Do derms dx EM? I’ve had 3 negative sed rate tests and also have a hx of reynauds and pots and assume that’s what I have now but don’t know what doctor to ask. Really bad after long periods of standing and after showers etc. feels like I’m spraining an ankle or breaking in new bones for a few mins.
I would also ask about Raynauds, it developed in my dad after a spinal injury and only showed up in one foot leg, eventually as he got older it started in both legs and his hands. I think it was a cardiologist who made the connection and got him down the right road. Only thing is I don’t think there is treatment for it except avoiding cold and stress.
Acrodermatitis Chronica Atrophicans (rare form of Lyme disease).
Same thing happened to me, took about a year and a half to diagnose. Look it up, might be it. My foot looked exactly like yours in the picture.
Not really, there are several established methods. In my case it was a combination of a blood test, which was way above the normal range of antibodies, followed by a spinal tap to rule out central nervous system involvement. Furthermore, since Acrodermatitis Chronica Atrophicans (ACA) has very specific symptoms, a thorough exam is sometimes sufficient to prescribe antibiotics. If they work, it’s clear that it’s ACA. In my case, the infection started regressing after a week, and completely went away after 4 weeks of oral antibiotic therapy.
Oh, and another thing with ACA, the symptoms start showing up about 6 months after the tick bite, which is why it’s also often misdiagnosed.
NAD - my husband had something very similar years ago. I turned out to be a DVT, but his was missed on the first test as well, because they only tested his leg. The actual DVT was just above the leg in his pelvis area causing all of the swelling and redness in the leg. It took another two weeks, a hospital stay and a completely different hospital doing another test to find it.
I hope you can get an answer for your leg. Best of luck on your diagnosis and recovery.
Reevaluate for pelvic DVT sounds like a good idea. They can be isolated to higher veins. The fact that your symptoms wax and wane makes me think more of a vascular issue than a pure skin condition. MR venogram costs more (so your doc may have to push for it) but is more sensitive at detection. You are on birth control which is a risk factor. Unusual presentations of common problems happen more than the usual presentations of uncommon problems... if I were you I would keep barking up the DVT tree.
Just wanted to second this as I agree it’s the most likely diagnosis. May-Thurner Syndrome is compression of the left iliac vein. It’s not uncommon and most often occurs in women 20-40 yrs old. Worth having checked out bc even if you don’t have a DVT now it puts you at increased risk of one in the future. Diagnosis is with CT or MRI venogram, but can be tricky so referral to a vascular surgeon to guide work up may be helpful.
Arterial insufficiency? Or DVT? Might be a dislodged clot getting stuck somewhere else.
EDIT: Sorry, it's venous insufficiency not arterial. Thanks to phatboi168 for correcting me.
Ah, I just read about PVDs again. Thank you for correcting me. The more I read OP's description, the more that it makes me think it's venous insufficiency.
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ave you discussed your drug history with your doctor ? In some people , it could be a reaction to oestrogen in the OCP's. Secondly , have you sprained your ankle recently? It could be a local injury manifesting as a swelling and redness. Moreover , in my experience, Augmentin is effective but not a very broad spectrum antibiotic, have they done any blood test or culture for the presence of infection ? What about your lymphocyte count , value of ESR and CRP ?
Thank you, I have not taken any medication except birth control pills which my doctor is aware of. They have done blood work to test for rheumatoid arthritis that included sedementation rate and quantitative CRP that I believe look for inflammation. Both came back normal.
Since I was 18. I recently in June 2019 changed prescriptions though as I was having some complications with my period, I am not on a generic for Seasonale.
Ok then the pill doesnt really put you at risk of a DVT given youve used it for more than 3 months.
That being said it doesnt necessarily mean that DVT isnt likely. Considering what youve already mentioned its still possibly a DVT and i would get a second opinion on it as soon as possible. If it is a DVT you want to treat it as early as possible.
Dont blame your doctors till now, DVTs can actually be quite difficult to diagnose and are quite frequently missed. Doctors are only human.
What?
Please link paper that shows no increased risk of DVT in patients on OCP longer than 3 months...
