Examination (ankle swelling)
Examination:
- local
- oedema - one or both legs
- signs of chronicity e.g. varicose eczema associated with chronic venous insufficiency
- associated ischaemia?
- systemic
- presence of an abdominal mass or ascites?
- signs of cardiac failure
- anaemia?
The degree of oedema is commonly described on a subjective 0 to 4+ scale in order of increasing severity (1).
Ankle circumference is a simple quantitative test for clinical practice with good reliability and is measured 7 cm proximal to the medial malleolus.(2).
Stemmer's sign is present if the examiner cannot pinch a fold of skin at the base of the patient's second toe. It is a sensitive test for primary and secondary lymphoedema (3)
References
- Brodovicz KG, McNaughton K, Uemura N, et al. Reliability and feasibility of methods to quantitatively assess peripheral edema. Clin Med Res. 2009 Jun;7(1-2):21-31.
- Brodovicz KG, McNaughton K, Uemura N, et al. Reliability and feasibility of methods to quantitatively assess peripheral edema. Clin Med Res. 2009 Jun;7(1-2):21-31.
- Goss JA, Greene AK. Sensitivity and specificity of the Stemmer sign for lymphedema: a clinical lymphoscintigraphic study. Plast Reconstr Surg Glob Open. 2019 Jun;7(6):e2295.
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