Symptom: Ankle Swelling

Initial Grading Reminder

CTCAE grading of limb edema:

Grade 1 (Mild): 5-10% inter-limb discrepancy; swelling or obscuration of anatomic architecture on close inspection
Grade 2 (Moderate): >10-30% inter-limb discrepancy; readily apparent obscuration of anatomic architecture; obliteration of skin folds; limiting instrumental ADLs
Grade 3 (Severe): >30% inter-limb discrepancy; gross deviation from normal anatomic contour; limiting self-care ADLs

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Do you have any joint, kidney, or cardiac problems? Have you ever had a deep venous thrombosis (blood clot)? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? Is the swelling persistent or just at the end of the day? Is it one or both ankles? Is it painful? Have you ever had this before?

One ankle and/or pain would be more consistent with arthralgia/arthritis or DVT. Both ankles would be more consistent with kidney (nephritis) or cardiotoxicity.

Grade the symptom

Ask the patient:

How bad is the swelling? Is your ankle usually swollen? Can you see your ankle(s)? Are you having trouble getting your regular shoes on?  Can you flex your foot up and down without it being painful or uncomfortable? Is the skin tight/tense? Are you able to carry out your normal activities?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Can you put weight on your ankle(s)?

Are you having any changes in urination? Are you swollen elsewhere? Do you have any nausea, vomiting? Are you confused or foggy? Any shortness of breath/dyspnea on exertion?

Any new or worsening fatigue? Does your heart feel like it is racing or skipping a beat? Are you having chest pain?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?