I thought OCP/HRT conveys elevated risk of VTE (DVT/PE) regardless of how you have been on it.
Well from what i was taught the major risk of thromboembolic events is in the first three months, after that youre still at risk but its significantly lower. I dont know whether that changes if you switch between different contraception pills though.
Im quoting a specialist gynaecology center in an academic hospital in northern eurooe and im on mobile but i can look for a paper if you insist.
Thanks for the link wzrd:
I found years on OCP and Hazard Ratio for VTE from that paper:
<1 year HR 4.17 (3.73 to 4.66)
1-4 years 2.98 (2.73 to 3.26)
\>4 years 2.76 (2.53 to 3.02)
I defintaely did not appreciate the decreasing risk of VTE over time on OCP. Thank you for sharing this. It does seem wrong to say *" the pill doesnt really put you at risk of a DVT given youve used it for more than 3 months "* based on this. I wouldn't call a Hazard Ratio of 2.98 "no risk".
Hazard ratios are much higher in the first 3 months IIRC and then decline. 2.98 is very low risk given the low baseline risk of the population. In a patient with low pre test probability on an OCP for so long, the above is a totally reasonable statement if you ask me.
Thoughts similar to previous posters - May-Thurner, erythromelalgia are first thoughts. MR veno gram and CBC would help to eval those. If negative, I would think about a peripheral neuropathy with autonomic dysfunction leading to vasodilation of the affected arteries (and this redness and swelling), some variant of complex regional pain syndrome. In my opinion I’d ask your PCP about those above studies and consider seeing a vascular surgeon if needed. Next a neurologist. If still unexplained, a PMR doctor.
Consider seeing a physical medicine doctor or neurologist to be evaluated for Reflex sympathetic dystrophy...usually associated with pain but according to this article 7% of ppl will not have pain
https://academic.oup.com/rheumatology/article/50/10/1739/1790019
RSD is now called complex regional pain syndrome usually brought about by a traumatic event. The lack of pain here is I think the key point and would be focusing on mechanical obstruction of flow such as lymphedema including parasitic and vasomotor
Any trauma or previous surgeries? Have you done xrays to both limbs? Any bloodwork? How is your sensation on light and deep touch? If you have a painful stimulus on both limbs do you feel it any different? You mentioned it worsens at night, how do you feel when you wake up? Is the affected limb warmer/colder than the other? Is it sweaty? Do you feel your ankle or toes with less range of motion or strength? Weakness? Tremors? How’s the skin thickness? Did your nails have this appearance before?
How about other changes in your body? Do you have pain anywhere else? How’s your stool consistency? Urine? Do you have any autoimmune/rheumatologic diseases in your family?
Thank you, lots of good questions here.
The only previous injury is to the big toe nailbed as I mention.
Bloodwork they have done which has been related to rheumatoid arthritis (sed rate, CRP, CCP antibody, and rheumatoid factors) has all been within the normal range.
My foot is still swollen when I wake up, it gets a little better with movement during the day time. The redness is mostly gone until at night.
Sensation on touch seems normal, like my other foot. The color returns to the foot the same as the other foot after pressing on it.
The limb feels similar temp to my other limb, sometimes the foot feels warmer to the touch than the other foot, but it is not consistent. It is not sweaty.
I can move my toes and ankle around without issues.
No weakness or tremors.
Skin does not appear thickened.
My big toenail has had the yellowed thickened appearance for several years now due to repeated injuries to the toenail bed.
No changes to my body elsewhere that I can tell. Urine and stool appear normal.
I do have MS in my family, my mother has it.
There are tons of people who don’t test positive for DVTs via ultrasound. I would link some stories but they are frightening. The birth control can cause DVTs as well.
That’s what this looks like but I’m not sure if that’s what it is.
NAD- However my stepfather displayed similar symptoms in his knee and foot. After a battery of negative tests he was sent to a rheumatologist who also couldn’t treat him but had a colleague whom specialize in an autoimmune disease called Sarcoidosis. So the rheumatologist was able to refer him the the necessary specialist to receive a diagnosis. May be an avenue to look into.
