Homans Sign Postpartum

Have you ever been to the doctor with leg pain and heard them mention the Homans’ sign test? You’re not alone: it’s an old-school test still used in some clinics today, especially for people at risk of deep vein thrombosis (DVT). But while it’s quick and simple, a positive Homans sign isn’t always a reliable diagnosis.

So, what exactly is the Homans sign, how is it used postpartum, and should you be concerned if you test positive? Let’s break it down in a way that actually makes sense.

What Is the Homans’ Sign Test?

The Homans’ sign is a basic physical exam used to check for potential blood clots – specifically, deep vein thrombosis in the leg. To perform the test, a healthcare provider gently flexes your foot upward (called dorsiflexion) while your leg is straight or slightly bent at the knee. If this movement causes sharp pain or tenderness in the calf, it’s considered a positive Homans’ sign.

It’s easy and non-invasive, but also a bit outdated.

Why a Positive Homans Sign Isn’t Always Helpful

Here’s the issue: even if you feel pain during the test, it doesn’t necessarily mean you have a blood clot. A 2013 clinical study showed that Homans’ sign has low sensitivity and specificity, meaning it often misses real cases of DVT or suggests DVT when there isn’t one.

To put it simply: Homans’ sign is like a car’s check engine light: it might blink, but it doesn’t tell you exactly what’s wrong.

False positives can happen due to:

• Muscle cramps
• A pulled calf muscle
• Vein inflammation (not from clots)
• Other vascular conditions
• Even a tight pair of shoes

So, while Homans’ sign is still taught and used, modern medicine rarely relies on it alone to diagnose a serious condition such as a blood clot.

But here’s the problem: postpartum leg pain is also widespread and can happen for many harmless reasons, including:

• Muscle strain from labor
• Leg position during delivery
• Water retention and swelling
• Shifts in posture or sleep

That’s why most hospitals today use the Homans’ sign only as an initial screen, and follow up with ultrasound imaging or lab tests if there’s any real concern.

What Else Can Cause a Positive Homans’ Test?

A positive Homans’ sign just means there’s calf pain during foot flexion, but that doesn’t mean DVT is the cause. Here are a few other conditions that can trigger pain and confusion:

• Superficial thrombophlebitis: Inflammation of a vein near the surface—not as dangerous as DVT, but still painful.
• Baker’s cyst: A fluid-filled swelling behind the knee that can press on nearby tissue.
• Muscle strain or cramp: Especially common after exercise or prolonged standing.
• Sciatica or disc issues: Nerve pain that radiates into the leg can mimic DVT symptoms.

So if your provider says “positive Homans,” take it as a sign to look further, not a final diagnosis.

What Should You Do If You Have a Positive Homans’?

The best course of action? Don’t panic, but don’t ignore it either. If you have any symptoms of DVT, especially in combination with swelling, redness, warmth, or pain, it’s essential to get tested with more accurate tools.

Modern tests include:

Wells Score: A Clinical Risk Assessment Tool

The Wells score is a widely used checklist that helps doctors estimate the likelihood of someone having deep vein thrombosis (DVT). It takes into account symptoms (like leg swelling or tenderness), recent surgery, medical history, and whether other diagnoses are more likely.

Each item on the list adds points, and your total score places you in a low, moderate, or high-risk category for DVT. The beauty of the Wells score is that it guides the next steps, for example, someone with a low score might avoid unnecessary imaging, while a high score would prompt immediate testing.

When it helps:

• It’s instrumental in emergency or outpatient settings when deciding whether to proceed with imaging.
• It works best when combined with a D-dimer test or ultrasound for confirmation.

Limitations:

It’s not used alone to confirm or rule out DVT.
It may be less accurate in pregnant patients or people with complex medical histories.

D-dimer Blood Test: A Clot-Detecting Marker

The D-dimer test measures the presence of a protein fragment that’s released when a blood clot breaks down. If you have a high level of D-dimer, it means your body may be forming (or trying to break down) clots.

It’s a quick, non-invasive blood test often used alongside the Wells score. A normal result is excellent news: it usually rules out DVT in low- or moderate-risk patients.

When it helps:

• Ideal for people with vague symptoms or moderate risk.
• Very useful for excluding DVT in healthy or younger patients without known risk factors.

Limitations:

• Not specific – D-dimer levels can rise due to infection, pregnancy, recent surgery, or inflammation.
• Not ideal for postpartum women, cancer patients, or people with chronic conditions, where false positives are common.

Duplex Ultrasound: The Gold Standard for DVT Diagnosis

A duplex ultrasound is the go-to imaging test to confirm or rule out a blood clot. It uses sound waves to create real-time images of your veins and assess blood flow. The “duplex” part means it combines two types of ultrasound: one to look at the structure of your veins and the other to track the flow of blood through them.

It’s painless, non-invasive, and incredibly accurate for detecting clots in the legs, especially the femoral and popliteal veins.

When it helps:

Perfect for confirming a suspected DVT after a positive Wells score or elevated D-dimer.
This is especially valuable if you have localized swelling, pain, or visible vein changes.

Limitations:

This method may be less accurate for clots in the pelvis or abdomen—additional imaging like CT venography may be needed.
It is not always immediately available in smaller clinics or rural hospitals.

If you’re postpartum and unsure whether your pain is “normal” or not, it’s always better to ask.

Why Homans’ Still Gets Used (Even If It’s Outdated)

Why do some providers still use the Homans’ sign test?

Because it’s:

• Fast
• Easy to do at the bedside
• A familiar tool in emergency or resource-limited settings

Think of it like checking someone’s temperature with your hand instead of a thermometer – it’s better than nothing, but far from exact.

At Texas Vascular Institute, we know that your peace of mind matters just as much as clinical precision. That’s why we use the most reliable diagnostic methods when evaluating vascular symptoms like leg pain, swelling, or visible veins.

Worried About Leg Pain or a Positive Homans’ Sign?

Whether you’re postpartum, experiencing unusual swelling, or just unsure about your symptoms, the team at Texas Vascular Institute is here to help. Our board-certified specialists offer modern, accurate testing and personalized treatment options without the guesswork.

Schedule your consultation today and get answers you can trust.