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Noticed Red And Purple Thing On Leg. Causing A Laceration. Segmental Pressures Done. Wearing Compression Stockings. Guide?
Question: Hi , Basically, not sure if the term is claudication, but my 80 y/o husband's rt leg above the ankle for about 3 " totally encircling his leg is red and purple if his stands too long. It has been this way almost 1 year and seems, perhaps, to have started after he bumped his leg, causing a laceration above the ankle that took at least 9 months to heal with treatment by wound specialists. He has had doppler testing of his leg which showed arterial blood flow was not a problem. Not sure about venous. My daughter does ultrasounds and i am a nurse, but other than suggesting to his doctor that he have segmental pressures done, we don't know if there is treatment for this. He has been wearing compression stockings to the knee, which leave a XXXXXXX showing they constrict the blood flow just below the knee. He is taking ASA 81mg daily and HCTZ 25 mg, Lisinopril 20mg which keeps his blood pressure wnl.
Brief Answer:
Did you check out for venous insufficiency?
Detailed Answer:
Hi and thank you so much for this query.
I am so sorry to hear about what your husband is experiencing with the right leg.
From the information you have provided, my suspicion for venous insufficiency is very high. I honestly think this is is the most likely explanation for his symptoms. Our veins return blood to the heart and if their ability to maintain an effective to the heart return of blood is compromised, excess blood would tend to accumulate in the limb and manifest as swelling. This swelling is generally absent in the early hours of the morning except in severe cases and as you rightly described, this is often more noticeable in an upright position. This is because a failed or failing vein just can't effectively return blood to the heart against gravity resulting in accumulation. While lying flat, there is no gravity opposing venous return of blood flow is a lot easier and explain why it often disappears in the early hours of the morning.
Treatment is mainly symptomatic. Compressive stockings, elevating the legs when sitting, avoiding unnecessary upright positions. He should also be very careful with this leg as the likelihood of having an ulcer is higher and healing prospects greatly compromised by this condition.
I hope this sheds some light on the on going swelling your husband has. Questions are welcomed for clarifications if needed. I wish you, your husband and your entire family well.
Thanks once more for this opportunity to exchange with you on this.
Dr, Ditah, MD
Did you check out for venous insufficiency?
Detailed Answer:
Hi and thank you so much for this query.
I am so sorry to hear about what your husband is experiencing with the right leg.
From the information you have provided, my suspicion for venous insufficiency is very high. I honestly think this is is the most likely explanation for his symptoms. Our veins return blood to the heart and if their ability to maintain an effective to the heart return of blood is compromised, excess blood would tend to accumulate in the limb and manifest as swelling. This swelling is generally absent in the early hours of the morning except in severe cases and as you rightly described, this is often more noticeable in an upright position. This is because a failed or failing vein just can't effectively return blood to the heart against gravity resulting in accumulation. While lying flat, there is no gravity opposing venous return of blood flow is a lot easier and explain why it often disappears in the early hours of the morning.
Treatment is mainly symptomatic. Compressive stockings, elevating the legs when sitting, avoiding unnecessary upright positions. He should also be very careful with this leg as the likelihood of having an ulcer is higher and healing prospects greatly compromised by this condition.
I hope this sheds some light on the on going swelling your husband has. Questions are welcomed for clarifications if needed. I wish you, your husband and your entire family well.
Thanks once more for this opportunity to exchange with you on this.
Dr, Ditah, MD
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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