1) Cellulitis – painful, red, warm, tender, swollen area of a limb, no clear demarcation, portal of entry – wound, ulcer, skin lesion, regional lymphadenopathy,
2) Erysipelas – the painful, red, warm, tender swollen area of a limb with a clear demarcation of the area, entry site has commonly seen (venous insufficiency, stasis ulceration, dermatophytes infection, eczemas, insect bites, intertrigo), predisposing factors common (diabetes, alcohol, HIV, nephrotic syndrome), red streaks centripetally distributed, regional proximal lymphadenopathy, fever, chills, sometimes precede 24-48 hrs, Mx – wet saline dressings, elevate the limb, Penicillin (250-500 mg qid PO) or Roxithromycin for 10-20 days, Erythromycin (250-500 mg PO qid, Pd 30-50 mg/kg/day in 3-4 divided doses)or Azithromycin of penicillin allergy,
3) Chronic venous diseases – leg pain and swelling, foot swelling and pain, discoloration of the skin of the ankles, complications include stasis ulcers, dermatitis,
5) Complex Regional Pain Syndrome – CRPS 1 (Reflex Sympathetic Dystrophy Syndrome) – severe burning pain in arms or legs after a minor or major injury, after a stroke or heart attack, pain worsens with the slightest touch or breeze, swelling of the painful area warm or cold, skin over the painful area dry, thin, change of color, increased nail and hair growth, the pain moves up or down the limb, after 1-3 months stage 2 CRPS 1 sets in: swelling spreads to the whole limb, skin changes become prominent, hair growth slows down, muscles and joints become stiff, X-ray changes of bones seen, after another 3-6 months stage 3 of CRPS 1 set in : entire limb hurting, tissue changes become permanent, muscle wasting, limited mobility of the limb, muscle contractions, depression and other mood changes, Tx – steroids, analgesics, bone loss medications, physical and occupational therapy, TENS, biofeedback,
6) Somatic anxiety syndrome
7) Somatic depression syndrome
8) Intermittent claudication – Peripheral Arterial Disease – intermittent claudication, calf or buttock pain while walking and stops at rest, usually comes earlier with an uphill walk, pain is located at muscles, usually unilateral, ischemic rest pain occurs at night, in toes and foot, hanging the leg out of the bed relieves the pain, raised leg turn pale and dangling leg blue and cyanotic, absent or weak pulses, gangrene, ulceration, Duplex scanning of lower limb vessels confirm the diagnosis, Mx – blood glucose control, stopping smoking, controlling hypertension, controlling dyslipidemia, controlling the other risk factors and comorbidities like carotid stenosis, abdominal aortic aneurysms (Noncoronary atherosclerosis markers, CHD risk equivalents), ACEI (ramipril in the HOPE study) to reduce the cardiovascular mortality,
9) Restless legs syndrome – (see under sleep problems), abnormal sensations of the limbs may be presented as pain which is vague in the limbs nocte,