Peripheral Arterial
Disease (P.A.D.)

Common Foot Problems

Peripheral Arterial Disease (P.A.D.)

Peripheral Artery Disease (P.A.D.), commonly known as "poor circulation" refers to the obstruction of arteries in the leg. Plaque - the build up of cholesterol and other substances in arterial walls causes the arteries to narrow and prevents oxygenated blood from reaching the legs and feet.

Patients with P.A.D. should be aware of a possibly more widespread build-up of plaque in the arterial walls that may affect the brain and cause a stroke, or affect the heart and cause a heart attack.

Patients often do not experience symptoms in the early stages of P.A.D. Symptoms are usually noticed in later stages when the arteries are severely blocked.

P.A.D. symptoms commonly include:

  • Intermittent claudication including leg pain or cramping when walking
  • Rest pain such as pain or cramping in the legs when lying down
  • Leg numbness or weakness
  • Coldness in the legs or feet
  • Sores on your toes, feet or legs that do not heal
  • A change in leg color
  • Hair loss on the feet and legs
  • Toe nail changes, including color and thickness

It is very important to be evaluated by Dr. Radovic if any of these symptoms are present. Neglecting to treat P.A.D. may result in debilitating and limb-threatening outcomes.

Since only half of people with P.A.D. notice symptoms, knowing the risk factors and being screened or examined for P.A.D. is crucial.

Risk factors include:

  • Increasing age, especially after reaching age 50
  • A history of smoking
  • Diabetes
  • High blood pressure
  • High cholesterol
  • A family history of P.A.D, heart disease, heart attack or stroke
  • Less frequent or no exercise

Dr. Radovic obtains a full medical history of the patient when diagnosing P.A.D. A physical examination of the lower extremity includes evaluating the pulses, skin condition and foot deformities to reveal the patient's risk for P.A.D. Dr. Radovic may order additional tests if any risk factors are present.

There are a number of non-invasive examinations available to evaluate P.A.D. For example, the ankle-brachial index (ABI) is a minor test that measures and compares blood pressure at the arm and ankle levels. An ABI outside of normal limits is a valid indicator of P.A.D. that may lead Dr. Radovic to refer the person to a vascular specialist for additional assessment and treatment if necessary.

P.A.D. is generally treated with lifestyle changes, medication and in select instances, surgery.

Lifestyle changes include quitting smoking, exercising regularly and eating a healthy diet low in saturated fat.

Medications may be presribed for improving blood flow, preventing blood clots, or controlling blood pressure, cholesterol and blood glucose levels.

Surgery is necessary for some patients to improve blood flow. Procedures include open bypass surgery and small incision (endovascular) procedures of the leg.

Commonly observed foot deformities such as hammertoes, bunions and bony prominences, or dermatologic conditions including ingrown or thickened fungal nails should be taken much more seriously in patients with P.A.D. Since blood flow is restricted in people with P.A.D. and blood is a necessary component of healing, usually minor problems including cuts, blisters or sores can lead to severe complications.

Patients with a combination of diabetes and P.A.D. face an increased risk of foot complications. Neuropathy - damage to the nerves that may cause foot numbness - is often found in patients with diabetes who do not feel pain that usually accompanies foot conditions. The combination of neuropathy and P.A.D. can lead to ulcers developing over foot deformities that may never heal. Consequently, P.A.D. and diabetes often necessitate foot or leg amputations in the United States.

P.A.D. can be corrected or improved once it is diagnosed. Dr. Radovic can correct the underlying foot condition to avoid future complications if circulation becomes severely restricted again.

Having regular foot examinations and promptly seeking medical attention when changes are noticed can prevent minor problems from worsening. P.A.D. needs to be monitored regularly.

People with P.A.D. should take the following precautions to prevent complications.

  • Regular foot hygiene is very important. Wash your feet everyday with warm (not hot) water and a mild soap. Gently and completely dry your feet and the area between your toes.
  • Moisturize the skin by applying a thin layer of lotion to the top and bottom of your feet. Do not use a lotion that contains alcohol, and do not moisturize between the toes.
  • Trim your toenails straight across and file the edges. Keep the edges rounded to prevent ingrown toenails, that may lead to infections.
  • Never walk barefoot, even indoors. Wear shoes and socks to prevent cuts and abrasions.
  • Wear proper shoes and socks. New shoes should be evaluated by an expert to assure proper fitting. Start by wearing the shoes for a few hours everyday to avoid blisters. Check your feet afterward for signs of irritation. Seamless socks should be worn to avoid developing sores.
  • Examine all areas of your feet daily by checking for sores, cuts, bruises, rashes and breaks in the skin. Also check for corns, calluses, blisters, red spots, swelling, ingrown toenails, toenail infections and pain.

Call Dr. Radovic right away if you notice any of the problems above. You should not attempt to treat cuts, sores or infections yourself.

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