EC Orthopaedics

A patient with intermittent claudication, evening leg pain, and unsteady gait secondary to peripheral artery disease and diabetic peripheral neuropathy were treated by enhanced external counterpulsation (EECP).

The case arose three years before the consultation. Conventional medical treatments involve controlling hyperglycemia, cholesterol levels, blood pressure, and physiotherapy. Opioids and NSAIDs were prescribed. These approaches reduced the pain from 10/10 to 7/10 in one year but did not improve the paresthesia and hyperesthesia of the feet and the walking distance. Frustrated by the lack of significant improvement after visiting multiple medical establishments and receiving over 100 various physiotherapy treatments, he reluctantly discontinued further physiotherapy treatments.

The laboratory tests since 2022 showed that the patient had diabetes. The glycemic parameters were all elevated. Examination using Tensiomed revealed an increased augmentation index and pulse wave velocity. A low nerve score, a measure of the sudomotor response, was also found, suggesting small fibres neuropathy. The findings indicated that the patient had peripheral artery disease (PAD) and early manifestation of diabetic peripheral neuropathy.

With his consent, he tried EECP treatment and nutraceuticals on him. His glycemic parameters improved after 19 sessions. After 35 sessions, which spanned over 7 weeks, he could walk for 500 metres, whereas before the intervention, he could only walk 100 metres. Also, the area of the left calf cramp during ambulation was reduced. More importantly, perhaps, the sensation in the sole improved, and he could walk more steadily. His gait was more balanced. Yet, the evening pain still persisted.

As we did not only use EECP for treatment, we cannot determine if the benefits derive entirely from the EECP. Further studies are required to elucidate whether EECP intervention improves peripheral artery disease (PAD) or diabetic peripheral neuropathy.

 Keywords: External Counterpulsation; Peripheral Artery Disease; Intermittent Claudication; Diabetic Peripheral Neuropathy

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