Assessing the Calves
Look at and feel the patient's calves, looking for signs of deep venous thrombosis.
Signs of DVT
- Erythema
- Swelling
- Tenderness
Peripheral Oedema
Look for swelling of the lower limbs; apply pressure to the anterior aspect of the tibia for fifteen seconds and then release to assess for pitting oedema.
Causes of Oedema
Pitting
- Fluid overload - excessive IV fluids, renal failure, heart failure
- Right ventricular failure
- Venous pathology - thrombosis / insufficiency
- Dependency (the effect of gravity)
- Hypoalbuminaemia - malnutrition, malabsorption, nephrotic syndrome, liver (synthetic) failure
Non-Pitting
- Impaired lymphatic drainage
- Pretibial myxoedema (hypothyroidism)
Lower Limb Pulses
Strong femoral, popliteal, posterior tibial and dorsalis pulses are reassuring, while weak or absent lower limb pulses represent vascular compromise that may be limb-threatening if acute.
Pulses in the Lower Limb
- Femoral - palpate within the inguinal region, halfway between the pubic symphysis and iliac crest.
- Popliteal - bend the patient's knee to 90 degrees, gently grasp both sides of the knee joint and palpate using tips of fingers within the popliteal fossa posteriorly.
- Posterior tibial - palpate posteriorly and inferiorly to the medial malleolus.
- Dorsalis pedis - palpate lateral to the extensor tendon of the great toe. This can be identified by asking the patient to extend their great toe.
Causes of Absent Lower Limb Pulses
- Vascular trauma
- Compartment syndrome
- Peripheral vascular disease
- Abdominal aortic aneurysm
- Shock
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