Examination (ankle swelling)

Examination:

• local
  • oedema - one or both legs
  • signs of chronicity e.g. varicose eczema associated with chronic venous insufficiency
  • associated ischaemia?
• systemic
  • presence of an abdominal mass or ascites?
  • signs of cardiac failure
  • anaemia?

The degree of oedema is commonly described on a subjective 0 to 4+ scale in order of increasing severity (1).

Ankle circumference is a simple quantitative test for clinical practice with good reliability and is measured 7 cm proximal to the medial malleolus.(2).

Stemmer's sign is present if the examiner cannot pinch a fold of skin at the base of the patient's second toe. It is a sensitive test for primary and secondary lymphoedema (3)

References

1. Brodovicz KG, McNaughton K, Uemura N, et al. Reliability and feasibility of methods to quantitatively assess peripheral edema. Clin Med Res. 2009 Jun;7(1-2):21-31.
2. Brodovicz KG, McNaughton K, Uemura N, et al. Reliability and feasibility of methods to quantitatively assess peripheral edema. Clin Med Res. 2009 Jun;7(1-2):21-31.
3. Goss JA, Greene AK. Sensitivity and specificity of the Stemmer sign for lymphedema: a clinical lymphoscintigraphic study. Plast Reconstr Surg Glob Open. 2019 Jun;7(6):e2295.