Circulator Boot™ has been used successfully for more
than 25 years to produce healing in patients with chronic
recalcitrant ulceration and related conditions due to vascular
insufficiency in the feet. There is a growing number of clinicians
actively using the technique as the first treatment of choice.
An estimated 4,000 legs have been saved and many lives saved.
It has FDA listing in the USA and Health Canada listing in
evidence 1, 2, 3, 4, 5 shows that the Circulator
Boot treatment method is effective as claimed. Its efficacy
as a treatment modality — and its overall effectiveness
in practical clinical settings along with appropriate wound
care and infection control — has been conclusively established
When only one of the patient's legs is treated, the contra
lateral leg serves as the control. It functions in the same
environment as the treated leg, with the only difference being
that the treated leg receives Circulator Boot therapy. It
is well documented that the control leg deteriorates further
while the treated leg improves.
Previous clinical experience shows that a low oxygen level
in the tissues produces ulceration and prevents healing in
all cases 4. Where the transcutaneous oxygen tension (tcPO2)
is below 20 mm Hg, healing is impossible with all other methods,
but with the Circulator Boot most patients show successful
Pneumatic pressure devices have been in use for at least 190
years to treat patients with poor circulation. During this
time the equipment has been continually improved to make use
of new materials, more accurate sensors and better electronics.
Clinicians have repeatedly refined the techniques to take
advantage of medical advances such as antibiotics and topical
oxygen. The healing process with the Circulator Boot is well
characterized and understood. The central concept of using
cardiosynchronous end-diastolic pneumatic compression to increase
blood flow to the extremities is self-evident and logical.
Published literature gives a great deal of information on
the biochemical nature of the healing process that fully supports
the scientific basis of the Circulator Boot.
Detailed published data 3, 4, 5 is available that
documents the clinical progress of patients who have received
Circulator Boot treatment. These patients had typically received
maximum attention using conventional wound care methods as
first line therapy; yet their condition deteriorated. Upon
commencement of Circulator Boot treatment, as the second line
therapeutic modality, their condition quickly started to improve.
Healing continued during treatment and after treatment.
is concluded therefore that effectiveness is positively established
with sufficient documented strength of evidence for its listed
indications at a Quality of Evidence II-2 and a Classification
of Recommendation A, using the ranking of the Canadian Task
Force on Preventive Health Care. The Circulator Boot is recommended
as appropriate and cost-effective for use as a therapeutic
modality in treating lesions of the feet and legs where high
clinical intensity is needed.
End-diastolic compression using the Circulator Boot should
be recommended for patients presented with vascular insufficiency
in the lower extremities.
Compression bandages, pressure offloading, wound management
therapy and physical exercise should be used.
Circulator Boot treatment should commence as soon as practicable
when there is no healing response for 30 days or if there
is evidence of infection or acute arterial thrombosis.
The Circulator Boot should be considered prior to any surgicial
procedures including angioplasty, resection and amputation.
After healing, patients should be instructed and encouraged
to maintain adequate nutrition and an exercise program to
help prevent re-occurrance of symptoms.
Koch CA. External leg compression in the treatment of vascular
disease. Angiology 1997; 48: S3-15.
RS. Patient Assessment and examples of a method of treatment.
Use of the circulator boot in peripheral vascular disease.
Angiology 1997; 48: S35-58.
RS. Fifteen years of experience in treating 2177 episodes
of foot and leg lesions with the circulator boot. Results
of treatment with the circulator boot. Angiology 1997; 48:S17-34.
A. Circulator boot therapy alters the natural history of ischemic
limb ulceration. Vascular Medicine 2000; 5: 21-25.
JR. Treatment of End-Stage "Trash Feet" with the
end-diastolic Pneumatic Boot. Angiology 2008; 59: 214-219
Boot Efficacy and Effectiveness in Clinical Practice (pdf)