Suggest Treatment For Red And Swollen Ankles

Posted on Sat, 24 Jun 2017

Question: Hi - my husband has a history of gout and is having an attack right now and for the last couple of weeks. His foot and ankle are severely swollen, red and painful. His doctor and the emergency room physician think he also has cellulitis. He is being treated with IV antibiotic infusion but we have seen very little change. His pertinent history is a recent L3 - S1 spinal fusion (May 4th 2017) and a fractured calcaneous in the affected foot (20 years ago) He has several screws in his ankle. My question is how can we tell the difference between gout and cellulitis? We have never seen his foot this swollen from a gout attack and nothing seems to be helping. He spent 11 days in the hospital and had several medication changes during that time. Are there medications that can cause gout? He also has high cholesterol, high triglycerides and abnormal liver function tests found in his hospital stay. He also had blood transfusions due to anemia and did not eat for 8 days in the hospital due to an ileus. Do any of these factors cause gout and/or cellulitis? could something entirely different be going on? Thank you!

Answered by Dr. Ahmed Aly Hassan (45 minutes later)

Brief Answer:
Doppler U/S on lower limb venous system to exclude any vascular injuries as it may show these symptoms .

Detailed Answer:
Hi i am Dr Ahmed Aly
thanks for using HealthcareMagic site ,
I had gone through your question and understand your concerns ..
I hope he feels better soon , from your given history cellulitis usually affects the skin and superficial layers while gout affects the joints which is a more deeper tissues .
For my patients i my recommend more investigations like PT , PTT , INR and Doppler U/S which is highly diagnostic tools for vascular clots . DVT ( deep venous thrombosis ) which is very common with postoperative bed ridden patients and may cause swelling .
DVT is very dangerous and may cause a lot of complications and may show his symptoms .

Please click and consider a 5 star rating with some positive feedback if the information was helpful. Wish you good health,
Any further clarifications feel free to ask.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Ahmed Aly Hassan (47 minutes later)

Dr. Aly,
He has had 2 ultrasounds which were both negative for DVT. I forgot to mention that he also has the chills but no fever. Is this indicative of cellulitis?

Answered by Dr. Ahmed Aly Hassan (15 minutes later)

Brief Answer:
_ Chills is one of the symptoms of severe high grade cellulitis but not

Detailed Answer:
_ Chills is one of the symptoms of severe high grade cellulitis but not indicative
_other symptoms include shaking , illness , fatigue , dizziness ,light headedness ,muscle aches , sweating , warm skin .
_ indication may require physical evaluation and biopsy for culture and sensitivity for presence of certain bacteria or microorganisms .

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Ahmed Aly Hassan (9 hours later)

HI Dr Aly, my name is andy(the patient). One of my concerns is that during the prep for surgery (quiting smoking, drinking, bad eating habits, ect) not to mention drugs that were prescribed by my primary for high blood pressure were removed and and entirely new drug regime was introduced by neurosurgery and others might have possible changed my overall body outlook and could still be adjusting?. While treatment with a 6day predisone treatment cleared the gout in the left foot/leg with out incident, the right foot/ leg, while the swelling is is going down slightly and today is thelast day of a 4 day iv infusion schedule with a primary follow up on monday. Could it be that that with all the tests and drug adds/ changes something simple might have been missed, so hard to tell with so may professionals involved.
Your thoughts? XXXXXXX

Answered by Dr. Ahmed Aly Hassan (16 minutes later)

Brief Answer:
Actually that is rare but possible , you mentioned a lot of proffessions

Detailed Answer:
Actually that is rare but possible , you mentioned a lot of proffessions may be a missed side effect from a prescription that is recently added .

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Vaishalee Punj