Swelling of the Foot and Ankle
See chapter “ Ankle Injuries ”.
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Venous Insufficiency * I87.2 Diagnosis. Most often visible varices and thrombophlebitis, vascular oedema, sometimes of the pitting oedema type, often brownish discolorations in the skin. Treatment. Compression therapy of different modalities, always elastic bandaging and instructions for increased physical activity. Weight reduction when appropriate. Consideration of surgical measures regarding the varices.
Deep Venous Thrombosis (DVT) I80.3 Diagnosis. In most age groups, but increased risk over 40, similar frequency between the genders. Grave prognosis if untreated. Among other risk factors extended immobilisation (e.g. with plaster-of-cast), previous DVT or pulmonary embolism, adiposity, congestive heart failure and infarction, fractures of the hip or leg, knee and hip arthroplasties, hip fracture surgery, multiple trauma, long journeys, contraceptive pills, pregnancy, infection, stroke and malignancy could be mentioned. Most begin in the veins of the calf with poor reflow. Most patients are asymptomatic; generally there are a few symptoms: pain and swelling on the upper foot, ankle and lower leg; phlebitis is also possible. Swelling that remains in spite of elevation. Tenderness, redness, certain induration and increased venous stasis picture. Pain in the calf with exasperation on dorsal extension of the foot (¼ Homan sign positive, but not fully conclusive for thrombosis). Venography (phlebography) is the golden standard method; also ultrasound Doppler is an adequate option. Thrombosis in, or proximal of, the popliteal fossa carries a 50 % risk of pulmonary embolisation.
S.-A. So¨lveborn, Emergency Orthopedics, DOI 10.1007/978-3-642-41854-9_7, # Springer-Verlag Berlin Heidelberg 2014
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Swelling of the Foot and Ankle
Treatment. Transfer to an internal medicine unit for immediate anticoagulation therapy.
Heart Failure * I50.9 Diagnosis. Distal swelling of pitting oedema type, i.e. when pits remain in the skin after finger pressure, most commonly bilateral. Look for heart symptoms like bandshaped pain and pressure over the chest. Treatment. Referral to an internal medicine unit.
Ankle Injury (Distorsion/Sprain, Fracture) * See chapter “Ankle Injuries”.
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