So what’s news this week from clinic; time for a reality check?
Case History: A patient presented with calf pain only a week following foot surgery. The most important part of any clinician’s role is to prevent problems. Sometimes we cannot do this, but we might predict if an event can arise (see below). Take the development of a blood clot in the leg after foot surgery. This is rare, and the College of Podiatry national database registers less than 1% for foot surgery (0.23%). Incidentally, hip and knee surgery produce a greater incidence of DVT than in the feet. Given that we have a database of around 60,000 patient consultations now, the risk of DVT looks low against a cohort of patients who have had 46674 surgical treatments. The value is based on proven clots. My own figures show 0.32% for around 1500 surgical treatments. This means an ultrasound scan shows up positively. So what if you have calf pain could this be a clot?
My patient was a female who mimicked DVT. The usual alternative suspect is calf spasm. That is the calf muscle tightens up often due to the foot being held awkwardly. Another type of calf pain caught us out this week; a cyst around the knee. The Baker’s cyst as it is called, forms behind the knee (the popliteal area) and is a benign swelling It is named after William Morrant Baker (1838–1896), the surgeon who first described it. The cuff around the thigh during surgery can disturb the cyst sufficiently to make the calf swell and appear as a DVT. Usually the cyst will settle down without specific treatment unless it ruptures. So as part of our concern we have suspected DVT and proven DVT.
Prevention is better than cure as they say! Well we work on previous history, including those from long haul flights, obesity, smoking and venous disease as well as blood disorders. The female contraceptive pill as well as HRT (hormonal replacement therapy) may still offer some concern although less so than when the high dose oral contraceptive hormone treatment was first used. Patients immobilised after foot surgery need to exercise and if they cannot then the risk from DVT will increase. After 30 years of surgical practise my own experience has shown a DVT arises typically from 3 to 12 weeks following surgery. Our case this week was more or less instant, narrowing the margins that a DVT was likely. The team at Spire were on the case.