What questions should be asked to establish a baseline for lower limb health?

Interview Questions for Establishing Baseline Lower Limb Health

A comprehensive patient interview for establishing baseline lower limb health should include questions about walking impairment, claudication, ischemic rest pain, and nonhealing wounds, as these are critical indicators of peripheral arterial disease and other lower limb conditions. 1

Medical History Questions

• Ask about age, diabetes status, smoking history, and other atherosclerosis risk factors, as these identify individuals at risk for lower extremity peripheral arterial disease (PAD) 1
• Inquire about known atherosclerotic disease in other vascular beds (coronary, carotid, or renal artery disease) 1
• Ask about family history of first-degree relatives with vascular disease 1
• Question about history of hypertension, hypercholesterolemia, and diabetes management 1

Symptom Assessment

• Ask about any walking impairment, including:

  • "Do you experience any pain, fatigue, aching, or numbness in your legs when walking?" 1
  • "How far can you walk before these symptoms occur?" 1
  • "Do these symptoms resolve with rest? How quickly?" 1

• Inquire about claudication specifically:

  • "Do you experience cramping, pain, or discomfort in your buttocks, thighs, calves, or feet when walking that is relieved by rest?" 1
  • "Does this pain force you to slow down or stop walking?" 1

• Ask about ischemic rest pain:

  • "Do you experience pain in your feet or legs when you're resting or lying down?" 1
  • "Is the pain worse when you elevate your legs? Does hanging your legs over the bed provide relief?" 1

• Question about nonhealing wounds:

  • "Do you have any sores or wounds on your feet or legs that have been slow to heal?" 1
  • "How long have you had these wounds?" 1

Functional Assessment

• Ask about limitations in daily activities:

  • "How many blocks can you walk before needing to stop?" 1
  • "Do you have difficulty climbing stairs?" 2, 3
  • "Has your walking speed decreased compared to others your age?" 1

• Inquire about balance and stability:

  • "Do you feel unsteady when walking?" 4
  • "Have you fallen in the past year? If so, how many times?" 4
  • "Do you use any assistive devices for walking (cane, walker)?" 4

• Ask about quality of life impact:

  • "How has your leg condition affected your ability to perform daily activities?" 3, 5
  • "Has your leg condition limited your social activities or recreational pursuits?" 3, 5

Pain Assessment

• Document pain characteristics:
  • "On a scale of 0-10, how would you rate your leg pain at rest? During activity?" 5
  • "Where exactly is your pain located? Does it move or radiate?" 1, 6
  • "What makes the pain better or worse?" 6

Previous Treatments and Interventions

• Ask about prior vascular interventions:

  • "Have you had any previous surgeries or procedures on the blood vessels in your legs?" 1
  • "Have you undergone any testing for circulation problems in your legs?" 1

• Inquire about current treatments:

  • "Are you taking any medications for circulation problems?" 1
  • "Have you participated in supervised exercise programs for leg pain?" 1

Examination Components to Document

• Document findings from pulse examination (femoral, popliteal, dorsalis pedis, posterior tibial) 1
• Note any skin changes, including color, temperature, hair loss, or trophic changes 1, 7
• Document presence of varicose veins or signs of venous insufficiency 7
• Record any foot deformities, calluses, or wounds 1

Objective Measurements to Consider

• Consider incorporating the Ankle-Brachial Index (ABI) measurement as part of the baseline assessment 1
• Document walking distance using standardized measures such as the 6-Minute Walk Test when appropriate 1, 4
• Consider using validated questionnaires like the Lower Limb Core Scale or PLUS-M™ for standardized assessment 4, 2

Common Pitfalls to Avoid

• Relying solely on the presence or absence of claudication, as many patients with PAD are asymptomatic or have atypical symptoms 1
• Failing to distinguish between arterial claudication and pseudoclaudication from other causes (e.g., spinal stenosis) 1
• Overlooking the impact of lower limb conditions on psychological well-being and quality of life 5, 6
• Not recognizing that asymptomatic PAD still carries significant cardiovascular risk and may be associated with functional impairment 1

By systematically addressing these areas in a patient interview, clinicians can establish a comprehensive baseline of lower limb health that will guide further evaluation and treatment decisions.