Lower extremity strength deficits in peripheral arterial occlusive disease patients with intermittent claudication

The purposes of this study were to quantify the degree and distribution of lower extremity weakness in patients with peripheral arterial occlusive disease (PAOD) compared to apparently healthy older patients and to determine if performance of a simple functional measure correlates with lower extremity strength. Older patients (n = 46), 31 with PAOD (mean age = 69.9 years; mean ankle-brachial index = 0.67) and 15 without PAOD (mean age = 62.6 years; mean ankle-brachial index = 1.20), underwent isometric strength testing of hip, knee, and ankle musculature. In patients with PAOD, dorsiflexion strength was 15% lower (p < 0.05) in the more affected limb (55 +/- 4 Newton-meters; mean +/- SE) versus the less affected limb (65 +/- 5 Newton-meters). Overall, the dorsiflexor muscles of the more affected extremity were 22% weaker (p < 0.05) in the PAOD group than in the non-PAOD group (73 +/- 6 Newton-meters). No other significant differences in strength were found between the PAOD and the healthy elderly groups or between the more affected and less affected limbs in the PAOD patients. The time to perform five sequential sit-to-stand transfers using an armless chair was 23% greater (p < 0.01) in the PAOD group (13.0 +/- 0.5 s) than in the healthy elderly (10.7 +/- 0.9 s). In the PAOD patients, dorsiflexor strength was correlated with chair stand time (r = -0.37, p < 0.05). The authors conclude that PAOD patients with intermittent claudication are functionally limited by dorsiflexion weakness, impairing their ability to perform tasks requiring distal lower extremity strength.