[46F] With chronic lower extremity swelling and rash

Patient Description

A 46-year-old female presents with chronic swelling in the ankles, legs, and feet that has persisted for years. The swelling is pitting in nature, leaving dents when pressed, and does not improve with leg elevation. The patient also reports a rash around the ankles that appears depending on how long she is on her feet, described as looking like blood surfacing under the skin. The swelling and throbbing pain worsen with prolonged standing at work. There is no known history of conditions related to veins or heart.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

  1. Chronic Venous Insufficiency (CVI):

    • Rationale: CVI occurs when the veins in your legs are not working effectively, making it difficult for blood to return to the heart. This can lead to swelling (edema), especially in the ankles and legs, and can cause skin changes such as rashes or discoloration.
    • Typical Treatments: Compression stockings, leg elevation, exercise, and in some cases, medications or procedures to improve vein function.
  2. Lymphedema:

    • Rationale: Lymphedema is a condition where lymph fluid builds up in tissues, causing swelling. It can be due to a blockage in the lymphatic system and often affects the legs.
    • Typical Treatments: Compression therapy, manual lymph drainage, exercise, and skin care to prevent infections.
  3. Heart Failure:

    • Rationale: Heart failure can cause fluid retention in the body, leading to swelling in the legs, ankles, and feet. This is because the heart is not pumping blood effectively, causing fluid to accumulate.
    • Typical Treatments: Medications such as diuretics (water pills), lifestyle changes, and in some cases, more advanced treatments like surgery or devices to support heart function.

What you can do

Chronic Venous Insufficiency (CVI):

  • Compression Stockings: Wear compression stockings to help improve blood flow in your legs.
  • Leg Elevation: Elevate your legs when possible to reduce swelling.
  • Exercise: Engage in regular physical activity to improve circulation.
  • Consult a Doctor: See a healthcare provider for a proper diagnosis and treatment plan.

Lymphedema:

  • Compression Therapy: Use compression garments as recommended by a healthcare provider.
  • Manual Lymph Drainage: Consider seeing a specialist for manual lymph drainage therapy.
  • Exercise: Gentle exercises can help reduce swelling.
  • Skin Care: Keep the skin clean and moisturized to prevent infections.

Heart Failure:

  • Medication Adherence: Continue taking your prescribed diuretics and other medications as directed.
  • Diet and Lifestyle: Follow a heart-healthy diet, reduce salt intake, and maintain a healthy weight.
  • Monitor Symptoms: Keep track of your symptoms and report any changes to your healthcare provider.
  • Consult a Doctor: Regular follow-ups with your healthcare provider are essential to manage heart failure effectively.

What you should look out for

Given the severity of your symptoms and the possibility of underlying conditions, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Sudden Increase in Swelling: If you notice a sudden increase in swelling or if it spreads to other parts of your body.
  • Shortness of Breath: If you experience difficulty breathing or shortness of breath.
  • Chest Pain: Any chest pain should be evaluated immediately.
  • Skin Changes: If the rash worsens, becomes painful, or shows signs of infection (redness, warmth, pus).

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

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3 mo ago


People Also Ask


What causes chronic swelling in the ankles, legs, and feet?

Chronic swelling in the ankles, legs, and feet can be caused by conditions such as chronic venous insufficiency, lymphedema, or heart failure. These conditions can lead to fluid retention and poor circulation, resulting in persistent swelling.


How can chronic venous insufficiency be managed?

Chronic venous insufficiency can be managed with compression stockings to improve blood flow, leg elevation to reduce swelling, regular exercise to enhance circulation, and consulting a healthcare provider for a tailored treatment plan.


What are the symptoms of lymphedema?

Symptoms of lymphedema include persistent swelling in the legs or arms, a feeling of heaviness or tightness, restricted range of motion, and skin changes such as thickening or hardening. It often occurs due to a blockage in the lymphatic system.


When should I seek medical attention for swelling and skin changes?

You should seek medical attention if you experience a sudden increase in swelling, shortness of breath, chest pain, or if the skin rash worsens, becomes painful, or shows signs of infection such as redness, warmth, or pus.

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