Did Anyone Assess your Legs After Your Stroke?

Assessing the legs for DVT after a stroke

Lower leg assessments are an important assessment that are frequently overlooked by the health care team when managing other disabling symptoms after a stroke. If your healthcare team has not assessed your feet and lower legs, be sure to ask them if they think there is any need to do so as part of your stroke recovery plan.

This post reviews the importance of lower leg assessments after a stroke, and outlines three compelling reasons to review your lower leg health with a qualified health care provider.

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Deep Vein Thrombosis: A Common Complication of Stroke

Several longitudinal studies have shown that many patients develop Deep Vein Thrombosis (DVT) after an ischemic stroke. DVT occurs when blood clots form in the deep veins of the legs, obstructing proper blood flow out the leg. Left untreated, DVT can result in the formation of large clots that break free and travel towards the lungs, triggering a serious medical condition called pulmonary embolism. These ‘venous blood clots’ could indirectly cause stroke if these large clots break apart further and continue onto the brain, although this is an unlikely cause of stroke.

In one study following stroke survivors over 15 years, the first three months after an ischemic stroke were associated with a 20 times higher risk of developing DVT. If you think about it, patients will experience a substantial increase in the amount of time sitting or lying in bed after a stroke. They also have several atherosclerotic risk factors, which increase the risk of developing DVT in those first three months.

This is why it is critically important for health care professionals to assess a person’s lower leg condition after a stroke. A lower leg assessment can rule out DVT, or provoke additional testing to ensure early detection and treatment of this often silent health condition. If DVT was confirmed early, the temporary addition of anticoagulants (blood thinners) or other therapies can prevent serious complications.

Arteries in Your Legs can also Clog, Just Like the Brain

Individuals living with Type 2 Diabetes (T2D) have a 2 times higher risk of developing stroke in their lifetime. Likewise, high blood pressure plays a role in about half of all strokes.

These risk factors for stroke can also cause a condition called peripheral arterial disease (PAD). PAD – essentially, reduced blood flow to the extremities – is often the result of stiff and inflexible arteries in the body. Studies show that when a stroke patient is also diagnosed with PAD, 22% will go on to have another vascular event or be re-hospitalized within one year of their stroke event.

Stroke patients diagnosed with PAD are also at a heightened risk of having another stroke. This is why secondary prevention of stroke is critically important. Up to 30% of stroke survivors will have a second stroke within five years. Confirming the presence of PAD increases the importance of chronic disease management to prevent the onset of a second stroke or other vascular complications (like heart attack or kidney failure).

This is another reason why lower leg assessments reduce the risk of post-stroke complications. Stroke patients diagnosed with PAD not only have an increased risk of vascular complications and hospitalization, but also a significantly higher risk of experiencing a second stroke in their lifetime. Personalized, preventative measures for ‘high risk’ clients can help protect against another stroke, and other vascular complications.

Microvascular Disease Also Predicts Your Potential for a Full Stroke Recovery

For the reasons discussed so far, lower leg assessments go far beyond assessing stroke-specific risk factors. The lower leg assessment also offers a window into your overall vascular health.

Microvascular disease is directly responsible for about 30% of strokes, and a significant factor in the development of dementia or other cognitive deficits after a stroke. While microvascular complications are often overlooked by stroke recovery therapists, the presence of these disease processes will likely delay or limit recovery after a stroke.

If you think about it, blood that can’t effectively reach your ‘tippy-toes’ likely can’t perfuse deep into your brain either. A comprehensive lower leg assessment can provide important information to potentially intervene and slow the progression of microvascular disease.

Article Summary:
  • Comprehensive lower leg assessments may help your health care team to augment your stroke rehabilitation plan, and evaluate your vascular risk profile after a stroke.
  • Lower leg assessments may improve rehabilitation outcomes by preventing further complications or even another stroke event.

As a result, lower leg assessments are not just a ‘routine check’ but rather an essential assessment when recovering from a stroke. These assessments help your care team to screen for DVTs, better understand potential relationships between PAD and post-stroke outcomes, and incorporate principles of secondary prevention. Patients are encouraged to request a more targeted and effective stroke rehabilitation plan through proactive requests to screen for lower leg health conditions.

The information in this presentation is based on research studies and Canadian guidelines for stroke rehabilitation. To request additional resources or supporting references, please feel free to leave general questions in the comments.

Published by Adam Henley

Adam is a Registered Nurse with experience in chronic disease management, symptom measurement, hematology/oncology, primary care behavioural health and geriatrics. He combines counselling, nutrition & exercise with traditional home nursing care. Adam cares to live health together with clients in a manner consistent with Parse’s Theory of Human Becoming. At the heart of his care, Adam offers evidence-based strategies to transform health together.

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