Limping Patient/PGS (VPL)

Diagnostics[edit | edit source]

Skin color and temperature:
- pinkish cold (arterial circulation disorders);
- flushed hot (DVT);
- red streak (thrombophlebitis);
- reddened swollen joints (arthritis - gout, rheumatoid arthritis, rheumatic fever).
Difference in the circumference of the calf'... usually over 2 cm (HVT, arthritis...).
Arterial pulsation in the leg:
- absent often in advanced ICHDK;
- permanently absent in acute arterial occlusion;
- many times pulsation cannot be demonstrated in significant swellings.
Reflexes:
- absent/reduced in prolapsed intervertebral discs, other neurological disorders – e.g. radicular sensitivity disorders, paresis, bladder emptying disorders;
- polyneuropathy (diabetic – characteristically the Achilles tendon reflex is extinguished first, look for disorders of deep sensitivityi – tuning fork – also impaired in peripheral paresis).
Sensitivity:
- acral sensitivity disorders – hosiery in polyneuropathies, especially deep sensitivity is affected;
- segmental failures – intervertebral disc prolapse, tumors, radiculitis.
Starting pain... characteristic of degenerative joint diseases - gonarthrosis, coxarthrosis, osteoporosis.
Claudication:
- typical for ICHDK – calf pain, unilateral/bilateral, dependent on length of walk;
- spinal canal stenosis – usually both limbs are affected, especially when walking down.
Further diagnosis according to the current symptomatology of the disease...== Differential diagnosis ==

Vascular Disorders	ICHDK, acute thrombotic occlusion of an artery, HŽT, thrombophlebitis, ergotism (vascular form)
Orthopedic	pelvic tilt, pseudoradicular lumbar vertebrogenic syndrome, coxarthrosis, intervertebral disc prolapse, spinal canal stenosis (claudicatio spinalis), aseptic bone necrosis (morbus Perthes), Köhler, Osgood-Schlatter ), osteoporosis
Neurological	nerve compression syndromes (meralgia paresthetica), polyneuropathy, multiple sclerosis, rheumatological, rheumatoid polyarthritis, fibromyalgia syndrome, spondyloarthritis, collagenosis
Muscular	myelogenous, calf cramps, dermatomyositis, myopathy, e.g. muscular dystrophy
Traumatic	muscle ruptures, fractures, compartment sy, Sudeck's dystrophy, dislocation, tendon injury, meniscus lesion, psychogenic, depression with somatizing tendency, somatizing neurosis
Other	metabolic – gout, inguinal ev. femoral hernia

GESENHUES, S – ZIESCHÉ, R. Vademecum of physicians. 1. Czech edition. Galen, 2006. ISBN 80-7262-444-X.