One of the most common yet misdiagnosed conditions we see at the Bluegrass Foot Center is superficial thrombophlebitis (thrombo flibytis). Chronic swelling of the legs is very common, and occurs for a number of reasons. Chronic high blood pressure, obesity, liver failure, venous insufficiency, history of numerous pregnancies, pelvic or groin surgery, radiation of pelvis or groin region, venous reflux, and inactivity are all potential reasons why one may develop chronic swelling of the legs. All of these conditions cause a reduced ability of the veins of the legs to return blood to the body. When this occurs, fluid builds up in the legs, resulting in swelling of the legs.
Our skin is like a balloon. If you blow up a balloon too much it pops. Similarly, as the legs swell, the skin gets irritated and inflamed, causing the skin to become red, hot, and tender to touch. If left untreated, the skin can develop sores, or venous stasis ulcerations.
Frequently, other health providers view the redness as an infectious process, called cellulitis. The patient is commonly admitted to the hospital, placed on IV antibiotics and in a hospital bed. This treatment often resolves much of the redness and swelling, not as a result of the antibiotics, yet due to elevation of the legs, resulting in the reduction of the redness and swelling. In fact, in most cases, infection was never present.
In many people with a history of venous stasis ulcers, chronic leg swelling, history of blood clots, or leg pain, a simple noninvasive test of the leg veins can be performed in our office to determine if the valves of the veins are damaged. This condition, called venous reflux, can be treated by an interventional cardiologist with a simple outpatient procedure, called a vein closure procedure. Unfortunately, there are few long term options beyond this procedure. The chronic swelling can be adequately controlled with compression hose worn on the legs daily, although compliance is frequently a problem.
Use of below the knee compression hose can effectively control the chronic swelling of the legs, reducing the recurrence of phlebitis (inflammation of the vessels of the skin). Compression hose are sold in the office,and are fit based on size of the legs. In addition, a lymphedema pump can also be of assistance. This involves wrapping the legs with inflatable bladders, with a machine elevating the bladders to squeeze on the legs at set time intervals. Finally, when the patient is either unable to tolerate or unable to apply compression hose on a daily basis, once weekly application of wraps, called Unnaboots, can help. These comfortable wraps are left clean, dry, and intact for 7 days, until the following week, at which time new wraps are applied.
The weekly application of wraps is indefinite. Unfortunately, any external compression treatment for treatment of venous insufficiency or phlebitis is transient, and needs to be employed indefinitely. Chronic swelling and repeat episodes of superficial thrombophlebitis can result in scarring of the skin, called post phlebitic syndrome. This condition can result in chronic wound formation of the skin, and may result in having to apply unnaboots to the legs on a once weekly basis indefinitely.
If you suffer from chronic swelling of the legs or frequent redness and tenderness of the lower legs, give us a call at 270-684-5252. Treatment options are available!
Dr Block is an excellent podiatrist. The staff is friendly and very professional.