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PREDISPOSING MEDICAL HISTORY |
CONTRIBUTING FACTORS | ||||
| L | R | L | R | ||
| DVT | Poor ankle movement | ||||
| Previous ulcer | Fixed ankle joint | ||||
| Cellulitis | Limited mobility | ||||
| Fracture | Tobacco usage | ||||
| Vascular surgery | Undernourishment | ||||
| Orthopaedic surgery | Obesity | ||||
| Trauma | Social isolation | ||||
| Abdominal surgery | Lack of information | ||||
| Pregnancy | |||||
| Ischaemic heart disease | |||||
| Hypertension | |||||
| TIA | |||||
| CVA | |||||
| Rheumatoid arthritis | |||||
| Diabetes | |||||
|
PRESENTING SIGNS AND SYMPTOMS IN THE LIMB
|
LIMB MEASUREMENT
|
INVESTIGATIONS
|
||||
| L | R | L | R |
BP _____________ HB ____________ ESR ____________ Urinalysis _______ |
||
| Varicose veins | Ankle CMS | |||||
| Skin pigmentation | Calf CMS | |||||
| Induration | ||||||
| Ankle flare | CONDITION SURROUNDING SKIN | |||||
| Atrophy blanche | L | R | ||||
| Generalised oedema | Dry eczema | |||||
| Strong pedal pulses | Wet eczema | |||||
| Intermittent claudication | Maceration | |||||
| Ischaemic rest pain | Cellulitis | |||||
| Foot dusky pink when elevated | ||||||
| Shiny hairless skin | ||||||
| Weak/absent pedal pulses | ||||||
|
DOPPLER RESULTS
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Right posterior tibial =
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Left posterior tibial = |
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Right dorsalis pedis =
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Left dorsalis pedis = |
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Brachial =
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Brachial = |
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RIGHT ABPI =
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LEFT ABPI = |