This person needs proper hospital setting clinical examination and tests. I am trying to answer each question one by one. Black discolouration at ankles with bilateral pedal edema could be due to varicose veins as well. Further clinical examination is required. But pedal edema with recent onset breathlessness and with age considered - we need to take cardiac evaluation as well. Fractures of malleoli need orthopedician suggestion.you mentioned D-dimer value without the units. There can be a lot of change based on the units. Better opinion about this can be given if you upload the report. Also about the varus deformities- is it at the knee or the toes? And when did it start developing? Any vitamin or mineral deficiencies?

Look like she has chronic venous insufficiency leading to Red to blackish discoloration around ankle and breathlessness and pedal edema can be due to chronic DVT.

It sounds like you are managing a very complex situation for this patient, especially given her age and recent fracture. Understanding the Symptoms: The "red to black" discoloration and long-term swelling (pedal edema) suggest a condition called Chronic Venous Insufficiency (CVI) due to varicose veins. - The D-dimer & Breathlessness: The elevated D-dimer (2.9) and her breathlessness are significant. This can sometimes indicate a blood clot, especially since she recently had an ankle fracture and is less mobile. This needs immediate medical evaluation to rule out a deep vein thrombosis (DVT) or a pulmonary embolism. Management Options (Conservative Care): If a doctor confirms the issue is venous insufficiency and rules out urgent risks like active clots or poor arterial circulation, they may suggest non-surgical "conservative" steps like Limb Elevation, Compression Therapy and some drugs. But first she should be examined by a doctor to rule out any serious conditions and other possibilities. Because she has multiple overlapping issues, a team approach is best: - General Surgeon or Vascular Specialist: They should examine her legs first. They need to ensure the discoloration isn't caused by "limb ischemia" (lack of oxygenated blood flow) and decide if compression is safe. - Orthopedic Surgeon: The varus deformity (bowed legs) and the recent fracture fall under their expertise. They can provide braces, specialized footwear, or physical therapy plans that don't require surgery but help her move more comfortably. - General Physician: Since she has breathlessness and a high D-dimer, her heart and lung health must be stabilized first before focusing on the leg appearance. Dr. Akash Ranjan Vijay Ranjan Singh MBBS (AIIMS), MS General Surgery (AIIMS)