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To the Editor.—
Many people have had to give up long journeys by coach or airplane due to the discomfort of ankle swelling. Passengers in cars and trains appear to be immune, and it would seem to be the unrelieved knee flexion that must be to blame. Similar conditions, as in a crowded air-raid shelter or prolonged tight flexion of knees over the rail of a deck chair, occasionally give rise to deep venous thrombosis (shelter leg, steamer leg). These have often been attributed to imagined kinking of the popliteal vein with obstruction, but no evidence of any such obstruction can be seen when the leg is flexed during phlebography.When blood flow through veins is at a minimum, there must be segments, the contents of which become completely stagnant. This would be particularly apt to happen in the numerous, wide sinusoidal veins of calf muscle, and these are indeed
Johnson HD. Traveler's Ankle. JAMA. 1973;225(12):1532-1533. doi:10.1001/jama.1973.03220400058021