Peripheral Vascular Disease
Peripheral vascular disease (PVD) is a disorder of the circulatory system involving blood vessels outside of the heart. It can affect any part of the body, but it is the legs and feet that are most commonly involved.
When these peripheral blood vessels, responsible for transporting blood throughout the extremities, are blocked, hardened or narrowed, it results in a reduced flow of blood to the legs. This increases the risk of infection in the limbs. Tissue death, also known as gangrene, can occur in severe cases of PVD.
Symptoms of PVD typically include:
- Leg pain that often occurs when exercising and ceases during rest
- Numbness, coldness, change of color or loss of hair in the legs or feet
- Leg cramps
- Paleness, blueness or weak or absent pulse in a limb
- A change in gait
Diagnosis of PVD is typically made after various tests have been performed. These assessments may include ankle brachial index, Doppler ultrasound, angiogram, MRI scan, plethysmogram and venogram.
There are several treatment methods for PVD, including the adoption of a supervised exercise routine, modifications to the diet, quitting smoking and controlling blood sugar. In addition, medication may be prescribed to manage blood pressure and cholesterol. For more severe cases of PVD, a surgical procedure may be necessary to restore proper circulation in the legs and feet.
Venous stasis involves an inflammation of the skin in the lower legs as a result of chronic venous insufficiency. If the valves or walls of the veins in the legs are not working properly, it is difficult for blood to circulate from the legs back to the heart. When pooled venous blood collects in the legs, it can result in skin inflammation and other complications as well. Treatment for this condition focuses on addressing the underlying condition and is usually successful.
Swelling and varicose veins may arise, along with lesions that first appear on the skin as red or brown discolorations, but may then begin to scale and crust. Other symptoms may develop, including itching, aching, a feeling of heaviness in the legs or pain upon standing. Ulcers, or sores on the skin, sometimes form, especially on the inner ankles.
To make a diagnosis, a physical examination is performed and a medical history taken. In some cases, testing including ultrasound imaging may be required to evaluate the blood flow through the legs.
Many cases of venous stasis can be treated through conservative methods such as elevating the leg and wearing compression garments to promote healing. Exercising regularly, losing weight and avoiding long periods of either sitting or standing often help to relieve symptoms. Sclerotherapy and endovenous thermal ablation can be used to dissolve the affected vein. For related skin issues, topical or oral antibiotics as well as topical steroid creams may be prescribed. Most cases of venous stasis can be effectively treated using noninvasive methods.
Lymphedema is a swelling, usually in the arms and legs, that occurs from a blockage within the lymphatic system. The lymphatic system helps to fight infection and disease by carrying lymph, a colorless fluid containing white blood cells, through the body. Acute lymphedema, which is often brought about by cancer treatment, usually goes away after six months. Chronic lymphedema, however, has no cure, although there are ways to manage it and keep it from getting worse. No matter the type, untreated lymphedema may result in decreased function and mobility in the affected part of the body, and can result in chronic infections and various illnesses.
Lymphedema is very common in the legs. Swelling may be barely noticeable or so extreme that using the leg becomes impossible. Symptoms of lymphedema in the leg include:
- Swelling, possibly including toes
- Aching or discomfort
- A full or heavy sensation
- Restricted range of movement
- Tight or shiny skin
- Lack of indentation in the skin when pressed
- Hardening and thickening of the skin
- Small warts or blisters that leak clear fluid
- Recurring infections
In some cases, a doctor’s exam, which includes measuring the affected limb against the normal one, may be sufficient to diagnose lymphedema. Additional ways to diagnose lymphedema include:
- CT scan
- MRI scan
- Doppler ultrasound
- Radionuclide imaging
Lymphedema treatment often includes:
- Compression stockings
- Exercise that incorporates gentle contraction of muscles in the affected limb
- Compression bandages that encourage lymph-fluid drainage
- Pneumatic-compression devices
- Massage that helps to drain lymph fluid
To reduce severe swelling, lymphedema may be treated with surgery that removes excess fluid and tissue from the affected limb.
Robert Spencer, DPM
Nitza Rodriguez, DPM
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