Why does my 90-year-old father have leg pain and swelling?

Question

Hello doctor,

My 90-year-old father has been experiencing pain in his lower leg for a duration of ten months. The pain worsens when he walks but subsides when he is at rest. Additionally, he has been dealing with a painful ulcer on his toenail and on the sole or heel for the past four months. There are no accompanying symptoms of fever or itching, but there is swelling around the ulcer. Over the past five days, he has also been experiencing lower back pain. He occasionally smokes and drinks. He has been administered intravenous Ceftriaxone, Soframycin ointment, dressing with Betadine, tablet Montina-L, capsule Doxt-SL, T-Bact ointment, tablet Orisine, and capsule Zeora DSR so far.

The result of his laboratory investigations are as mentioned below:

Complete blood count (CBC): Absolute monocyte count is decreased.
Random plasma glucose is within normal range.
Renal function test is within normal range.
Serum electrolyte is within normal range.
C-reactive protein is within normal range.
Pus culture detected Staphylococcus Aureus.
Sensitivity to Amikacin and Norfloxacin is positive.
His blood pressure is measured at 130/90 mm of Hg.

Kindly suggest the diagnosis and treatment for his condition.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understood your concern.

Based on the information you provided, the absence of pain during rest indicates intermittent claudication. Intermittent claudication occurs when there is reduced blood flow to the muscles during exercise due to arterial blockage, which also explains the development of ulcers. The incidence of this condition tends to increase with age, and smoking is a significant risk factor that accelerates the progression of arterial obstruction. I have reviewed your laboratory reports (attachment removed to protect the patient’s identity), and the CBC (complete blood count) and RFT (renal function test) results appear normal. The culture and sensitivity analysis of the ulcer indicates the presence of Staphylococcus aureus, a bacteria that is sensitive to the antibiotics Amikacin (Aminoglycoside) and Norfloxacin (Fluoroquinolone). Amikacin can be administered intravenously (IV), while Norfloxacin can be taken orally. I suggest you consult your specialist doctor, discuss with them and take the medicines with their consent. Please continue dressing the ulcer under the supervision of a qualified dresser. Regarding pain management, I suggest the cessation of smoking and limiting walking distances to a tolerable level. If you desire further evaluation of the lower leg pain, you may consider undergoing a Doppler arterial ultrasound of the lower limb. This test will assess the condition of the blood vessels in your lower limb and provide additional information about your vascular health. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. I have reviewed the arterial color Doppler study (attachment removed to protect the patient’s identity), and it detected thrombosis in the arterial system of both lower limbs and atherosclerotic changes. This is the underlying cause of the leg pain experienced during walking and the presence of the ulcer on the toenail and heel. To treat the ulcer, it is necessary to perform regular dressing with antibiotics to address any infection based on the culture and sensitivity report. For thrombosis, I suggest antiplatelet medication and lipid-lowering medication. I suggest you consult your specialist doctor, discuss with them, and take the medicines with their consent. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.