Intrinsic foot motion measured in vivo during barefoot running

Abstract

Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE) is a serious, preventable disease occurring frequently in the UK and globally. The costs to NHS related to VTE are likely to be underestimated but the risk of developing VTE is significant in surgical patients. The overall incidence of VTE in orthopaedic patients is up to 40–60%. Patients following orthopaedic surgery have multiple risk factors making them vulnerable to developing VTE. VTE prophylaxis can be divided into general, mechanical and pharmacological methods. General methods, including early mobilization and optimizing hydration, are simple approaches widely. Mechanical methods include anti-embolism stockings, intermittent pneumatic compression devices and foot pumps. These are commonly used in combination with pharmacological agents. The latter include antiplatelet and anticoagulant drugs such as aspirin, unfractionated heparin, low-molecular-weight heparin (LMWH), vitamin K antagonists, factor Xa inhibitors and direct thrombin inhibitors. Chemical thromboprophylaxis and antithrombotic drugs continue to be an area of debate and controversy within orthopaedics. There is no single universal answer to thromboprophylaxis but, in the UK, The National Institute for Health and Care Excellence (NICE) has produced guidelines and every surgeon and hospital should have an evidence-based protocol to adhere to.