The Application of 30° Foot Elevation and Ankle Pump Techniques to Reduce Lower Limb Edema in Patients with Chronic Kidney Disease
DOI:
https://doi.org/10.53713/htechj.v4i1.443Keywords:
chronic kidney disease, edema, ankle pump, 30°-foot elevationAbstract
Lower extremity edema is a common complication in patients with stage 5 chronic kidney disease (CKD) due to fluid imbalance. Non-pharmacological therapies such as ankle pump exercises and 30°-foot elevation can be effective alternative interventions to reduce edema. This study aims to determine the effectiveness of combining ankle pump exercises and 30°-foot elevation in reducing the degree of edema in CKD patients. This research employed a quantitative descriptive case study method involving one patient with stage 5 CKD. The intervention consisted of ankle pump exercises and 30°-foot elevation conducted over three consecutive days. Each ankle pump session lasted 1 minute per position, and foot elevation was maintained for 5–10 minutes per session. Edema assessment was conducted pre- and post-intervention using the Grading Pitting Edema scale. The study showed no reduction in the edema grade from day one to day three. However, a decrease in edema depth was observed on the third day of the intervention, indicating that no significant reduction in the overall edema grade occurred. The application of ankle pump exercises and 30°-foot elevation over three days did not show a clinically significant reduction in edema. However, a positive effect began to emerge on the third day, with a 1 mm decrease in edema depth. The combination therapy has the potential to reduce lower extremity edema in CKD patients, but it requires consistent application and optimal intensity to achieve significant outcomes. This intervention may serve as a safe, non-invasive, and practical non-pharmacological option in evidence-based nursing care.
References
Abassi, Z., Khoury, E. E., Karram, T., & Aronson, D. (2022). Edema formation in congestive heart failure and the underlying mechanisms. Frontiers in Cardiovascular Medicine, 9, 933215. https://doi.org/10.3389/fcvm.2022.933215
Agustin, L., Mofidah, & Wardani, H. R. (2023). Nursing Care of Chronic Kidney Disease with Activity Intolerance Nursing Problems: A Case Study. Health and Technology Journal (HTechJ), 1(4), 400–405. https://doi.org/10.53713/htechj.v1i4.88
Ahmed, K., Dubey, M. K., Dubey, S., & Pandey, D. K. (2025). Chronic kidney disease: Causes, treatment, management, and future scope. In Computational Intelligence for Genomics Data (pp. 99-111). Academic Press. https://doi.org/10.1016/B978-0-443-30080-6.00010-9
Elendu, C., Elendu, R. C., Enyong, J. M., Ibhiedu, J. O., Ishola, I. V., Egbunu, E. O., Meribole, E. S., Lawal, S. O., Okenwa, C. J., Okafor, G. C., Umeh, E. D., Mutalib, O. O., Opashola, K. A., Fatoye, J. O., Awotoye, T. I., Tobih-Ojeanelo, J. I., Ramon-Yusuf, H. I., Olanrewaju, A., Afuh, R. N., Adenikinju, J., … Yusuf, A. (2023). Comprehensive review of current management guidelines of chronic kidney disease. Medicine, 102(23), e33984. https://doi.org/10.1097/MD.0000000000033984
Ermert, K., Buhl, E. M., Klinkhammer, B. M., Floege, J., & Boor, P. (2023). Reduction of Endothelial Glycocalyx on Peritubular Capillaries in Chronic Kidney Disease. American Journal of Pathology, 193(2), 138–147. https://doi.org/10.1016/j.ajpath.2022.11.003
Govender, D., & Howard, A. Q. (2025). Swelling of the legs and feet. Surgery (Oxford), 43(5), 286-298. https://doi.org/10.1016/j.mpsur.2025.03.008
Hasan, H., Rahman, M. H. ., Haque, M. A., Rahman, M. S. ., Ali, M. S. ., & Sultana, S. . (2024). Nutritional Management in Patients with Chronic Kidney Disease: A Focus on Renal Diet. Asia Pacific Journal of Medical Innovations, 1(1), 34-40. https://doi.org/10.70818/apjmi.2024.v01i01.05
