Around two weeks ago news came out that Australian Cricket Coach and former Test Cricketer Darren ‘Boof’ Lehmann had been hospitalised with a blood clot in his leg, commonly known as a DVT (Deep Vein Thrombosis).

‘Boof’ previously developed a DVT post-operatively some years ago, and he is not the first Australian cricket superstar to develop DVT. Steve Waugh developed a DVT in his leg following a long-haul flight at the end of a Tour.

CAUSES

DVT is a condition whereby various cellular components in the blood aggregate to form a blood clot within the deep veins of the lower leg. A number of factors predispose individuals to DVT, including:

• Hypercoagulability (various conditions that lead to an abnormality of clotting factors that increases the likelihood of a clot developing)
• Venous stasis (where blood flow is impeded either via immobilisation in a cast or CAM Walker, disease of the veins, or long periods of immobility such as may occur on long haul flights)
• Major trauma and surgery (due to cellular components of healing known as tissue factor entering the blood in the healing process, increasing the likelihood of a clot)
• Pregnancy and hormone replacement therapy (including the contraceptive pill) increase the risk of clotting.

Signs and Symptoms

DVT as a disease process can progress to form an embolus, a clot that can detach from the original site of pathology and travel to other parts of the body. This can then lodge in the lungs (and result in a Pulmonary Embolus – PE) or the brain (resulting in Embolic Stroke). Both conditions are potentially fatal.

Signs of a DVT include:

• Pain or a cramping sensation in the calf or lower leg
• Redness of the lower leg
• Swelling of the lower leg and/or foot
• Shortness of breath (more indicative of a PE)

Importantly, approximately 50% of DVT cases will be asymptomatic.

Diagnosis

Often clinical signs (where present) will lead the clinician to be highly suspicious of DVT. Correlation or further examination is performed using Doppler Ultrasound or MRI techniques.

Treatment and Prevention

Initial management will typically consist of administration of an intravenous anticoagulant agent such as Heparin for a short period of time, with patients then placed onto medium-term anticoagulant treatment using Warfarin, Xarelto or similar agents.

Typically compression therapy of the veins lower limb is warranted via specialised medical-grade compression stockings. These are measured and fitted by an appropriately qualified practitioner using graduated compression socks and stockings to achieve specific targeted levels of compression.

Ultimately control of risk factors is the primary method of prevention:

• surgeons typically use anticoagulant treatment after major surgery, including oral tablets (eg Xarelto/Rivaroxaban) or injections (Clexane/Enoxaparin)
• people with venous disease (eg varicose veins, oedema) are encouraged to utilise compression garments to reduce venous stasis
• it is encouraged that for all airline travel and even long-haul bus travel passengers use compression garments to reduce venous stasis
• women using the contraceptive pill or HRT need to be made aware of the increased risk for DVT and monitor for signs or symptoms
• patients immobilised following a fracture or significant lower leg injury in a cast or CAM walker should be educated by their practitioner on managing DVT risk factors

Compression Stockings

Eastern Foot Care stocks the Venosan range of compression stockings in a variety of different classes of compression. All of our Podiatrists are competent and qualified to assess and fit compression garments. Where necessary a customised stocking can be arranged through Venosan, although typically this is not necessary.

To make an appointment to see one of our Podiatrists contact:

Eastern Foot Care Knox                                                     Eastern Foot Care Ringwood

5a/426 Burwood Hwy                                                        27 Wantirna Rd

WANTIRNA SOUTH VIC 3152                                          RINGWOOD VIC 3134

Ph: (03) 9887 2233                                                             Ph: (03) 9870 1301