Peripheral vascular disease goes by many names. PVD, PAD, arteriosclerosis, blockage of leg arteries, claudication, intermittent claudication, vaso-occlusive disease of the legs, arterial insufficiency of the legs and poor blood flow of the legs, are all names used to refer to this common condition. Regardless of what you call it, it is a very serious medical condition that sometimes presents with no symptoms what so ever. When there are symptoms, the most common complaints are recurrent leg pain and cramping and calf pain with exercise. Peripheral vascular disease is a condition of the blood vessels that leads to narrowing of the arteries that supply the legs and feet. The narrowing of the blood vessels leads to decreased blood flow, which can injure nerves and other tissues. Causes, incidence, and risk factors Peripheral artery disease is caused by many factors. Basically, this problem occurs when fatty material, called plaque, builds up on the walls of your arteries. This causes the arteries to become narrower. The walls of the arteries also become stiffer and cannot widen to allow greater blood flow when needed. This is very similar to build up in a pipe that leads to slower drainage of water and ultimately a clogged drain. As a result, when the muscles of your legs are working harder, like with exercise, they cannot get enough blood and oxygen. Eventually, there may not be enough blood and oxygen, even when the muscles are resting. Peripheral artery disease is a common disorder that usually affects men over age 50 but it can affect both sexes and people as young as 30. People are at higher risk if they have a history of: • Diabetes • Abnormal cholesterol • Heart disease • High blood pressure • Kidney disease involving hemodialysis • Smoking • Stroke Symptoms The classic symptoms are pain, achiness, fatigue, burning, or discomfort in the muscles of your feet, calves, or thighs. These symptoms usually appear during walking or exercise and go away after several minutes of rest. At first, these symptoms may appear only when you walk uphill, walk faster, or walk for longer distances. Slowly, these symptoms come on more quickly and with less exercise. Your legs or feet may feel numb when you are at rest. The legs also may feel cool to the touch, and the skin may look pale. When peripheral artery disease becomes severe, you may have: • Pain and cramps at night • Pain or tingling in the feet or toes, which can be so severe that even the weight of clothes or bed sheets is painful • Pain that is worse when you raise the leg and improves when you dangle your legs over the side of the bed • Skin that looks dark and blue • Sores that do not heal • impotence Signs and tests During an examination, the health care provider may find: • Decreased blood pressure in the affected limb • Loss of hair on the legs or feet • Weak or absent pulses in the limb When PVD is more severe, findings may include: • Calf muscles that shrink • Hair loss over the toes and feet • Painful, non-bleeding sores on the feet or toes (usually black) that are slow to heal • Paleness of the skin or blue color in the toes or foot • Shiny, tight skin • Thick toenails Sometimes there are no symptoms. This is often referred to as a “silent killer.” Unfortunately, people with PVD have a five year mortality rate of 64%. This is higher than prostate cancer, breast cancer or colon cancer. Testing A simple, painless, in office test is all that is needed to confirm this diagnosis. We offer the test at Sarasota Foot Care Center. It is called a vascular test. If you have diabetes and are over the age of 50, the American Diabetes Association recommends getting the vascular test as a screening tool. Treatment Self-care: • Balance exercise with rest. Walk or do another activity to the point of pain and alternate it with rest periods. Over time, your circulation may improve as new, small blood vessels form. Always talk to the doctor before starting an exercise program. • Stop smoking. Smoking narrows the arteries, decreases the blood's ability to carry oxygen, and increases the risk of forming clots. • Take care of your feet, especially if you also have diabetes. Wear shoes that fit properly. Pay attention to any cuts, scrapes, or injuries, and see your doctor right away. Tissues heal slowly and are more likely to get infected when there is decreased circulation. • Make sure your blood pressure is well controlled. • Reduce your weight, if you are overweight. • If your cholesterol is high, eat a low-cholesterol and low-fat diet. • Monitor your blood sugar levels if you have diabetes, and keep them under control. Calling your health care provider Call your health care provider if you have: • A leg or foot that becomes cool to the touch, pale, blue, or numb • Chest pain or shortness of breath with leg pain • Leg pain that does not go away, even when you are not walking or moving, called rest pain • Legs that are red, hot, or swollen • New sores/ulcers • Signs of infection • Symptoms of arteriosclerosis of the extremities Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com
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