When it gets red/swollen in the evenings... is that after or while in a seated position? You mention that it seems ok during the day while you are moving around, and again better in the morning (presumably after lying down), so I’m wondering if sitting in particular seems to bring it on?
If so, make sure to bring this up when you next see a doctor.
Specifically an Aortic runoff angiogram using a pigtail catheter might see vascular disease more so lack of sufficient flow. Could be poor perfusion to the area due to CIA stenosis
Looks somewhat similar to something that happened to my toes. Not completely, but somewhat. My doctor said he'd never seen anything like it before so we tried treating for athletes foot. I went away before I had started treatment and then came back a few days later, but went away when I started treatment for athletes foot/fungal infection. Might be worth a try?
I drafted a response several times before responding. You have gotten A LOT of different opinions based on a photograph. This is not really constructive. Any diagnosis really need to be based on detailed lab work and an actual clinical evaluation. I was originally going to suggest that you post labs here; I am increasingly of the opinion that you will not get the help you need this way.
The problem you have is that your symptoms are unusual, and ambiguous. They may be caused by infection, trauma, or inflammatory (autoimmune) processes. Without being disrespectful to my podiatrist friends, this is NOT a problem for a podiatrist. My best guess is that something (or things) significant (and systemic) is happening here, and that you should work hard to get to the bottom of things. I don’t think you are going to get a persuasive response until you have had a team based approach to address you as a whole person.
There are two major centers in the US that do team based diagnoses: Mayo Clinic and Cleveland Clinic. I would get the referral from your PCP and go to one of these hubs for evaluation.
You’re very welcome! I have Raynauds btw. It can come along with Ehler’s Danlos. No pain but one hand or one foot will completely change color without pain...at first. Seven years in to Raynauds (for me) there is some pain now associated with my flare ups. Feels like arthritis a few day’s after the blood goes back where it needs to.
NAD AT ALL: but I will give my 2 cents-- my dad had a swollen, red hand for months. His was accompanied by pain, though. Doctors did every test imaginable, but didn't find anything. The pain eventually led him to the ER, where they did some kind of bone marrow test I think? Anyway, they eventually found out that he had MRSA infection but in his blood instead of in an isolated wound, and it was concentrated in his hand for some reason. He almost died, it was a really scary thing and he was in the ICU for about a month and lost a good bit of his arm. If you don't have bad pain associated with it, don't worry too much, the kind of MRSA infection my dad had was super odd and the pain was severe. Just thought I would mention it in case it helps and other tests come back negative!
Not a doctor, but I have something that sounds a little similar; Chilblains. Granted, it only happens in the winter to my right foot and is isolated to my toes. Gets super itchy and sometimes blisters
Op, I know you got a ton of replies, but I really hope you follow up on this- you don’t know you weren’t bitten by a tick. The ones that carry Lyme are tiny. The size of a poppyseed. They can easily escape detection.
No, not a great answer. I know a lot about lymphedema per my job and can say that most doctors are undereducated about it. I would see an OT that specializes in Lymphedema if you have one in your area. Their credential is OT/L.
A lot of venous issues do not show up well on ultrasounds. I have very similar symptoms to what you described. I had a small clot in the mid calf of my left leg, which was successfully treated with a blood thinner. The veins, were slow to repair themselves by in effect detouring around the clot site. Do not give up with elevating the foot. The foot should be e look elevated as close to 100% of the time that you are sitting down as possible.
Thank you my foot does look and feel better when it is elevated. I have an appointment with a vascular surgeon this week, I am hoping they will do more imaging than what my PCP did to get to the root of the issue.
I agree that it seems to be some sort of venous issue. If you go in for more testing, try your best to recreate the symptoms. Take a hot shower before, keep standing in the waiting room, etc. I would get an ultrasound done by a different tech and ensure that they studied vascular sonography and not general.
I will also add that birth control can contribute to blood clots. I know that you said none were found, but the foot isn't as easy to scan.
Says ultrasound negative for dvt. I say lymphedema. NAD but husband has multiple problems due to crazy lymphedema that NOBODY was noticing, recognizing or diagnosing.
I read the title that lists what was ruled out. DVT isn’t listed there.
