Calf Pain





Calf pain is a common problem in Orthopaedic OPD. Pain is usually aching and mild to

moderate.There are varietites of causes for this. Some of them are

1.Calf muscle strain due to physical exertion

2.Calf muscle contusion due to trauma

3.Vascular claudication (inadequate blood supply )

4.Radiating Pain from nerve  compression in lumbar disc herniation

5.Lumbar canal stenosis

6.Anxiety and nervouoness

7.Ruptured Baker Cyst

8. Polpliteal Artery Aneurysm

9.Electrolyte /hormonal imbalances

10.Blood clots in veins of legs (Venous thrombosis )







Man suffering from leg pain, calf pain. mono tone red highlight. Man suffering from leg pain, calf pain. mono tone highlight at calf, leg isolated on white royalty free stock photography

                                                            dreamstime.com





When is calf pain considered serious and requires urgent medical care ?

Calf pain along with swelling might be serious .It can be due to venous thrombosis( DVT). Its a

condition where there  will be the blood clots inside the deep venous system of the legs. These might

be carried   to chest and occlude pulmonary arterys partially or completely.This can be very fatal in

no time.This can be dangerous.



When is there a risk of DVT ?

Risk factors for DVT.

1.Advanced age

2.Prolonged bed rest

3.Pregnancy

4.DM with uncontrolled blood sugar level

5. Trauma and surgery of leg , hip and spine

6. Some drugs like Oral Contraceptive Pills (OCPs), steroids

7.Inherited Thrombophilia

When to diagnose DVT ? 

based on history , physical examination and investigation , its diagnosed.

Based on history
     prolonged bed ridden, metabolic diseases like Diabetes mellitus, air travelling
 
     pregnant , septic abortion,

     drug uses like steroids , OCPs

Physical Examination

     calf swelling , tenderness , painful dorsiflexion of ankle


Investigation

   USG is sufficient most of the times .

   Other investigations

     D-dimer test

     Decreased homocystiene , protein - C  and S ,

    Deficiency of antithrombin III
   
   Contrast venography , MRI


These confirm the DVT.


How is this treated ?

  1.Prevention
 
      Spinal or Epidural Anaesthesiae

      Meticulous surgical Techniques

      Stockinette

      Calf pumping exercises

      Heaprin -Unfractionated or LMWH

      Venacava filters


2. Treatment

      Warfarin , Heparin ,newer anticoagulants

        Inferior vena cava filters

       Thrombectomy

        Catheter directed thrombolysis




Are there other dangerous conditions to be worried in calf pain ?

Yes sometimes acute Arterial thrombosis of lower limbs can pose threat to limb and life. Such

patients have severe pain and coldness of the leg. In such condition the limb might turn avascular if

not intervened in less than 6 hours. Such condition should be ruled out.

Diagnosis is based on

 history of severe pain not relieved with any medication

advanced age , smoking history , history of cardiac illnesses

on examination - limb may be cool , no pulsation on Dorsalis pedis and posterior tibial artery

Investigation - Doppler study of arterial system of the limb may reveal clots proximally and no blood

flow distal to clot



How to manage such patients ?

  Detailed history taking

  Phyiscal Examination

  Councelling and clear meassage to the family of risks of limb and life , provision of urgent

   treatment  and possible need of surgery



   Investigations - Blood - Coagulation profile - BT/CT /PT/INR

                                           Routine lab investigations

                                           Cardiac work up - ECG ,

                           USG - Doppler study

                         
      Start anticoagulants

       Cardilogist  Consultation

       Thrombectomy




Apart from these two conditions other causes of calf pain can be  managed with ease. They are not life threatening.
































Comments

Post a Comment

Popular posts from this blog

OSTEOMYELITS

What is Osteomyelitis ?    Its a infection of bone and Bone Marrow. Bone marrow is a spony tissue inside the bone. It                 produces new bloods cells. What do you mean by acute and chronic osteomyelits ?    Acute Osteomyelitis means the disease onset is within a week.If it persists for more than 2 weeks     we call it Chrnoic Osteomyelitis.And after one week we call it subacute osteomyelitis. If its treated    within 24 hours then the chances of halting progression to chronic Osteomyelitis is very very     less.Once it progresses to subacute and chronic osteomyelitis then it won't be cured.There is     always a risk of disease recurrence. Which Organisms cause Osteomyelitis ?    Staphylococcus Aureus is the commones bacteria.     Streptococcus Sp.      In toddlers , E. Coli, Haemophilus Influenzae   ...
Read more

Back Ache

Image
Back Ache: Brief introduction, causes and principle of treatment Back Ache generally refers to pain on dorsum, lumbar region and up to the tail bone. It’s one of the commonest Orthopaedic Problems in adults. Various reasons might cause back ache. It hampers activities of daily living as well as job performance. Some factors that contribute to this situations are poor posture, depression, obesity, age and height, smoking, stress, exercise etc. Life time risk for this problem is 60-70 % in developed nations. The problems may lie on skin, muscle, bone or deeper organs of urogenital system, intestine, stomach or Aorta. Whenever someone comes to a physician, generally he may be asked about duration of illness, any event preceding back ache, pain radiation to other sites on body, stool and urine incontinence, associated fever, weight loss, night pain and any relevant medical or surgical diseases in the past and few other relevant questions. After that, he will be thoroughly examined ...
Read more

Osteoporosis

Image
What is Osteoporosis ? It is a condition with decreased bone mineral density. It's a major health problem affecting 10 million Americans. It increases porosity inside bones leading to increased risk of fracture .                                                                         Normal bone (left ) and porosity in Osteoporotic bone (right ) What are the risk factors for this problem ? Risk factors for  Osteoporosis A. Life-style     Alcohol     Excess vitamin A     Frequent falls     Prolonged bed rest      Low calcium intake      Tobaccoo use      High caffeine       High salt       low body mass index B. Genetic factors     ...
Read more