Sarah’s foot pain was dismissed by doctors as plantar fasciitis. Days later, she ended up in the hospital fighting for her life. This is the little-known condition that really caused it… and why so many GPs overlook it

When Sarah Bassra’s leg became swollen and painful, she initially attributed it to an ankle injury.

But the symptoms were the first sign of a potentially life-threatening medical condition.

It started two months earlier, in June 2022, when she noticed her toes were red and warm to the touch. Shortly afterwards this spread to her ankle, which also became swollen and inflamed.

Two separate visits to the GP gave her different answers. She was initially told it could be an allergic reaction to the gel nail polish she was using.

But when her symptoms worsened despite removing the nail polish, she returned to her GP, who said so was probably plantar fasciitis – a condition that causes pain on the bottom of the foot, around the heel and arch of the foot.

‘They told me to find orthopedic trainers and sent me home without a blood test,’ says Sarah, now 36, from Nottingham.

But the pain persisted, this time spreading to her calf and to her thigh.

“I thought maybe I was walking too much or overcompensating for the pain in my ankle by putting pressure on other areas,” she says.

Then, during a day out at a music festival, she developed chest pains and struggled to catch her breath.

On the way to the taxi at the end of the night she collapsed.

“I thought I was having a heart attack,” she says.

A test at A&E showed this Sarah had deep vein thrombosis, which happens when a blood clot forms in a deep vein in the lower leg.

A separate scan showed she also had a pulmonary embolism, a dangerous blockage in a pulmonary artery caused by the blood clot flowing from the vein in her leg.

“Now that I look back and know it was a blood clot, I could literally feel it running down my leg,” she says.

Sarah’s life was in danger and she spent five days in hospital and was given a course of blood thinners, which prevent the formation of new blood clots and cause existing clots to get bigger.

It wasn’t until months later that she finally received a diagnosis that explained her symptoms.

The condition that caused Sarah’s blood clots is: antiphospholipid syndrome (APS) – also known as Hughes syndrome.

APS is an immune system disorder that makes the blood too ‘sticky’, increasing the risk of dangerous blood clots and pregnancy problems such as recurrent miscarriage.

APS is thought to affect around 35,000 Britons – and is most common in women aged between 20 and 50.

Many people have no symptoms until a clot or pregnancy complication occurs.

Crucially, experts say the first signs of a blood clot are swelling, pain or tenderness, and warmth or redness in an affected arm or leg – but add that many GPs ignore these symptoms, especially in young people.

If a clot travels to the lungs, it becomes a medical emergency. Signs include sudden shortness of breath or difficulty breathing, sharp chest pain that worsens when you breathe in or cough, a fast or irregular heartbeat, and coughing up blood.

Experts believe that the condition is present in about one in six cases of young strokes, deep vein thrombosis and heart attacks under the age of 50.

But research shows that this is too often missed by general practitioners.

A 2023 study found that nearly 15 percent of patients with APS were diagnosed late or misdiagnosed, often waiting more than seven years for the correct diagnosis.

Professor Beverley Hunt, an expert on APS and founder and co-chairman of the trustees of Thrombosis Great Britainsays, ‘Clots are missed because medical professionals are looking for the wrong thing.

“About 80 percent of deep vein thromboses don’t manifest as the large, swollen leg we learned about, so people with unexplained leg pain or swollen ankles and toes are often turned away until the clot reaches their lungs.”

‘Our research shows that people with deep vein thrombosis often go to the doctor several times before someone recognizes the clot, simply because healthcare providers are not aware of how varied and subtle the symptoms can be.’

APS can run in families and experts believe that lifestyle factors such as poor diet, insufficient exercise and smoking can increase the chance of developing the condition.

Certain medications, including the combined contraceptive pill, can also cause the condition in some people.

Unmanaged APS can also restrict blood flow to the placenta, causing pregnancy complications such as miscarriages or late stillbirths.

When the condition is diagnosed early, it can be treated safely and effectively with daily blood-thinning tablets or, for pregnant women, even more powerful blood-thinning injections.

Sara says she is “in a way” grateful that she collapsed at the festival because it forced a diagnosis and treatment.

“I think the GP thought I was being overdramatic when I went to them with my swollen ankle,” she says.

‘All they would have needed was a simple blood test to see it was a blood clot and they would have discovered it two months earlier.’

Sarah, who has been told she will likely have to take blood thinners for the rest of her life, says the drugs have many side effects.

“It was very scary at first,” she says.

‘My hair started falling out and the medication made my periods heavier, which really had an impact on me.

‘I didn’t have any holidays for the first two years because I was so afraid I would get a blood clot during a flight.

‘I also got out of breath very easily on 30-minute walks because of the damage to my lungs. It probably took about three years for this to stop happening.”

She hopes her experience will make it clear to others how important it is to get a second opinion if they suspect something is wrong.

“It’s believed that blood clots are things that happen to old people, but I was in my early 30s when this happened,” she says.

‘If I had gotten a second opinion and diagnosis earlier, the disease would never have spread to my lungs and I would not have suffered any permanent damage.’

Professor Hunt says unexplained leg pain, new swelling or color changes in your foot or ankle and chest pain should always be taken seriously.

“They may be subtle,” she says. “But these symptoms may be the first clues that a dangerous clot is forming.”