[50F] Experiencing severe lower leg pain with swelling and inflammation

Patient Description

A 50-year-old female has been experiencing severe pain, inflammation, and swelling in her lower legs, specifically in the feet, ankles, and calves for 6 weeks. The pain, rated 9 to 10 on a severity scale, worsens with walking and standing after sitting. Despite normal blood work results, she has been referred to a cardiovascular surgeon. The patient also reports skin changes, including peeling due to prolonged swelling. She has a history of COPD diagnosed in 2005 and high blood pressure diagnosed in the early 2000s. Currently, she is on Losartan (25 mg twice daily), Lasix (20 mg daily with potassium), and Clindamycin (300 mg four times a day). She also takes Ibuprofen (800 mg every 6 hours) for pain management. The patient has a known allergy to Keflex, Cipro, and Amoxicillin, leading to anaphylaxis. She suspects having varicose veins but is unsure about other venous or arterial diseases in her family history.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

  • Chronic Venous Insufficiency (CVI): This condition occurs when your leg veins don't allow blood to flow back up to your heart. Symptoms can include swelling, pain, and changes in skin color. Your history of varicose veins and the symptoms you're experiencing could suggest this condition.

    • Treatment typically includes compression stockings, exercise, and elevating your legs. In some cases, surgery may be necessary.
  • Peripheral Artery Disease (PAD): This condition is caused by a buildup of plaque in the arteries that supply blood to your legs and feet. Symptoms can include pain, swelling, and changes in skin color. Your history of high blood pressure and COPD could put you at a higher risk for this condition.

    • Treatment typically includes lifestyle changes, medication to control blood pressure and cholesterol levels, and in some cases, surgery.
  • Deep Vein Thrombosis (DVT): This is a blood clot in a deep vein, usually in the legs. Symptoms can include swelling, pain, and changes in skin color. However, DVT would typically cause more acute symptoms rather than the chronic symptoms you're experiencing.

    • Treatment typically includes anticoagulant medications.
  • Lymphedema: This is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system. Symptoms can include swelling and changes in skin color.

    • Treatment typically includes compression garments, proper skin care, and exercises to encourage lymph drainage.

Please note, these are only possible diagnoses and you should consult with your healthcare provider for a formal diagnosis.

What you can do

Until you see your healthcare provider, here are some things you can do to help manage your symptoms:

  1. Elevate your legs whenever possible.
  2. Wear compression stockings if you have them.
  3. Stay active and exercise regularly. Walking is a good exercise that can help improve blood flow.
  4. Avoid standing or sitting for long periods of time.
  5. Maintain a healthy weight and diet.
  6. Keep your skin moisturized to prevent dryness and cracking.

What you should look out for

Please seek immediate medical attention if you experience:

  • Sudden or severe swelling in your legs.
  • Sudden or severe pain in your legs.
  • Changes in skin color or temperature.
  • Chest pain or difficulty breathing.
  • Any other symptoms that concern you.

Remember, this advice is intended to be general in nature, and specific causes may need different management. Always consult with your healthcare provider for appropriate examinations, treatment, testing, and care recommendations.

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8 mo ago


People Also Ask


What are the common symptoms of Chronic Venous Insufficiency (CVI)?

Common symptoms of Chronic Venous Insufficiency (CVI) include swelling in the legs or ankles, pain that worsens when standing, skin changes such as discoloration or thickening, and varicose veins.


How can Peripheral Artery Disease (PAD) be managed or treated?

Peripheral Artery Disease (PAD) can be managed with lifestyle changes such as quitting smoking, exercising regularly, and eating a healthy diet. Medications to control blood pressure and cholesterol may be prescribed, and in some cases, surgical procedures like angioplasty may be necessary.


What are the risks associated with Deep Vein Thrombosis (DVT)?

Deep Vein Thrombosis (DVT) can lead to serious complications such as pulmonary embolism if the clot travels to the lungs. It is important to seek medical attention if you suspect DVT, as it requires treatment with anticoagulant medications to prevent clot growth and reduce the risk of complications.


What lifestyle changes can help manage lymphedema?

Lifestyle changes that can help manage lymphedema include wearing compression garments, engaging in regular exercise to promote lymph drainage, maintaining a healthy weight, and practicing good skin care to prevent infections.


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