How to treat swollen foot with bluish discoloration in an 82-year-old?

Patient's Query

Hello doctor,

Patient is an 82-year-old female. She weighs only about 45 kg. No BP, no diabetes.

She is having inflammation and swelling in the right foot. It seems to be a blockage somewhere in the right foot blood vessel and it appears bluish one month back.

And now it subsided a bit but the swelling is there. She is on Neurowin injection, Ecospirin, and Zerodol SP. She is moving comfortably now but the swelling is there and the bluish color has reduced a bit.

Answered by Dr. Sagar Ramesh Makode

Hello,

Welcome to icliniq.com.

Her foot appears to be in good condition now (attachment removed to protect patient identity). The likely cause for bluish discoloration is blockages only and is called peripheral arterial disease. So of she should be treated on the line of blockages itself.

Now blockages in the foot raise the strong possibility of blockages elsewhere in the body like heart, brain, and its fortunate that she did not suffer any consequences due to that. So she should be evaluated with few investigations, like ECG (echocardiogram), Echo, Fasting lipid profile (sugar if not done recently). Also, to confirm the diagnosis, she should undergo CT (computed tomography) angiography of both the lower limbs.

Now coming to the treatment part, obviously, the best would be to open it with stents. But as of now, she will need some more medications than what she is having. You may continue with Neurowin or better to have it in a tablet form once daily, and it is just a multivitamin supplement. She should also continue plain Ecospirin and dose should be 75 mg only at bedtime.

Now in my opinion, she should additionally have tablet Rosuvastatin 10 mg bedtime once daily and tablet Cilostazol 50 mg twice daily after food. She should also have some antacids along with these medications like tablet Cyra 20 mg (Rabeprazole) once daily before breakfast. So these three medications should be added additionally until her evaluation is completed and probably will need to continue for the long term.

Zerodol SP should be avoided as it may harm her by causing bleeding or raising blood pressure. Plain paracetamol is allowed. She should be encouraged to move and walk atleast 30 minutes a day as it would improve blood flow.

I hope this helps.

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