May 5, 2006

Doctor’s Corner:

Swollen feet, should you be worried?

By Eduardo Grunvald, M.D.

Three days after flying non-stop from Buenos Aires to San Diego, you notice that your foot is swollen, painful and red. Should you be worried? Maybe.

Many things can cause a swollen foot or leg. The challenge is differentiating between a dangerous DVT (Deep Venous Thrombosis) and a more benign cause. DVT does not share the same household notoriety as diabetes or strokes, but increased awareness of this not uncommon malady could save lives.

DVT is a condition that occurs when blood abnormally clots in the large deep veins, usually – but not always – in the legs.

The arteries of the legs pump blood toward your foot and the veins drain it back toward the body. With each pump of the heart this process carries on in harmony. Interestingly, each time you walk the muscles in your calves also work as pumps to help blood overcome gravity on its way up.

If blood does not move along however, it can clot – nature’s ingenious way of making sure a “plug” forms if blood sits around a cut on the skin. But if this occurs inside the veins, the results can be deadly. The clot in the leg can be very painful and unsightly, but as long as it remains in that position, it will probably not pose a threat to life. If the clot breaks off, it can migrate into the lungs, causing dangerously low oxygen levels or even sudden cardiac arrest.

When DVT is detected, taking blood thinners can easily prevent potential complications. The problem is that the symptoms – swelling, redness, and warmth – can be caused by more common problems, which can be mistaken by both patient and doctor. Infections, tendon or ligament injuries, ankle sprains, and gout, are some examples of conditions that can mimic the symptoms of DVT.

And what risk factors can predispose someone to developing a DVT?

The major ones include immobility — for example, being in bed for a long time because of an illness or sitting on a long airplane ride — recent surgery, a trauma, like a broken leg; obesity, advanced age, having a diagnosis of cancer, or taking birth control pills — especially if the pill taker smokes.

There are also certain blood diseases that can cause blood to clot easier than usual.

It is estimated that up to two million people in this country develop DVT’s each year, and 200,000 die from the complications. More importantly, up to 75 percent of those who develop the complication of the clot moving to the lungs never knew they had a clot.

The key to remember is that if you develop swelling, pain, or redness of one leg, particularly if you have any of the risk factors mentioned above, immediately seek medical attention. A DVT can be easily diagnosed with an ultrasound test of the legs.

The problem is easy to diagnose and treat. The challenge lies in detection. So stay active and healthy and remember the symptoms of DVT.

Dr. Grunvald is Assistant Clinical Professor, Department of Medicine at the Perlman Internal Medicine Group, UCSD Medical Center.

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