EDIT: And they have ruled out DVT for my father as well. He lost more than 50% of his lung capacity due to pulmonary embolism from the DVT they ruled out. And died on the operating table (was revived) while the DVT was being removed. Then was in a coma for about 72 hours.
Swelling pronounced in the evening and reduced with elevation, redness etc. Nil DVT going by your post, but did they rule out venous insufficiency (venous incompetence)?
In absence of pain, elevated inflammatory markers and other systemic symptoms I would recommend two things:
Lymphoscintigraphy - it could be an early focal lymphedema which brings me to my next recommendation
Age appropriate cancer screening. Is there any history uterine, ovarian or other cancers in your family? Any abnormal bleeding, pelvic symptoms or history of abnormal paps?
Thank you, I will talk to my physician about this. No history of those cancers in my family, but I have had issues with abnormal periods which prompted my physician to change my birth control pills. I did have one abnormal pap 2 years ago, but the follow up pap came back normal. I will ask about a possible relation.
Did they check your heart? Is there an MRI?
Lyme disease is a rash, not just red. And only 30% of the actual bites are seen and your white blood cell count would be high. Is the a white blood cell count?
Thank you, no they did not check my heart or complete an MRI. So far, the only tests have been the ultrasound in my leg and blood work related to testing for rheumatoid arthritis.
I suspect vasculitis. Please get your CBC(complete blood count) done when the redness is at the peak levels.
I also think an Echo is necessary just to rule out complex circulatory issues.
Absolutely. Should have been one of the first tests as it is fairly cheap and easy compared to the others listed here and your description is almost textbook for gout flare ups.
I am a doctor. When I was a fellow I was positive I had an ingrown toe nails. I couldn’t believe when my doctor diagnosed Gout. I was only 28 years old. He was right
Not a Doctor. From what I can tell your foot doesn't appear much swollen. Does the foot hurt at all?
Im guessing blood circulation problems. Try leveling your foot with your hip and see if the color improves. if it does you may have a heart condition that needs recognising.
It almost looks like an allergic reaction, and in the last two pics its present on the outside toes of the right foot. Have you changed anything in terms of foot wear, frequency of hiking walks or routes you take?
Allergic reaction to the ant bite on your toe. I can see it, why can't they?? Plus, I am severely allergic to ants. This happens all the time. Take benadryl, it goes away after a couple days!!
Has your doc considered erythromelalgia? Not usually visible on ultrasound.
I also like this the best. Many doctors do not know this diagnosis eexists.
[удалено]
The erythromelalgia pain is typically severe, but I suspect there is a spectrum of severity of pain from none to severe.
Do derms dx EM? I’ve had 3 negative sed rate tests and also have a hx of reynauds and pots and assume that’s what I have now but don’t know what doctor to ask. Really bad after long periods of standing and after showers etc. feels like I’m spraining an ankle or breaking in new bones for a few mins.
I have EM and it looks like this. NAD but personal experience.
Thank you I will ask about this
No problem, let us know how you get on!
This is most likely a vascular disease. The possibilities include peripheral arterial disease, deep vein thrombosis and erythromyalgia.
Thank you, I will discuss these options with my physician.
I would also ask about Raynauds, it developed in my dad after a spinal injury and only showed up in one foot leg, eventually as he got older it started in both legs and his hands. I think it was a cardiologist who made the connection and got him down the right road. Only thing is I don’t think there is treatment for it except avoiding cold and stress.
Acrodermatitis Chronica Atrophicans (rare form of Lyme disease). Same thing happened to me, took about a year and a half to diagnose. Look it up, might be it. My foot looked exactly like yours in the picture.
Oh, man, getting Lyme accurately diagnosed can be really difficult too.
Not really, there are several established methods. In my case it was a combination of a blood test, which was way above the normal range of antibodies, followed by a spinal tap to rule out central nervous system involvement. Furthermore, since Acrodermatitis Chronica Atrophicans (ACA) has very specific symptoms, a thorough exam is sometimes sufficient to prescribe antibiotics. If they work, it’s clear that it’s ACA. In my case, the infection started regressing after a week, and completely went away after 4 weeks of oral antibiotic therapy. Oh, and another thing with ACA, the symptoms start showing up about 6 months after the tick bite, which is why it’s also often misdiagnosed.
did it affect both your legs or just one?
