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LEG SYMPTOMS• If the problem is in the joint 33.• If the problem is in the foot 37.Recognise the patient with leg symptoms needing urgent attention:• Unable to bear weight following injury• Swelling and localised pain in calf : DVT likely especially if > 35 years, BMI > 25, smoker, immobile, pregnant, on oestrogen, recent surgery, TB or cancer• Muscle pain in legs or buttocks on exercise associated with pain at rest, gangrene or ulceration: critical limb ischemia• Sudden onset of weakness of leg perhaps with vision problems, dizziness, difficulty speaking or swallowing: consider stroke/T/A 76.Refer same day.Approach to the patient with leg symptoms not needing urgent attentionIs there leg swelling?NoYesPain in buttockradiating downback of legMuscle pain inlegs or buttockson exerciseBoth legs swollenIs there cough/wheeze/difficult breathing?One leg swollenHas there been a recent injury?Irritation ofsciatic nervelikelyRefer same week.Claudicationlikely• Leg pulses areweak or absent.• Skin is cool,shiny andhairless.Manage forperipheral vasculardisease 79.YesNo16. • Exclude pregnancy.If pregnant 93.• Check for kidneydisease on urinedipstick: if blood orprotein, check BP73 and refer todoctor.If none of the above or unsure ofdiagnosis, refer same week.YesSoft tissue injury likely• Ensure patient can bear weighton leg, otherwise refer sameday.• Apply firm supportive bandage.• Advise patient to use leg withinlimits of pain.• Give ibuprofen 400mg 3 timesa day with food up to 5 days,or if peptic ulcer, hypertensionor asthma, paracetamol 1g 4times a day.• Review if no better after 2weeks or if symptoms worsen.NoExamine skin for discolouration, ulcers orlumps.Discolouration,ulcers or breaksin skinVenous stasislikely• Advise patientto exercise dailyand raise the legperiodically.• If ulcer 46.Purple lumps onlegs or elsewhereon bodyKaposi’ssarcoma likely• If status unknowntest for HIV 60.• Patient needs ARTwithin 2 weeks61.• Refer to KS clinic.36TB HIV CHRONIC RESPIRATORYDISEASECHRONIC DISEASESOF LIFESTYLEMENTAL HEALTH EPILEPSY MUSCULOSKELETALDISORDERSWOMEN'S HEALTH