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Patients present with an acute onset of swelling, pain, erythema, prominent tenderness, warmness and limited range of motion in both ankles. [1] [2] Lower legs and heels may also be involved, however the distal parts of feet and toes are usually spared. Patients may also experience high-graded fever, pitting edema and hypotension.
Hereditary lymphedema is a primary lymphedema – swelling that results from abnormalities in the lymphatic system that are present from birth. Swelling may be present in a single limb, several limbs, genitalia, or the face. It is sometimes diagnosed prenatally by a nuchal scan or postnatally by lymphoscintigraphy. [medical citation needed]
The condition is more concerning if it starts suddenly, or pain or shortness of breath is present. [2] Treatment depends on the underlying cause. [2] If the underlying mechanism involves sodium retention, decreased salt intake and a diuretic may be used. [2] Elevating the legs and support stockings may be useful for edema of the legs. [3]
Because of its similarities to deep vein thrombosis (DVT), May–Thurner syndrome is rarely diagnosed amongst the general population. In this condition, the right iliac artery sequesters and compresses the left common iliac vein against the lumbar section of the spine, [5] resulting in swelling of the legs and ankles, pain, tingling, and/or numbness in the legs and feet. [6]
If the impaired vein function causes significant symptoms, such as swelling and ulcer formation, it is referred to as chronic venous disease. [3] It is sometimes called chronic peripheral venous insufficiency and should not be confused with post-thrombotic syndrome in which the deep veins have been damaged by previous deep vein thrombosis.
The legs and face are the most common sites involved, although cellulitis can occur on any part of the body. [1] The leg is typically affected following a break in the skin. [1] Other risk factors include obesity, leg swelling, and old age. [1] For facial infections, a break in the skin beforehand is not usually the case. [1]
The management of lipodermatosclerosis may include treating venous insufficiency with leg elevation and elastic compression stockings. [9] In some difficult cases, the condition may be improved with the additional use of the fibrinolytic agent, stanozol. Fibrinolytic agents use an enzymatic action to help dissolve blood clots.
[10] [11] [12] Other underlying disorders include vasculitides such as polyarteritis nodosa. [8] Other causes of edema include heart failure, hypoalbuminemia, nephrotic syndrome and venous stasis. The key distinguishing feature is that these conditions don't tend to manifest with pitting edema at the back of the hands.