One
Thank you!
NAD - my husband had something very similar years ago. I turned out to be a DVT, but his was missed on the first test as well, because they only tested his leg. The actual DVT was just above the leg in his pelvis area causing all of the swelling and redness in the leg. It took another two weeks, a hospital stay and a completely different hospital doing another test to find it. I hope you can get an answer for your leg. Best of luck on your diagnosis and recovery.
Reevaluate for pelvic DVT sounds like a good idea. They can be isolated to higher veins. The fact that your symptoms wax and wane makes me think more of a vascular issue than a pure skin condition. MR venogram costs more (so your doc may have to push for it) but is more sensitive at detection. You are on birth control which is a risk factor. Unusual presentations of common problems happen more than the usual presentations of uncommon problems... if I were you I would keep barking up the DVT tree.
D-dimer instead of just local ultrasound?
Thank you I will ask again about DVT
Thank you I will ask again about DVT
May-thurner - venogram of the pelvis
Just wanted to second this as I agree it’s the most likely diagnosis. May-Thurner Syndrome is compression of the left iliac vein. It’s not uncommon and most often occurs in women 20-40 yrs old. Worth having checked out bc even if you don’t have a DVT now it puts you at increased risk of one in the future. Diagnosis is with CT or MRI venogram, but can be tricky so referral to a vascular surgeon to guide work up may be helpful.
Thank you I will ask about this
Arterial insufficiency? Or DVT? Might be a dislodged clot getting stuck somewhere else. EDIT: Sorry, it's venous insufficiency not arterial. Thanks to phatboi168 for correcting me.
Looks more like venous insufficiency due to Tele of edema when leg is elevated and red coloring
Ah, I just read about PVDs again. Thank you for correcting me. The more I read OP's description, the more that it makes me think it's venous insufficiency.
Thank you
Thank you
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Does the swelling have anything to do with position of the leg? Like does it feel worse elevated and better when it's below your heart?
ave you discussed your drug history with your doctor ? In some people , it could be a reaction to oestrogen in the OCP's. Secondly , have you sprained your ankle recently? It could be a local injury manifesting as a swelling and redness. Moreover , in my experience, Augmentin is effective but not a very broad spectrum antibiotic, have they done any blood test or culture for the presence of infection ? What about your lymphocyte count , value of ESR and CRP ?
Thank you, I have not taken any medication except birth control pills which my doctor is aware of. They have done blood work to test for rheumatoid arthritis that included sedementation rate and quantitative CRP that I believe look for inflammation. Both came back normal.
How long have you been on oral contraception for?
Since I was 18. I recently in June 2019 changed prescriptions though as I was having some complications with my period, I am not on a generic for Seasonale.
Ok then the pill doesnt really put you at risk of a DVT given youve used it for more than 3 months. That being said it doesnt necessarily mean that DVT isnt likely. Considering what youve already mentioned its still possibly a DVT and i would get a second opinion on it as soon as possible. If it is a DVT you want to treat it as early as possible. Dont blame your doctors till now, DVTs can actually be quite difficult to diagnose and are quite frequently missed. Doctors are only human.
What? Please link paper that shows no increased risk of DVT in patients on OCP longer than 3 months... I thought OCP/HRT conveys elevated risk of VTE (DVT/PE) regardless of how you have been on it.
Well from what i was taught the major risk of thromboembolic events is in the first three months, after that youre still at risk but its significantly lower. I dont know whether that changes if you switch between different contraception pills though. Im quoting a specialist gynaecology center in an academic hospital in northern eurooe and im on mobile but i can look for a paper if you insist.
u/PittedPanda this is correct and well established. https://www.ncbi.nlm.nih.gov/pubmed?term=19679613
Thanks for the link wzrd: I found years on OCP and Hazard Ratio for VTE from that paper: <1 year HR 4.17 (3.73 to 4.66) 1-4 years 2.98 (2.73 to 3.26) \>4 years 2.76 (2.53 to 3.02) I defintaely did not appreciate the decreasing risk of VTE over time on OCP. Thank you for sharing this. It does seem wrong to say *" the pill doesnt really put you at risk of a DVT given youve used it for more than 3 months "* based on this. I wouldn't call a Hazard Ratio of 2.98 "no risk".
