One Podiatrist’s Experience With A Novel NMES Device For Patients With PAD

In previous articles, I have written about medicine having endless career opportunities. One opportunity in the medical field is that to evaluate and potential provide feedback on an array of products or medical devices, in hopes of participating in the betterment of patient care. To me, advising on new innovations is always an exciting time because I believe becoming aware of the latest and cost-efficient technology to aid my patients with pain relief, healing, or even improved quality of life is imperative.

In recent months, I had the unique opportunity to trial a circulation booster device for the legs and feet (Revitive Medic, Actegy) with select patients. The aim of this blog is to create a space in which we can begin to share what is out there for advancement purposes in the medical field.

It is important to note that 40 to 50 percent of patients that have peripheral arterial disease (PAD) experience atypical leg pain.¹ As lower extremity experts we often see and treat patients complaining of atypical leg pain, rest pain, or classic intermittent claudication. In my practice, I begin by advocating for patient exercise at least thirty minutes a day to help improve symptoms or worsening of the condition. In addition to ordering standard non-invasive arterial studies, I often send patient referrals to the vascular surgery team for assessment and evaluation if care is not already established. This is the moment when I find the patient replies that they have been through this before with other providers without much relief or a long-term plan. Yet, they still cannot comfortably walk their dog or play with their grandchildren.

It is this patient population that may note benefit from such a circulation booster. I believe it can play an integral role as part of the overall treatment plan. Revitive Medic is clinically proven to boost circulation during device use, with many patients citing their ability to return to daily activities.^2,3 This device focuses on boosting the leg circulation. I counsel patients, stressing that it does not cure risk factors or underlying conditions. The technology involves neuromuscular electrical stimulation (NMES), which elicits the stimulation of the muscle fibers via a controlled electrical current (maximum current of 15mA).² This differs from transcutaneous electrical nerve stimulation or TENS units which act on sensory nerves and take away from the pain pathway to the brain during stimulation. A UK study demonstrated with minimal use of thirty minutes daily for six weeks, NMES can significantly impact patient outcomes for improved walking distance before pain and disease-specific quality of life scores.³

Multiple Case Experiences With A Novel NMES Device

The first candidate was a young healthy female in her mid-thirties that works as a chef, requiring her to stand on her feet at least 12 hours a day. She had painful plantar fasciitis that I could not relieve even after trying multiple oral and topical NSAIDs, corticosteroid injections, shoe wear modification, orthotics, exercising, and stretches. Out of curiosity, I requested the company send her a unit to trial, because surgical intervention was not an option for this young entrepreneur. After three sessions of using the device, she noticed an immediate difference in pain during her work day.

The second patient I tried the device on was an elderly patient in her late seventies with a medical history of peripheral arterial disease and not a candidate for surgical or procedural intervention. Although her disease was mild-to-moderate, the patient would present with her son complaining of leg cramping, inability to walk short or long distances comfortably, and rest pain. I decided to give her a unit to trial and give feedback. This patient did not follow up until three months from that initial visit, but when she returned to the office she and her son were both in different spirits. The patient reported that she was no longer experiencing cramping of the lower legs and the rest pain was resolved.

The last experience I will discuss was actually with my colleague, to whom I gave a unit to test out, because I knew he would be honest about feedback. I knew he had concerns of some lower leg cramping after long cycling and running days, so I told him to try it out and let me know. Two weeks after distributing the device, he felt so positively about the device that he expressed interest in conducting research with it. His feedback was that the device seemed like a simulation of walking and stretching without actually walking or stretching. It was truly enlightening to reflect on the patients' and colleague's feedback.   

Final Thoughts

I’ve observed a shift in the healthcare management paradigm over the last decade from a more aggressive intervention standpoint to a less invasive and minimalist approach to patient care. Our patients want the least invasive treatment as possible, whether it means avoiding oral medication and looking for a topical alternative, or avoiding pharmaceuticals all together and finding a nutraceutical. This NMES device could serve as an additional modality in treating a patient experiencing acute or chronic pain who wants alternatives. In my experience, this same device could contribute to patients returning to taking their daily walks with their loved ones or four-legged companion. I encourage you to practice due diligence if you choose to evaluate if this modality fits into your treatment algorithms, and not to take my experiences as hard evidence. Do not hesitate to reach out to me personally with specific questions or feedback.

Dr. Johnson is a Clinical Assistant Professor in the Division of Metabolism, Endocrinology and Diabetes-Podiatry (MEND) at the University of Michigan in Ann Arbor.

Dr. Johnson discloses that he is a Brand Ambassador and Endorser for Actegy Health, Inc., which owns and operates the Revitive product line.

References

1. Rooke TW, Hirsch AT, Misra S, et al. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(14):1555-1570.

2. Ravikumar R, Lane TR, Babber A, Onida S, Davies AH. A randomised controlled trial of neuromuscular stimulation in non-operative venous disease improves clinical and symptomatic status. Phlebology. 2021;36(4):290-302

3. Babber A, Ravikumar R, Onida S, Lane TRA, Davies AH. Effect of footplate neuromuscular electrical stimulation on functional and quality-of-life parameters in patients with peripheral artery disease: pilot, and subsequent randomized clinical trial. Br J Surg. 2020;107(4):355-363.