In this section Cypress Foot and Ankle specialist Dr. Christopher Correa discusses Peripheral Arterial Disease (PAD). The peripheral vascular system is made up of arteries and veins connected by capillaries in an extensive network to bring blood to every portion of the body. Arteries are thick structures surrounded by a layer of muscle that carries blood away from the heart. These muscles embedded in the arterial walls collectively assist in control of overall blood pressure and directly control the amount of blood being delivered to any part of the body. This level of control is important for shunting blood to local areas of the body that may have an increased need. An example of this is shunting blood to the gut and away from muscle to aid in digestion vs shunting blood away from the gut and to the muscles during exercise. This is also useful for directing increased blood flow to injured structures to aid in healing. The thick walls of arteries help them manage the increased pressure seen in the arterial system. Veins on the other hand carry blood to the heart and have much thinner walls and minimal muscle surrounding them. Since there is no internal pump to move blood through the veins, they rely on compression from external muscles to push the blood back towards the heart. Internally veins have many valves throughout the system to help facilitate this where arteries do not need peripheral valves. Venous pressure is also significantly lower than that found in arteries. Veins can also expand and act as an internal reservoir however excess expansion can lead to pathology. Veins and arteries are connected by capillaries which are thin-walled structures that allow for the exchange of oxygen, nutrients, and waste.
What is Peripheral Arterial Disease?
Peripheral Arterial Disease (PAD) is a pathological condition that can affect the arteries of both upper and lower extremities. While it is possible to develop PAD in both upper and lower extremities, lower extremity disease is far more common. Chronic damage to the internal lining of the arteries occurs over long periods of time usually from long standing disease processes/ social habits. The more common factors that speed up arterial damage and narrowing are Diabetes, uncontrolled high blood pressure, history of smoking and elevated “bad” cholesterol. Over time the arteries harden and develop focal restrictions which can restrict down stream flow and inhibit the body’s ability to effectively control blood pressure. This is because downstream blockages increase back pressure and since the arteries have hardened, they are unable to dilate and lower the overall blood pressure contributing to chronic blood pressure problems.
As Peripheral Arterial Disease relates to podiatry, as mentioned earlier, feet and legs are affected far more often than hands and wrists and so podiatrist are frequently recognizing and diagnosing PAD. Symptoms often seen by podiatrist are hair loss in the feet and legs, wound healing problems, and changes in skin character leading to a thin, atrophic and/or “modeled” appearance. In severe cases discoloration can occur. In advanced cases patients will experience claudication pain in the calf muscles. This is where a restriction in blood flow to the calf muscles causes painful cramping after walking a short distance (1-2 city blocks). The cramping abates with rest and resumes with continued exercise. Another worrying symptom is rest pain. This is foot and leg pain that occurs any time the patient elevates their feet. This is usually seen at night and has been known to wake patients up from a dead sleep. Symptoms are usually improved by dangling feet off of the side of the bed (getting the limb lower than the heart) or by standing up. Both of these symptoms are signs of SEVERE arterial disease and should prompt expedient vascular work up. If left untreated peripheral arterial disease can lead to spontaneous non healing ulcerations of the feet and ankles or even tissue death (gangrene).
It is important that people with known peripheral arterial disease and or diabetes seek regular follow up with their doctors for monitoring of their condition. It is also very important that such people do not attempt self-care of their feet. No one other than a podiatrist should clip, chip, shave, cut or scrape anything off of their feet or ankles. All wounds that do not heal in a timely fashion should be evaluated quickly. If you think you or anyone you know may have peripheral arterial disease, give the experts art Select Foot and Ankle Specialists a call today and take the first step towards recovery!
