Exercise & Training

Ultrasound Doppler Assessment of Popliteal Vein Velocity During Foot Exercises: Cross-Sectional Observational Study.

Kodaka M, Fukuda T, et al. • A&A practice • 2026

PubMed 42228875 DOI 10.1213/XAA.0000000000002227
TL;DR

Among three foot and leg movements examined using ultrasound Doppler in healthy volunteers, ankle bending produced the highest popliteal vein velocity while toe squeezing produced the lowest, and left-side velocity during calf milking was significantly lower than the right side.

Key Findings

Results

Ankle bending ('Bending') produced the highest popliteal vein velocity among the three exercises tested.

  • Three exercises were compared: bending the ankle back and forth ('Bending'), squeezing the toes ('Squeezing'), and massaging and milking the calf ('Milking')
  • Popliteal vein velocity was measured using ultrasound Doppler in healthy volunteers
  • The study design was a cross-sectional observational study
Results

Toe squeezing ('Squeezing') produced the lowest popliteal vein velocity among the three exercises tested.

  • Squeezing the toes resulted in lower venous velocity compared to both ankle bending and calf milking
  • All three movements were assessed in the same healthy volunteer population
  • Venous velocity was measured at the popliteal vein using ultrasound Doppler assessment
Results

Left-side popliteal vein velocity during calf milking ('Milking') was significantly lower than right-side velocity.

  • Left and right sides were compared for each of the three exercises
  • A significant side-to-side difference was found specifically during the 'Milking' exercise
  • No mention of significant left-right differences was reported for the 'Bending' or 'Squeezing' exercises
Background

The study investigated venous velocity changes during foot and leg exercises in the context of venous thrombosis prevention based on Virchow's triad.

  • Venous thrombosis is influenced by Virchow's triad, and decreased venous velocity is considered one of the risk factors
  • The study used healthy volunteers and ultrasound measurement of popliteal vein velocity
  • The study design was cross-sectional and observational

What This Means

This research suggests that simple foot and leg movements differ meaningfully in their ability to boost blood flow through the veins behind the knee. The researchers measured blood flow velocity in the popliteal vein (located behind the knee) of healthy volunteers using ultrasound while participants performed three different movements: bending the ankle back and forth, squeezing the toes, and massaging/squeezing the calf. They found that ankle bending was the most effective at increasing venous blood flow, while toe squeezing was the least effective, with calf milking falling somewhere in between. The study also found an interesting left-right asymmetry: during the calf milking exercise, blood flow on the left side was significantly lower than on the right side. This kind of asymmetry could be relevant in clinical settings where one-sided interventions are applied. This research matters because sluggish blood flow in the veins is one of the known risk factors for developing blood clots (deep vein thrombosis), particularly in people who are immobile, such as during long flights, hospitalization, or after surgery. Understanding which simple, low-effort movements are most effective at stimulating venous blood flow could help inform recommendations for preventing dangerous blood clots in at-risk individuals.

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Citation

Kodaka M, Fukuda T, Sakamaki A, Okazaki R, Uetani A, Komori M, et al.. (2026). Ultrasound Doppler Assessment of Popliteal Vein Velocity During Foot Exercises: Cross-Sectional Observational Study.. A&A practice. https://doi.org/10.1213/XAA.0000000000002227