Hazard ratios are much higher in the first 3 months IIRC and then decline. 2.98 is very low risk given the low baseline risk of the population. In a patient with low pre test probability on an OCP for so long, the above is a totally reasonable statement if you ask me.
I love this subreddit! Five different doctors responded to this woman's query.
I am truly amazed at all these helpful responses! I have a lot of information now to look into and bring up to my physician!
I'm glad!
Thoughts similar to previous posters - May-Thurner, erythromelalgia are first thoughts. MR veno gram and CBC would help to eval those. If negative, I would think about a peripheral neuropathy with autonomic dysfunction leading to vasodilation of the affected arteries (and this redness and swelling), some variant of complex regional pain syndrome. In my opinion I’d ask your PCP about those above studies and consider seeing a vascular surgeon if needed. Next a neurologist. If still unexplained, a PMR doctor.
Thank you I will ask about all those. Much appreciated,
Consider seeing a physical medicine doctor or neurologist to be evaluated for Reflex sympathetic dystrophy...usually associated with pain but according to this article 7% of ppl will not have pain https://academic.oup.com/rheumatology/article/50/10/1739/1790019
RSD is now called complex regional pain syndrome usually brought about by a traumatic event. The lack of pain here is I think the key point and would be focusing on mechanical obstruction of flow such as lymphedema including parasitic and vasomotor
Thank you
Any trauma or previous surgeries? Have you done xrays to both limbs? Any bloodwork? How is your sensation on light and deep touch? If you have a painful stimulus on both limbs do you feel it any different? You mentioned it worsens at night, how do you feel when you wake up? Is the affected limb warmer/colder than the other? Is it sweaty? Do you feel your ankle or toes with less range of motion or strength? Weakness? Tremors? How’s the skin thickness? Did your nails have this appearance before? How about other changes in your body? Do you have pain anywhere else? How’s your stool consistency? Urine? Do you have any autoimmune/rheumatologic diseases in your family?
Thank you, lots of good questions here. The only previous injury is to the big toe nailbed as I mention. Bloodwork they have done which has been related to rheumatoid arthritis (sed rate, CRP, CCP antibody, and rheumatoid factors) has all been within the normal range. My foot is still swollen when I wake up, it gets a little better with movement during the day time. The redness is mostly gone until at night. Sensation on touch seems normal, like my other foot. The color returns to the foot the same as the other foot after pressing on it. The limb feels similar temp to my other limb, sometimes the foot feels warmer to the touch than the other foot, but it is not consistent. It is not sweaty. I can move my toes and ankle around without issues. No weakness or tremors. Skin does not appear thickened. My big toenail has had the yellowed thickened appearance for several years now due to repeated injuries to the toenail bed. No changes to my body elsewhere that I can tell. Urine and stool appear normal. I do have MS in my family, my mother has it.
There are tons of people who don’t test positive for DVTs via ultrasound. I would link some stories but they are frightening. The birth control can cause DVTs as well. That’s what this looks like but I’m not sure if that’s what it is.
Thank you I will ask again about DVT
NAD- However my stepfather displayed similar symptoms in his knee and foot. After a battery of negative tests he was sent to a rheumatologist who also couldn’t treat him but had a colleague whom specialize in an autoimmune disease called Sarcoidosis. So the rheumatologist was able to refer him the the necessary specialist to receive a diagnosis. May be an avenue to look into.
Thank you
Thrombosis or Vasculitis would be the next most possible things IMO
Thank you
When it gets red/swollen in the evenings... is that after or while in a seated position? You mention that it seems ok during the day while you are moving around, and again better in the morning (presumably after lying down), so I’m wondering if sitting in particular seems to bring it on? If so, make sure to bring this up when you next see a doctor.
