Differential diagnosis of Deep vein thrombosis from mechanical dysfunction of the lower leg.

Do you need that water pill for your swollen leg or is the problem mechanical?  

Homans sign is a common test to diagnose a possible DVT Deep Vein Thrombosis aka DVT. A  manual examination of the calf and the patient’s vitals can determine the medical necessity for performing an ultrasound on the leg to determine whether a clot has formed. While neither a Homan sign nor an ultrasound Doppler is 100 percent diagnostic, they can help determine if the patient has a serious problem developing.

Homans Sign

In most cases, the swelling will worsen and the area will feel warm when a clot has formed however, infection should also be suspected if the area turns red and there are signs of cellulitis developing.

In school, we were taught that heart problems and congestive heart failure will cause bilateral swelling of the feet and lower leg.  In my own experience with my mom, water pills helped her stay out of the hospital when there were no other options to prevent the excess fluids from pooling in her legs and lungs.

Some of our older patients may have one leg that swells.  There are numerous reasons for this however, the one most often overlooked is mechanical.

Medical providers often miss the mechanical basis for calf and lower leg swelling; here’s why.

All doctors practice what they were trained to do, and chiropractic doctors do as well.   Medical doctors have very little training in the musculoskeletal system and how to diagnose it appropriately. When doctors don’t know they test.   An ultrasound to rule out a clot is typically ordered however there is no data on how many of these percentage-wise reveal a clot.

Often, a swollen leg in an older patient is managed with a support hose and water pills.  Perhaps, another approach to care will be a better path to resolving why the calf is swollen minus the side effects of medication and symptoms management.

Chiropractic physicians are trained in vascular and cardiac assessment and often will look at the mechanics of the patient too as this is their specialty. They will also check your pulses, perform a Homan sign, and take a thorough history of not only your swollen calf but of your musculoskeletal history.  Often this can be quite revealing as chronic problems of the back, neck, and shoulder may be problems with your gait and may be the reason for the swollen calf. Sometimes this can be as simple as a pulled muscle.  Not so simple is understanding why you pulled a muscle. Figure out the why and you prevent it from continuing to happen again and again.

A thorough holistic chiropractic evaluation can quickly

A much younger Dr. Charschan working a track and field event.

assess whether the problem is mechanical vs. DVT.

This recently happened with one of our patients who have high arches and some chronic back issues.   Her doctor noticed the inside of her left ankle was swelling and immediately suggested an ultrasound without properly assessing her lower legs. If the problem is mechanical, the patient will often notice the swelling either resolve completely or reduce significantly after improving the mechanics of the area.  Chiropractors use both soft tissue techniques and manipulation of the joints to do this.   In her case, the straight leg raise showed the ankle and leg were tight and stiff causing problems resulting from impact. The next day, the swelling was gone and she no longer had pain.

Another older patient has an active scar from an old c-section that has periodically caused her problems.  During a recent visit, her left knee had swelled.  The evaluation showed the abdominal active scar was affecting her left leg movement and restricted movement in the hip while increasing impact on the left ankle.  The result was limping and a swollen left knee.  Improving the motion of the hip while reducing the restrictions of the scar resolved her knee inflammation naturally over a few short visits.

In the world of healthcare, we have made navigating the system complicated, costly, and scary when it does not need to be.  Chiropractors are trained to use a primary care approach to diagnosing musculoskeletal conditions but will refer to the medical system when needed.  They will also communicate with your primary medical doctor if necessary.

Chiropractic physicians keep it simple.   You do not need multiple specialists to manage a problem in the leg that is due to impact.  You simply need to walk better.   You also need to understand that many of the other problems such as knee pain, hip pain, foot pain, and back and shoulder problems may be the symptoms of the foot problem making your ankle and lower leg swell.

If you need to worry about this being a serious symptom of a health problem requiring medical attention, your chiropractor will let you know.  Will your medical provider refer you to the chiropractor to solve a simple problem?

Do you need a water pill or perhaps a chiropractic adjustment for the problem that is causing you to impact the ground hard making your leg swell?

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