Need advice for patient with recurrent swelling

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Hi

I wondered if anyone could help me?

38 year female presented with right foot swelling along the whole of the medial side of the foot BUT this only happens every 2 weeks. This swelling lasts for a few days where she will rest it and take ibuprofen, she informs me that the foot is difficult to walk on and also itches due to the swelling. This has been happening for 10 years.
On palpation today, no pain was reproduced and gait analysis revealed nothing majorly abnormal. She does not get pain in the gastrocnemius. No varicose veins or anything abnormal in the area. She has a requisition for a x-ray but am unsure if it will show anything. She does have orthotics (prescribed by another podiatrist) and she feels they aggravate the condition. The orthotics were prescribed years after the problem occurred. As usual the patient didn't have them with her!
I am a little lost as to how to proceed apart from encouraging her to go for the x-ray but feel an MRI would be better suited as doubtful it is bone origin. I did consider the chance it may be a blocked lymph vessel as she mentioned she does have a few blocked lymph nodes around the arm and chest area. I suggested to her to try compression stockings or even an elastic ankle support brace to contain the swelling.
Any comments would all be gratefully accepted as I am at a loss as to how to diagnose and then treatment options.
Many thanks for your time and expertise in this matter
Lucy

 

Re: Need advice

Hi Lucy.:welcome: to the arena.

If the old device makes the problem worse get the patient to remove then for a constant period of time.

Compression sounds a good idea and I would think a letter to the Dr who looks after the lymph condition for a assessment of her feet be a good 1st step

Also is it every 2 weeks like clockwork if so what activities bring it on.

Good luck

 

Lymphodema? Tight underwear constricting femoral vein.?

 

As Mike said a letter to the specialist who looked at the lymph condition would be great if you have those details but i'd put a letter to her GP as well stating what is happening and your suspicions that it could be related to the previous lymph condition and ask for his/her opinion.

 

Hi Lucy,

As a new member and recent graduate, my knowledge and experience is continuing to grow however i do believe that as the presentation of the complaint is like clock work, hence every 2 weeks, there must be a significant contributing factor, perhaps a hobbie or form of exercise.

I would be grateful if you coud let us know what comes of this patient as im very interested in your findings.

Thank you and good luck!

 

Hi

Thank you once again for everyone's contribution and also for taking the time out of your schedules to post a reply. I really do appreciate it.

Fortunately I work at a Family Health Team (FHT) here in Canada so have access to full medical records, know the patient's doctor etc etc. I had already written to the patient's family doctor and the reply I got after mentioning about a blocked lymph vessel was "any help would be gratefully accepted". So I think if I request any blood test or MRI I think it would be granted, so good start there.
I spoke to a pharmacist at the FHT who also even mentioned it could be hormonal which I hadn't considered since it is so regular.

At present I am holiday (have the family visiting from Britain, I am British and worked in the NHS for 8 years and took the registration exam for Ontario in 2008 after emigrating). Just before I went on holiday I did try to contact the patient in question but as always no reply! So I will certainly try again once I return next week as I want her to keep a journal/diary of activities. Plus talk a little more to her doctor as to how to proceed.

I promise to keep you updated and sincere thanks again for your replies.
Lucy