Leg Indentation: Causes and When to Seek Medical Help

It will indent when pressed?

Hello, doctor.
My mother is 41 years old, weighs 60 kg, and is 165 cm tall.
She has a history of chronic gastritis and allergic rhinitis, and she often suffers from migraines.
In recent months, she has noticed that when she presses down on her calves, they noticeably indent, and she frequently feels fatigued.
What could this condition be? Should she seek medical attention, and which specialty should she consult? What organs might be involved? Thank you.

Mr. Ku, 10~19 year old female. Ask Date: 2004/08/01

Dr. Chen Fuquan reply Internal Medicine

Dear Mr.
Ku,
As you mentioned, your aunt has been experiencing noticeable edema in her lower legs and feelings of fatigue over the past few months.
I have a few questions regarding her condition:
1.
Liver Issues: Has your aunt been a carrier of Hepatitis B or C for many years, and does she have early signs of liver cirrhosis? This could potentially lead to lower leg edema or even ascites.
A blood test to check liver function and serum albumin levels at our internal medicine department could provide insight, although this is less likely given her young age.
2.
Kidney Issues: If there is persistent proteinuria, it could indicate poor kidney function or nephrotic syndrome, especially if she has been taking pain medications long-term.
A blood and urine test at our internal medicine department would clarify this.
3.
Cardiac Issues: If there is a congenital heart valve disease, it may lead to exertional dyspnea and lower limb edema over time.
A cardiac auscultation would help determine if there are any heart murmurs present.
4.
Nutritional Issues: (Less likely) Has your aunt been following a long-term vegetarian diet?
I recommend that your aunt visit my clinic for a physical examination, including auscultation, blood tests, and urinalysis.
Based on the results, she can be referred to other specialty clinics if necessary.
Best regards,
Chen Fu-Chuan

Reply Date: 2004/08/01

More Info

Understanding leg indentation, particularly in the context of your mother’s symptoms, requires a comprehensive approach to identify potential underlying causes and determine the appropriate medical response. Given her age, weight, and existing health conditions, there are several factors to consider.

Possible Causes of Leg Indentation
1. Fluid Retention (Edema): One of the most common causes of leg indentation is fluid retention, which can occur due to various reasons, including heart, kidney, or liver issues. When pressure is applied to the skin, it can create a temporary indentation that may take time to disappear. This condition can be exacerbated by prolonged sitting or standing, especially in individuals with underlying health issues.

2. Venous Insufficiency: This condition occurs when the veins in the legs are unable to pump blood back to the heart effectively. It can lead to swelling and indentation in the legs, particularly after long periods of inactivity. Symptoms may include aching, heaviness, or fatigue in the legs.

3. Lymphedema: This is a condition characterized by swelling due to lymphatic system blockages. It can cause significant swelling and indentation in the legs, often accompanied by discomfort or a feeling of heaviness.

4. Nutritional Deficiencies: Deficiencies in certain nutrients, such as protein or vitamins, can lead to edema and other symptoms. For example, low protein levels can cause fluid to leak into the tissues, leading to swelling and indentation.

5. Medication Side Effects: Certain medications, particularly those for hypertension or other chronic conditions, can cause fluid retention as a side effect. It’s important to review any medications your mother is taking with her healthcare provider.

6. Underlying Health Conditions: Given your mother’s history of gastrointestinal issues and migraines, it’s essential to consider how these may be interconnected. Conditions like chronic kidney disease or heart problems can manifest through symptoms like leg indentation and fatigue.

When to Seek Medical Help
Given the symptoms of leg indentation and fatigue, it is advisable to seek medical attention. Here are some guidelines on when to see a doctor:
- Persistent Symptoms: If the indentation in the legs persists or worsens over time, it is crucial to consult a healthcare professional.

- Accompanying Symptoms: If your mother experiences additional symptoms such as shortness of breath, chest pain, severe headaches, or changes in consciousness, seek immediate medical attention.

- Impact on Daily Life: If the fatigue and leg symptoms interfere with her daily activities or quality of life, it is essential to address these concerns with a healthcare provider.

Which Specialist to Consult
For the symptoms described, it would be appropriate to start with a primary care physician who can conduct a thorough evaluation. They may refer her to specialists such as:
- Cardiologist: If there are concerns about heart health or circulation.

- Nephrologist: If kidney function is suspected to be an issue.

- Endocrinologist: If there are concerns about metabolic or hormonal imbalances.

- Rheumatologist: If there are signs of autoimmune conditions that could affect the joints and muscles.

Conclusion
In summary, leg indentation accompanied by fatigue can be indicative of various underlying health issues, ranging from fluid retention to more serious conditions. It is essential to seek medical advice to determine the cause and appropriate treatment. Early intervention can lead to better management of symptoms and overall health outcomes. Encourage your mother to keep a record of her symptoms, including when they occur and any associated factors, as this information can be invaluable during her medical consultation.

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