Surgeons

Identify common etiologies of leg pain

Develop protocols to effectively triage patients

Order appropriate diagnostic testing

Achilles tendinitis/rupture ACL injury Baker’s cyst Bone Cancer Bursitis Chondromalacia Chronic exertional compartment syndrome Claudication Deep Venous Thrombosis Fibromyalgia Gout Growing pains Growth plate fractures Hamstring Injury Herniated Disc Infection Juvenile rheumatoid arthritis Legg Calve Perthes Disease Meniscal injury Muscle Cramp

Neuropathy Osgood-Schlatter Osteoarthritis Osteochondritisdissecans Paget’s Disease Patellar Tendonitis Peripheral Arterial Disease Piriformis Syndrome Popliteal Entrapment syndrome Pseudogout Rheumatoid arthritis Sciatica Shin splits Spinal stenosis Sprains/strains Stress fractures Tendonitis Thrombophlebitis Varicose veins Venous Insufficiency

Achilles tendinitis/rupture ACL injury Baker’s cyst Bone Cancer Bursitis Chondromalacia Chronic exertional compartment syndrome Claudication Deep Venous Thrombosis Fibromyalgia Gout Growing pains Growth plate fractures Hamstring Injury Herniated Disc Infection Juvenile rheumatoid arthritis Legg Calve Perthes Disease Meniscal injury Muscle Cramp

Neuropathy Osgood-Schlatter Osteoarthritis Osteochondritisdissecans Paget’s Disease Patellar Tendonitis Peripheral Arterial Disease Piriformis Syndrome Popliteal Entrapment syndrome Pseudogout Rheumatoid arthritis Sciatica Shin splits Spinal stenosis Sprains/strains Stress fractures Tendonitis Thrombophlebitis Varicose veins Venous Insufficiency

Why are you here Location, duration, quality, quantity/severity, timing, setting,

alleviating/aggravating factors, associated symptoms Past medical and surgical history Physical Exam Testing

Why are you REALLY here Any Injury recent or remote – Invasive procedures count How long have you had this problem When did it start to get worse Is it really the same problem Where does it start and where does it go When does it happen

Will this kill the patient

Can the patient suffer loss of limb or limb function

Is this something that causes chronic discomfort

Venous thromboembolus Venous Insufficiency

Legs get heavy as the day goes on Legs swell as day goes on Ulcer won’t heal

Varicose veins Focal thrombophlebitis

Venous Claudication History of DVT or other occlusive disease Bursting thigh pain, takes longer than arterial claudication, more vigorous

excercise

Venous thromboembolus Long trip History of cancer/hypercoaguable disorder Recent Injury surgery

Venous Insufficiency Job/environment DVT/Injury

Varicose Veins Venous claudication

DVT + venous insufficiency

Venous thromboembolic (Deep venous thrombosis) D-dimer Venous ultrasound

Thrombophlebitis Physical exam

Venous Insufficiency Venous reflux study

Venous claudication Venous reflux study CT scan/Venogram

Asymptomatic “found it on a test”

Mild claudication Doesn’t really bother me much

Moderate claudication Have to stop and rest

Disabling claudication Cant make it my mailbox

Rest pain Pain on dorsum of foot Get out of bed to make pain go away

Tissue Loss

Physical Exam Disease occurs one level below

lesion ABI Arterial Duplex PVR

Asymptomatic Mild claudication Moderate claudication Disabling claudication Rest pain Tissue Loss

Asymptomatic ABI 0.9

Mild claudication ABI below 0.9

Moderate claudication Disabling claudication Rest pain

ABI 0.5 multilevel disease

Tissue Loss ABI below 0.8

Sign/Symptom Complex

Diagnosis

Testing/Staging

Treatment