Observation
Purpose: Visual observation of the lower leg assists the therapist in beginning to diagnose the problem that is happening with the patient. Some conditions produce specific skin or other changes that should be noted upon visual inspection, and may help the therapist in the diagnostic process. For the purposes of this help page, visual changes caused by the conditions covered in the mobile application will be detailed in the abnormal result section.
Procedure: The physical therapist should ask the patient to remove clothing from the area to be inspected. The physical therapist should scan the area to observe the involved segment or tissues and document any changes from normal appearance that are observed and document what they are.
Normal Result: Skin is of normal color, hair is present on the lower extremity (unless purposefully removed by the patient), skin is of normal temperature, and
Abnormal Result:
Arterial Insufficiency: Skin will appear pale or blue, bright red in dependent position, pale in elevated position; nail beds will demonstrate trophic changes, skin will feel cool to touch, skin will appear dry, scaly, and shiny, nails will not grow well, hair loss may be experienced. Little to no edema will be present. Wounds may be present on the toes or dorsum of the foot.
Venous Insufficiency: Skin has reddish or brownish discoloration (hemosiderin staining), skin may be scaly and dry, varicose veins may be observed, spider veins may be present around the malleolus. Lipodermatosclerosis may form (leg will have an inverted champagne bottle shape, skin will harden, skin will be reddened). Edema will be noted, usually bilateral in nature. Venous eczema may be present. Wounds, if present will be shallow and located in the gaiter region (ankle to mid calf).
Compartment Syndrome: Visible muscle bulging may be present in the affected limb. Edema restricted to the affected limb, which may be severe. Skin may turn red, purple, or pale.
Congestive Heart Failure: Bilateral edema usually noted in lower extremities. Edema may extend to the trunk. Edema is pitting. Patient may experience edema around their sacrum. The nail beds may be cyanotic (blue).
Deep Vein Thrombosis: A raised, red area may be seen on the calf in the direction of the involved vein. The patient may have swelling distal to the DVT. The limb may become reddened and warm to touch.
Lymphedema: The patient usually has unilateral edema in one limb. The skin is usually of normal color. There may be creasing at the distal ankle. The skin may become dry and scaly. There may be folds and bulges in the limb. Dry, warty spots may appear (papillomatosis).
References:
https://medlineplus.gov/ency/article/000156.htm
http://www.dermnetnz.org/topics/lymphoedema/
Goodman, C. C., & Snyder, T. K. (2013). Differential diagnosis for physical therapists. Elsevier Health Sciences.
McCulloch, J. M., & Kloth, L. C. (2010). Wound healing: Evidence-based management. FA Davis.
Procedure: The physical therapist should ask the patient to remove clothing from the area to be inspected. The physical therapist should scan the area to observe the involved segment or tissues and document any changes from normal appearance that are observed and document what they are.
Normal Result: Skin is of normal color, hair is present on the lower extremity (unless purposefully removed by the patient), skin is of normal temperature, and
Abnormal Result:
Arterial Insufficiency: Skin will appear pale or blue, bright red in dependent position, pale in elevated position; nail beds will demonstrate trophic changes, skin will feel cool to touch, skin will appear dry, scaly, and shiny, nails will not grow well, hair loss may be experienced. Little to no edema will be present. Wounds may be present on the toes or dorsum of the foot.
Venous Insufficiency: Skin has reddish or brownish discoloration (hemosiderin staining), skin may be scaly and dry, varicose veins may be observed, spider veins may be present around the malleolus. Lipodermatosclerosis may form (leg will have an inverted champagne bottle shape, skin will harden, skin will be reddened). Edema will be noted, usually bilateral in nature. Venous eczema may be present. Wounds, if present will be shallow and located in the gaiter region (ankle to mid calf).
Compartment Syndrome: Visible muscle bulging may be present in the affected limb. Edema restricted to the affected limb, which may be severe. Skin may turn red, purple, or pale.
Congestive Heart Failure: Bilateral edema usually noted in lower extremities. Edema may extend to the trunk. Edema is pitting. Patient may experience edema around their sacrum. The nail beds may be cyanotic (blue).
Deep Vein Thrombosis: A raised, red area may be seen on the calf in the direction of the involved vein. The patient may have swelling distal to the DVT. The limb may become reddened and warm to touch.
Lymphedema: The patient usually has unilateral edema in one limb. The skin is usually of normal color. There may be creasing at the distal ankle. The skin may become dry and scaly. There may be folds and bulges in the limb. Dry, warty spots may appear (papillomatosis).
References:
https://medlineplus.gov/ency/article/000156.htm
http://www.dermnetnz.org/topics/lymphoedema/
Goodman, C. C., & Snyder, T. K. (2013). Differential diagnosis for physical therapists. Elsevier Health Sciences.
McCulloch, J. M., & Kloth, L. C. (2010). Wound healing: Evidence-based management. FA Davis.
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HOAC-II-1 Trainer Help
These pages are to assist you with information you may need to work with the HOAC-II-1 Trainer Application. |