Hi,

Thanks for writing your query here.

You seem to be suffering with pedal edema associated with focal pigmented spots. I would like you to elaborate this problem:
- The duration of complaints?
- Is it restricted to one side or is it over both legs?
- Do you have pain along with the swelling?
- Were you injured?
- Is there a diurinal variation (the severity of swelling change during the course of day)?
- Does it increase with standing/walking around? / Relieved with rest?
- Do you have swelling of other areas - other joints, abdomen, hand, eyes?
- History of high blood pressure, blood sugar, thyroid disorder?
- Are you on regular pills?

I hope you will provide all these details and any other details that you feel can be helpful.

I await your response...

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Hi,

Apologies for the late reply and thank you for providing more details; the pictures have been helpful too.

The picture revealed pitting odema - pitting on constant pressure from the mouth of socks perhaps. This type of presentation is seen in venous pooling. In the action of gravity, veins in lower limb need to pump the blood above to the heart. Either due to pumping mechanism failure or due to overload, when blood isn't pumped sufficiently, the resulting pooling can lead to this type of swelling. As deep vein thrombosis is ruled out by Doppler scan, this is most likely a problem of superficial veins.

I was able to appreciate pigmented spots around the thigh and calf. Without an opportunity to examine those spots under broad light, it would be difficult to relate them. However based on the pictures, it is less likely to be related to the swelling at the ankle. Please note that we also find pigmented spots with venous pooling, therefore that's not completely excluded. You will also have to consider the role of minocycline here; there are reports that pigmented skin lesions occur with minocycline therapy.

That being said, venous insufficiency/pooling is going to be chronic condition; something which you may have to live with. Use of compression stockings is definitely going to benefit you on the long run. Avoid any activity where gravity effects are going to be maximum - such as prolonged standing. Similarly avoid any circumstances where venous blood flow would be obstructed such as use of ligatures/tight bands. Besides these, if your blood pressure and renal functions are normal, a diuretic (water pill) such as hydrochlorothiazide can be taken to keep the swelling as minimal as possible.

In addition to the above, thyroid functions, blood sugar, liver and renal functions need to be assessed with specific tests. Talk about this swelling whenever you XXXXXXX a new doctor; few medicines need to be prescribed in moderation / after weighing the benefits in the presence of this swelling.

I wish that you consult and discuss about these aspects with your local doctor. You may plan further tests as specified. Accordingly plan your treatment. Follow up with your doctor regularly to be able to avoid any future complications.

Hope this answer is informative and helpful. Let me know if you need clarification.

Cheers!!

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