Ielapi, N., Andreucci, M., Bracale, U. M., Costa, D., Bevacqua, E., Giannotta, N., Bevacqua, M. G., Serraino, G. F., Mastroroberto, P., Provenzano, M., & Serra, R. (2022). Elevate to Alleviate – Evidence Based Vascular Nursing Study. Nursing: Research and Reviews, 12(February), 39–45. https://doi.org/10.2147/nrr.s345076
Kushwaha, R., Vardhan, P. S., & Kushwaha, P. P. (2023). Chronic Kidney Disease Interplay with Comorbidities and Carbohydrate Metabolism: A Review. Life, 14(1), 13. https://doi.org/10.3390/life14010013
Kusumawati, Istiqomah, I. N., Mashuri, Anggia Astuti, & Laili Nur Azizah. (2025). Ankle pump exercise to reduce edema in congestive heart failure. Nursing and Health Sciences Journal (NHSJ), 5(4), 492–499. https://doi.org/10.53713/nhsj.v5i4.588
Li, T., Yang, S., Hu, F., Geng, Q., Lu, Q., & Ding, J. (2020). Effects of ankle pump exercise frequency on venous hemodynamics of the lower limb. Clinical Hemorheology and Microcirculation, 76(1), 111–120. https://doi.org/10.3233/CH-200860
Maharem, T. A. S., Shehata, A. M., & Khalil, B. M. (2022). Effect of ankle pump exercise on fatigue sensation, comfort, and lower limb hemodynamics among deep vein thrombosis patients. International Journal of Health Sciences, 6(S9), 4945–4957. https://doi.org/10.53730/ijhs.v6nS9.14488
Markarian, B., Toro, C., Moreira, K., Polam, S., Mathew, N., & Mayrovitz, H. N. (2024). Assessment Modalities for Lower Extremity Edema, Lymphedema, and Lipedema: A Scoping Review. Cureus, 16(3), e55906. https://doi.org/10.7759/cureus.55906
Nursanti, A., Rosyida, R. W., & Setyorini, Y. (2024). The Combination of Ankle Pumping Exercise and 30Ëš Leg Elevation on Foot Edema in Chronic Kidney Disease. Jurnal Kesehatan Prima, 18(2), 61–68. https://doi.org/10.32807/jkp.v18i2.1338
Putri, M. ., Idramsyah, I., & Husni, H. (2025). Application Of Contrast Bath Therapy And 30-Degree Foot Elevation To Reduce Foot Edema In Patients With Congestive Heart Failure. Journal of Vocational Nursing, 6(1), 19–28. https://doi.org/10.20473/jovin.v6i1.61148
Rondhianto, Rohmah , A. ’Izzatur, Mustakim, & Sutawardana, J. H. (2025). Ankle Pump Exercise and Foot Massage Intervention on Reducing Leg Edema in Chronic Kidney Disease (CKD) Patients. Health and Technology Journal (HTechJ), 3(6), 789–796. https://doi.org/10.53713/htechj.v3i6.462
Shi, J., Weng, X., Liu, C., Ge, Y., Chai, L., Ru, X., ... & Huang, X. (2023). The effect of the Ankle Pump Exercise (APE) counter system-assisted ankle pump motion in patients after femoral neck fracture. BMC Musculoskeletal Disorders, 24(1), 925. https://doi.org/10.1186/s12891-023-06869-x
Singh, S. K., & Revand, R. (2022). Physiological basis of lower limb edema. In Approach to lower limb oedema (pp. 25-43). Springer Nature Singapore. https://doi.org/10.1007/978-981-16-6206-5_3
Smith, B., Park, J., Landi, J. L., McConnell, B., Rahman, A., Omari, A. R., Shahab, Z., Carilli, A., Pearl, K., Kim, B., & Costin, J. M. (2024). Chronic Edema Management of the Lower Extremities. Cureus, 16(7), e63840. https://doi.org/10.7759/cureus.63840
Wang, N., & Zhang, C. (2023). Recent Advances in the Management of Diabetic Kidney Disease: Slowing Progression. International Journal of Molecular Sciences, 25(6), 3086. https://doi.org/10.3390/ijms25063086
Widayati, Maharani, N. D., & Nistiandani, A. (2025). Interdialytic weight gain and fatigue in chronic kidney disease patients undergoing hemodialysis: A Correlational study. Nursing and Health Sciences Journal (NHSJ), 5(2), 264–271. https://doi.org/10.53713/nhsj.v5i2.482












