If swelling or edema is present, palpate for pitting edema. Press firmly but gently with your thumb for at least 2 seconds (1) over the dorsum of each foot, (2) behind each medial malleolus, and (3) over the shins (Fig. 1). Look for pitting—a depression caused by pressure from your thumb. Normally there is none. The severity of edema is graded on a four-point scale, from slight to very marked.
FIGURE 1. Palpate for pitting edema.
Palpate for any venous tenderness or cords, which can accompany a DVT. DVTs often have no demonstrable signs, so diagnosis often depends on clinical suspicion and testing.
■ Palpate the inguinal area just medial to the femoral pulse for tenderness of the femoral vein.
■ Next, with the patient's leg flexed at the knee and relaxed, palpate the calf. With your fingerpads, gently compress the calf muscles against the tibia, and search for any tenderness or cords.
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