leg pain and venous problems Flashcards
what are s&s of an achilles rupture?
sudden ,severe calf pain
load popping sound
unable to weight bare
swelling and bruising in the calf or heel
+ve calf squeeze test
what is the imaging of choice for a suspected achilles rupture?
ultrasound
what is the cause of chronic venous insufficiency?
malfunction of the valves in the veins creating increased venous pressure
what are risk factors for chronic venous insufficiency?
age
family history
female
history of DVT
obesity
pregnancy
sitting or standing for prolonged periods
tall height
what are s&s of chronic venous insufficiency?
dull aching, heaviness or cramping in legs (also during the night)
itching and tingling
pain worse with standing, better with elevation of legs
skin colour changes
varicose veins
thickening and hardening of skin around the area
varicose ulcers
what are varicose veins?
abnormally dilated superficial veins
what are s&s of varicose veins?
achy or heavy legs
itchiness of the skin over the veins
restless legs
swelling of legs
what is a compartment syndrome?
ischaemia or reduced blood flow of the leg compartments, can be acute or chronic
what are s&s of acute compartments syndrome?
severe, increasing leg pain
redness, warmth and swelling of the compartment
weakness or paralysis of the foot
sensory changes in calf and foot
painful stretching of the compartment
–> surgical emergency! irreversible neuro deficits if not treated
what is the cause of chronic compartment syndrome?
increase in intra-compartmental pressure from increased blood flow in the muscles during physical activity causing muscle tissue swelling and the pressure induces vascular insufficiency
what are s&s of chronic compartment syndrome?
abnormal tight fascia compresses arteries & nerves, causing local and distal ischaemic symptoms:
- cramping in leg
- weakness and sensory loss in leg due to deep peroneal nerve compression
- artery compression leading to foot cyanosis
- diminished pulse
- post exercise muscle contracture
what is deep vein thrombosis (DVT)?
thromboembolism affecting the deep veins causing venous insufficiency
what are s&s of DVT?
50% is asymptomatic
deep, aching, constant pain within the calves
swelling, redness, warmth over calf
tender to touch
what is virchow’s triad?
3 factors that predispose a person to develop vascular thrombosis:
1. blood stasis in vein: immobility, surgery or long flights
2. hyper-coagulability: smoking, cancer, oral contraceptive pill, clotting disorders
3. damage to the intima of veins: previous DVT, venous surgery
what are the most common investigations for DVT?
CPTA: computed tomographic angiogram
D-dimer blood test (detects fragments of the breakdown products of a blood clot)
duplex ultrasound
magnetic resonance venography
contrast venography
what is the management for DVT?
urgent hospital referral
treatment: heparin, then oral anticoagulants
what is peripheral arterial disease (PAD)?
arterial insufficiency causing ischaemia in the lower limb
what are the risk factors for PAD?
diabetes
history of cardiovascular disease
hypercholesterolaemia
> 60 years
what are s&s of PAD?
calf cramping and pain after walking a set distance (intermittent claudication)
pain is relieved by rest
pain occurs faster with uphill walking
pain relieved by lowering leg out of bed
paleness, bleu, cold, loss of hair on leg
ulceration/gangrene of lower leg and foot
weak or absent pulses
bruit may be heard when auscultating the femoral arteries or aorta
when is beurger’s test positive?
> 90°: normal
15-30° for 30-60 seconds cause pallor: ischaemic leg
<20°: severe ischaemia