing, Wayne State University, Detroit, MI.

    Thomas Templin, PhD, is at the College of Nursing, Wayne State University, Detroit, MI.

    John R. Ebright, MD, is at the Department of Internal Medicine, Wayne State University School of Medicine and Detroit Medical Center, Detroit, MI.

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    Copyright © 2006 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.