A 40-year old female with pain over the right first metatarsal was diagnosed with Hallux Valgus and had a right scarf and Akin osteotomy. A geko device was fitted to help accelerate the reduction of post-operative swelling which can delay return to function, interfere with shoe wear, compromise wound healing and increase patient anxiety. The device was used for 10 days with daily patient review. Patient tolerability of the geko device was measured along with measurements of oedema, pain, movement, and function. The device was well tolerated and at 4 days post-operatively, swelling reduced significantly and Visual Analogue Scale (VAS) pain scores showed a clinically significant improvement from 8/10 to 1/10, (VAS 1-10: 0-no pain, 10-most pain). Both patient and surgeon reported they thought the device was extremely beneficial. This initial case study illustrates that the geko device may be useful in helping to reduce swelling following foot surgery and this encouraging outcome warrants further investigation.
The aim of bunion surgery is to relieve pain and improve the alignment of the big toe. Surgery to correct Hallux Valgus is a largely successful operation with a good or very good outcome in 85% of patients .
However, after bunion surgery, foot and ankle swelling can be expected for several months . Swelling may occur because of the post-operative rehabilitation instructions that are necessary to ensure bone healing, such as partial weight bearing with a heel wedge shoe and walking with the aid of elbow crutches. This prevents the foot and ankle muscle pumps from working as normal and leads to a frequent tendency towards swelling. In addition impaired wound healing may also occur in 2-4% of .
The geko device (Firstkind Ltd, High Wycombe, United Kingdom) is a discrete, self-contained, self-adhesive, battery-powered neuromuscular electro stimulation device (Fig. 1). It is applied over the common peroneal nerve, at the head of the fibula (Fig. 2). It delivers charge-balanced short single pulse stimulation at 1 Hz. This activates the motor nerves of the ankle dorsiflexors and foot everters, resulting in a rhythmical contraction. This expresses blood from the superficial and deep venous systems by means of distension of the vessels within the calf muscle pump and foot pump. The technique enhances venous flow velocity and volume in the lower limb and also increases arterial and microcirculatory blood flow .
A 40 year-old female with presented to the foot and ankle clinic with a 2-year history of pain and deformity of her right first metatarsal. The patient reported that the pain had been accompanied by a significant worsening of functional ability over recent months. Conservative treatment had not been successful. The patient was a recreational runner before the pain increased and would like to return to jogging. She was a non-smoker with a low weekly intake of alcohol. On examination pre-operatively the right first metatarsal was significantly swollen and inflamed. There was reduced flexion and extension of the first metatarsophalangeal joint and a prominent bunion deformity. X rays confirmed moderate hallux valgus disease and a right scarf and Akin osteotomy was performed together with a lateral release to correct the deformity. A standard post operative protocol was followed with two elbow crutches and a heel wedge shoe for six weeks; elevation of the right leg, daily ankle circulatory exercises and wound care.
A geko device was fitted in recovery one hour post-operation to help accelerate the reduction of post-operative swelling. The device was used for 10 days and the patient was reviewed daily over this period for the purpose of this paper. Ten devices were used in total with the patient changing the device daily and experiencing no difficulty in doing so. There was no discomfort or adverse effects, no difficulty sleeping with the device switched on and no disturbance with mobility. Treatment with the geko device demonstrated a marked reduction in swelling, following three days of consecutive treatment. There was a decrease in the patients pain score using the Visual Analogue Scale. First day post-operatively the patient reported 8/10 pain, reducing to 5/10 on the second day post-operatively and 3/10 on the third day post-operatively. The skin sutures were removed on the tenth day. At this stage the patient had a full passive range of movement of her first metatarsophalangeal joint and no swelling was identified.
We believe this is the first published case study that has used the geko device to reduce post-operative swelling and promote earlier functional activity following forefoot surgery. Further research is warranted to confirm the efficacy of the device in this patient group but this initial case study is extremely encouraging.
It is also of interest to note that recent national guidance in the United Kingdom supports the use of the geko device for people who have a high risk of venous thromboembolism (VTE) and for whom other (standard) methods of VTE prevention, such as leg compression and blood thinning drugs, are impractical or contraindicated . The geko device could therefore provide these patients with the dual benefit of reduced post-operative swelling and VTE prophylaxis.
The authors declare no conflict of interest.
- Rippstein P, Tiziano Z. The ‘Scarf’ osteotomy for the correction of hallux valgus. Orthopaedics and Traumatology. 2001;9(2):101-12.
- Tucker A, Maass A, Bain D, Chen L, Azzam M, Dawson H, et al. Augmentation of venous, arterial and microvascular blood supply in the leg by isometric neuromuscular stimulation via the peroneal nerve. Int J Angiol. 2010;19:e31-7 pubmed
- 0 NICE. The Geko device for reducing the risk of venous thromboembolism. NICE Medical Technologies Guidance MTG19. Accessed 24/09/14. Available from: www.nice.org.uk/guidance/MTG19,