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I have currently seen a young male (30's) who underwent a Renal Transplant 3 years ago. He is taking a multitue of medications and has been experiencing some problems with his feet. For the past couple of months the patient has been experiencing Dorsal Non-pitting oedema on B feet, but only 1 foot at a time. When the Swelling appears it stays for about 7-10 days and disappears with the use of massage by my patient's partner. The recent swelling however has appeared in the Right Foot and is painful for the patient to walk. It has been present for about 14 days now. The pain is confined to the dorsal apect of the metatarsal heads and seems to be an "ache" that doesn't get better over the period of the day. The pain is at its worst in the morning after rest. Walking has become a problem as the patient is finding it very difficult. There is no significant underlying biomechanical problems, and his GP seems to think that it is not linked to his medication.

I am currently looking for any ideas from anyone who might have experienced anything like this or with other transplant patients? I am unsure what to do as for referral to specialst or treatment options?

Hollywest, I would look at a referral back to his renal physician/transplant surgeon, and also get the GP to run a full blood analysis to ensure Kindney function is still OK.
Otherwise treat the oedema with compression.
Occasionally some of the anti-rejection drugs can lead to increasing oedema, and may need adjusting

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Stephen Tucker
Eastern Health
Podiatry Manager

My location

Thanks Stephen, That was exactly what I am thinking!

Thanks for your reply.

Holly

I know this is a bit 'left field' but could there be a Charcot type joint involvement. I keep hearing of Renal patients who have developed them althouigh I haven't seen one myself.

Phil

Stress fractures in renal transplant patients due to long term prednisone use is fairly common.
Also: what was the original pathology requiring transplant......
Steve

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DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Green Bay, Wisconsin, USA

Hey Phil,

Sorry there is no Charcot type joint involvement. He has really normal feet, if you can say there was such a thing.

Thanks Holly

Thanks for your reply Steve,

The patient was reluctant to tell me the underlying pathology for his renal transplant, he is taking a large amount of medications related to his renal transplant and his GP has done scans and no signs of fracture. I think the thing that it making it difficult is that it keeps swaping from the Left foot to the Right?? His other medications include: Calcitriol, Norvasc, Coversyl, Prednisolone, Azothiorprine, Lipitor and Fosamax.

thanks for your help

Holly

Neuropathy is also common in renal/dialysis patients.Think of this also.

Small point, I'm a renal-to-be-transplant customer, on 5 mg norvasc (amongst others), and my feet /lower ankles balloon through the day (r>l, no alternating)and no pain