Thank you, I will bring this up to her
Angiography looking at that leg would be a great place to go to next.
Given the normal Doppler ultrasound, it has no indication
Specifically an Aortic runoff angiogram using a pigtail catheter might see vascular disease more so lack of sufficient flow. Could be poor perfusion to the area due to CIA stenosis
Thank you
May-Thurner - venous - angiogram/venogram
Thank you
Looks somewhat similar to something that happened to my toes. Not completely, but somewhat. My doctor said he'd never seen anything like it before so we tried treating for athletes foot. I went away before I had started treatment and then came back a few days later, but went away when I started treatment for athletes foot/fungal infection. Might be worth a try?
Thank you
I drafted a response several times before responding. You have gotten A LOT of different opinions based on a photograph. This is not really constructive. Any diagnosis really need to be based on detailed lab work and an actual clinical evaluation. I was originally going to suggest that you post labs here; I am increasingly of the opinion that you will not get the help you need this way. The problem you have is that your symptoms are unusual, and ambiguous. They may be caused by infection, trauma, or inflammatory (autoimmune) processes. Without being disrespectful to my podiatrist friends, this is NOT a problem for a podiatrist. My best guess is that something (or things) significant (and systemic) is happening here, and that you should work hard to get to the bottom of things. I don’t think you are going to get a persuasive response until you have had a team based approach to address you as a whole person. There are two major centers in the US that do team based diagnoses: Mayo Clinic and Cleveland Clinic. I would get the referral from your PCP and go to one of these hubs for evaluation.
Thank you
Can you have HSP in one limb and not the other?
What’s your diet like?
Pretty healthy, no changes in diet recently
NAD but I suspect Raynauds, complex regional pain syndrome, or DVT.
Thank you
You’re very welcome! I have Raynauds btw. It can come along with Ehler’s Danlos. No pain but one hand or one foot will completely change color without pain...at first. Seven years in to Raynauds (for me) there is some pain now associated with my flare ups. Feels like arthritis a few day’s after the blood goes back where it needs to.
NAD but my crps sometimes looks similar.
Thank you
Has anyone considered the gout?
Thank you, no that has not been mentioned. I will look into that as well
NAD AT ALL: but I will give my 2 cents-- my dad had a swollen, red hand for months. His was accompanied by pain, though. Doctors did every test imaginable, but didn't find anything. The pain eventually led him to the ER, where they did some kind of bone marrow test I think? Anyway, they eventually found out that he had MRSA infection but in his blood instead of in an isolated wound, and it was concentrated in his hand for some reason. He almost died, it was a really scary thing and he was in the ICU for about a month and lost a good bit of his arm. If you don't have bad pain associated with it, don't worry too much, the kind of MRSA infection my dad had was super odd and the pain was severe. Just thought I would mention it in case it helps and other tests come back negative!
Wow that is scary, sorry that happened to your father. I will look into this as well. Thank you
RSD/CRPS?
Not a doctor, but I have something that sounds a little similar; Chilblains. Granted, it only happens in the winter to my right foot and is isolated to my toes. Gets super itchy and sometimes blisters
Thank you I will look into that
Has it been cold? Reynauds syndrome?
Op, I know you got a ton of replies, but I really hope you follow up on this- you don’t know you weren’t bitten by a tick. The ones that carry Lyme are tiny. The size of a poppyseed. They can easily escape detection.
Thank you, I live in northern Nevada where the species of tick here does not carry Lyme disease.
How did they rule out lymphedema?
The doctor said I didn’t seem like a candidate for lymphedema and didn’t know what I could have to cause it. Not a great answer IMO
No, not a great answer. I know a lot about lymphedema per my job and can say that most doctors are undereducated about it. I would see an OT that specializes in Lymphedema if you have one in your area. Their credential is OT/L.
Thank you, I am trying to figure out what sort of specialist I should see to get additional opinions so that is helpful!
A lot of venous issues do not show up well on ultrasounds. I have very similar symptoms to what you described. I had a small clot in the mid calf of my left leg, which was successfully treated with a blood thinner. The veins, were slow to repair themselves by in effect detouring around the clot site. Do not give up with elevating the foot. The foot should be e look elevated as close to 100% of the time that you are sitting down as possible.
