Limping patient

Diagnosis[edit | edit source]

Skin color and temperature:
- pinkish and cold (arterial circulatory disorders);
- red and hot skin (deep venous thrombosis = DVT);
- red stripe (thromboflebitis);
- red swollen joints (arthritis uratica, rheumatoid arthritis, rheumatoid fever).
Differences in calf circumference...usually more than 2 cm (DVT, arthritis....).
Arterial pulsation in the leg:
- usually absent in advanced lower limb ischemia;
- permanently absent in acute arterial occlusion;
- often cannot be found because of edema.
Reflexes:
- absent/reduced in intervertebral disc prolapse, other neurological disorders – for example radicular sensitivity disorders, paresis, urinary bladder emptying disorders;
- polyneuropathy (diabetic – first the Achilles tendon reflex is reduced, we should look for deep sensitivity disorders – tuner – also disrupted in peripheral paresis).
Sensitivity:
- acral sensitivity disorders – "stocking-glove pattern" in polyneuropathies, deep sensitivity disrupted;
- segmental loss of sensitivity – intervertebral disc prolapse, tumors, radiculitis.
Start pain (the pain occurs when the patient starts to walk)... characteristic in degenerative joint diseases – gonarthrosis, coxarthrosis, osteoporosis.
Claudication:
- typical for lower limb ischemia – calf pain, one side/both sides, depends on the length of the walk;
- spinal canal stenosis – usually both limbs are affected, especially while walking down.

Vascular disorders	lower limbs ischemia, acute thrombotic arterial occlusion, DVT, thromboflebitis, ergotism (vascular type)
Orthopedical	slant position of the pelvis, pseudoradicular lumbal vertebrogenic syndrome, coxarthrosis, intervertebral disc prolapse, spinal canal stenosis (claudicatio spinalis), aseptic bone necrosis (morbus Perthes, Köhler, Osgood-Schlatter), osteoporosis
Neurological	syndrome of nerve compression (meralgia paresthetica), polyneuropathy, multiple sclerosis, rheumatological, rheumatoid polyartritis, fibromyalgic syndrome, spondylarthritis, collagenosis
Muscular	myelogenosies, calf cramps, dermatomyositis, myopathy, for ex. muscular dystrophy
Traumatic	muscle ruptures, fractures, compartment syndrome, Sudeck's dystrophy, luxation, tendon injuries, meniscus lesions, psychogenic, depression with somatizing tendency, somatizing neurosis
Other	metabolic – arthritis uratica, inguinal or femoral hernia

GESENHUES, S a R ZIESCHÉ. Vademecum of the doctor. 1. Czech edition. Prague : Galén, 2006. ISBN 80-7262-444-X.