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Judy
Judy, Nurse
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Experience:  RN in ICU for 35 years
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swollen left foot and ankle. No sign of puncture or insect ...

Resolved Question:

swollen left foot and ankle. No sign of puncture or insect bite. No pain, but the area is cold to the touch. What could be the cause, and how serious is the issue?
Submitted: 8 years ago.
Category: Health
Expert:  Judy replied 8 years ago.
How much of the foot and ankle is cold when you have not had ice on it for a period of time?

Is there any discoloration to the foot, toes?


Customer: replied 8 years ago.
Reply to Judy's Post: Judy,

There's no discoloration at all, it's just swollen. I've looked at his leg again, and it seems to only be cold and swollen from the sock line down, so not very far up the shin.
Expert:  Judy replied 8 years ago.
I am worried about the circulation in this foot, it should not be cool
or cold to the touch. Is it much cooler than the other one?


Do you know how to check for pulses? There should be a pulse
along the top of the foot. If you drew a line along the length of
the top of the foot between the big toe and 2nd toe up toward the ankle
and checked a point at the end of that line just on top of the highest
part of the foot itself (not the ankle) there should be a fairly strong
pulsation. Please try to find it on the right foot first as that
would be easier to find. Then when you know where to look, find
it on the affected foot. If you can feel it on the right but not
on the left, there is a serious problem with the circulation of that
left foot. If this is the case, please go to the emergency room!

Do you remember hurting the foot at all? There is something
called compartment syndrome and this can threaten the circulation of an
injured extremity even when there is no outside visible injury.
The area swells so much that there is not room to swell any more and
the pressure builds up on the blood vessels and nerves in the
extremity.

I think you should have this checked tonight!




Customer: replied 8 years ago.
Reply to Judy's Post: Since I last posted, the swelling in his foot has gone down considerably, but the ankle remains very swollen. I will check for the pulse now, and reply.
Expert:  Judy replied 8 years ago.
I am waiting for your reply, glad the swelling is down!

Customer: replied 8 years ago.
Reply to Judy's Post: I checked the pulse on both of his feet, and it appears to be even stronger on the left than on the right. I was able to find the pulsepoint with no trouble at all.
Expert:  Judy replied 8 years ago.
Excellent, then there is no immediate emergency, but still the question
remains as to why it is swollen. You say no injury at all?
Generally swelling is from injury, circulation problems. When
only one foot is involved we can usually eliminate such things as
heart, diabetes, and kidney problems. I am still thinking.........

Customer: replied 8 years ago.
Reply to Judy's Post: We live in the country, and I'm concerned that he's stepped on, or somehow acquired a spider bite. It's common here, and it's been known to cause such a reaction. My husband's just immigrated here, and it's quite possible that he hasn't ever had any sort of exposure to the spiders like we have here.

He swears that he's not having any pain, he can't remember twisting an ankle, or any other obvious reason for the swelling. Since the swelling has started to go down, the foot and ankle are not cold to the touch anymore, which I take as a good sign. He did admit to me that he'd gone outside yesterday evening barefoot... not sure how much that plays into it.
Expert:  Judy replied 8 years ago.
Yes, that could be a possiblity, thank you for the extra info.
The only other thing that I can suggest is that he get an ultrasound /
doppler study of the leg to be sure the circulation is ok.



Please check the foot now so that you can see if there is any evidence
of a bite. The longer this waits, the less it will be seen as the
bite will probably heal before the foot looks normal. Then if
there is a residual problem, the docs will have something to work
on. The bite could even be on the bottom or between the toes,
although there would probably be a lot more swelling of the toes than
the foot if that was where the bite was.



It sounds as though the urgent need for a hospital visit is not so
likely now. If there is increased swelling in the morning,
though, I would definitely go to the emergency department.





Customer: replied 8 years ago.
Reply to Judy's Post: We will do just that. Thanks so much for your diligence, and thorough advice. :)
Expert:  Judy replied 8 years ago.
Good luck and good night!
Judy, Nurse
Category: Health
Satisfied Customers: 914
Experience: RN in ICU for 35 years
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Judy
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RN in ICU for 35 years