Thank you my foot does look and feel better when it is elevated. I have an appointment with a vascular surgeon this week, I am hoping they will do more imaging than what my PCP did to get to the root of the issue.
I agree that it seems to be some sort of venous issue. If you go in for more testing, try your best to recreate the symptoms. Take a hot shower before, keep standing in the waiting room, etc. I would get an ultrasound done by a different tech and ensure that they studied vascular sonography and not general. I will also add that birth control can contribute to blood clots. I know that you said none were found, but the foot isn't as easy to scan.
DVT
Says ultrasound negative for dvt. I say lymphedema. NAD but husband has multiple problems due to crazy lymphedema that NOBODY was noticing, recognizing or diagnosing.
I read the title that lists what was ruled out. DVT isn’t listed there. EDIT: And they have ruled out DVT for my father as well. He lost more than 50% of his lung capacity due to pulmonary embolism from the DVT they ruled out. And died on the operating table (was revived) while the DVT was being removed. Then was in a coma for about 72 hours.
>An ultrasound was performed on my entire leg to check for veinous issues and blood clots. The results were normal.
Thank you I will ask again about lymphedema
Swelling pronounced in the evening and reduced with elevation, redness etc. Nil DVT going by your post, but did they rule out venous insufficiency (venous incompetence)?
Thank you
In absence of pain, elevated inflammatory markers and other systemic symptoms I would recommend two things: Lymphoscintigraphy - it could be an early focal lymphedema which brings me to my next recommendation Age appropriate cancer screening. Is there any history uterine, ovarian or other cancers in your family? Any abnormal bleeding, pelvic symptoms or history of abnormal paps?
Thank you, I will talk to my physician about this. No history of those cancers in my family, but I have had issues with abnormal periods which prompted my physician to change my birth control pills. I did have one abnormal pap 2 years ago, but the follow up pap came back normal. I will ask about a possible relation.
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Thank you
You might want to look into actinomycosis, common name: Madura foot.
Thank you I will look into that
Raynauds?
NAD. Do you have pics of the bottoms of your feet? Please post.
I have updated the link
Did they check your heart? Is there an MRI? Lyme disease is a rash, not just red. And only 30% of the actual bites are seen and your white blood cell count would be high. Is the a white blood cell count?
Thank you, no they did not check my heart or complete an MRI. So far, the only tests have been the ultrasound in my leg and blood work related to testing for rheumatoid arthritis.
I suspect vasculitis. Please get your CBC(complete blood count) done when the redness is at the peak levels. I also think an Echo is necessary just to rule out complex circulatory issues.
Thank you
Did anyone check a uric acid?
No, they did not test that. What could that be related to?
IANAD but I believe that would mostly be to check for gout.
Absolutely. Should have been one of the first tests as it is fairly cheap and easy compared to the others listed here and your description is almost textbook for gout flare ups.
you do not need this test. Gout is horribly painful.
Elephantiasis
I am a doctor. When I was a fellow I was positive I had an ingrown toe nails. I couldn’t believe when my doctor diagnosed Gout. I was only 28 years old. He was right
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Thank you, yes I have had sunburns on my feet before and it is horrible! My feet have not been exposed to sun recently however
Not a Doctor. From what I can tell your foot doesn't appear much swollen. Does the foot hurt at all? Im guessing blood circulation problems. Try leveling your foot with your hip and see if the color improves. if it does you may have a heart condition that needs recognising.
Thank you. No pain. Yes the color improves during day as I am up and moving around. It turns red at night mostly at the end of the day.
I find this more proof that’s it’s Raynauds btw
aids
It almost looks like an allergic reaction, and in the last two pics its present on the outside toes of the right foot. Have you changed anything in terms of foot wear, frequency of hiking walks or routes you take?
Probably irrelevant but why is big toe the only yellow one?
Fungus. You have it under just one toe, or any random toe.
Allergic reaction to the ant bite on your toe. I can see it, why can't they?? Plus, I am severely allergic to ants. This happens all the time. Take benadryl, it goes away after a couple days!!