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Fall, 2009 Volume II Issue 3
CLINICAL TOPIC OF THE SEASON
We are often asked for professional advice on various diagnosis and treatment matters and will address these in our newsletters. Many of these subjects are covered under TOPICS in our website at http://www.podiatryaffiliates.com. One of the most frequently asked questions is, “What is PAD?”
What is Peripheral Vascular Disease (PAD)?
Peripheral arterial disease (PAD) describes when there is blood flow constriction to the extremities (arms and legs), internal organs (heart, brain, digestive tract, kidneys) that results in pain, loss of function, and tissue loss. Changes in your feet and legs can indicate the presence of similar changes throughout your body. Your podiatrist can be instrumental in first detecting signs and symptoms of PAD.
PAD is caused by atherosclerosis (the deposition of cholesterol and fatty plaques to the inner lining of arteries) resulting in narrowing of the arteries and constriction of blood flow. These constrictions and the symptoms of PAD may be treated with drugs, angioplasty, or atherectomy (plaque removal via surgery).
PAD is more common in older people and men. It affects 15-20% of people aged 70 or over. Smoking and diabetes increase your risk. Also histories of high blood pressure, obesity, high cholesterol and inactive lifestyle increase risk.
Symptoms in the Legs and Feet
| Skin Changes | |
| Early diminishment of blood flow can lead to hair loss on the toes or shins, dry or cracked skin, thickened toenails, red or purple discoloration, or cold toes. | |
| Intermittent Claudication | |
| This is pain associated with activity such as walking or exercise that results in pain in the calf and thigh primarily that is alleviated by rest. The pain feels like a cramp or aching or tired feeling in the muscles, not the joints. The pain is alleviated by resting for 1-5 minutes unlike pain associated with spinal or nerve related pain. | |
| Rest Pain | |
| As more narrowing of arteries occurs the distance you can walk before developing pain decreases to the point where they can hurt even doing no activity. Eventually your legs and feet hurt at rest especially when lying down. Pain is frequently in the heels or toes and can be severe and unrelenting. Elevation of your legs makes it worse and hanging your feet off the bed improves it. | |
| Gangrene/Necrosis (Tissue Loss) | |
| The most severe consequences are gangrene (where tissues die and become blackened) or skin ulcers where skin loss exposes underlying bones and joints leading to infection and amputation. | |
Diagnosis of Peripheral Arterial Disease
Early diagnosis of PAD is done with a Doppler examination. Our practice is now able to test in office with the Biomedix Doppler Unit. The test is painless and requires no pre-preparation. The Doppler uses ultrasound and a process called photocell plethysmography to measure the pulse and volume of blood flow in the arteries. The patient is placed on an exam table at rest and blood pressure cuffs are placed at various levels of the legs and special sensors are placed on the toes. The examination takes about 30 minutes to perform. After the test is performed the results are sent electronically through the PADnet+ system (Figure One) for review by a vascular surgeon certified in interpreting these results and a full color report and recommendations are generated. This report will be sent to your primary care doctor. This eliminates the process of going to a hospital or second specialist for the test and waiting for an interpretation that may be mailed days later to your doctor.
Treatment
Treatment can range from medication or a referral to a specialist for angioplasty which can be semi- invasive (reaming out the plaque) or open surgery. Restoration of blood flow eliminates pain and promotes healing of the previously undernourished tissues.
If You Have PAD-Foot Care
- Inspect your feet daily for cracks, sores, corns and calluses.
- Clean your feet daily and dry them thoroughly.
- Have a podiatrist care for your nails, corns and calluses.-Do not self treat!
- Do not use corn removers or medicated pads
- Do not wear tight garters of stockings with tight elastic at the top
- Do not wear open shoes or walk barefoot
- Acquire prescription shoes if you have deformities like bunions
- Do not soak your feet in hot water or chemical solutions
Back-to-School Shoe Shopping Tips
When the final weeks of a care-free summer vacation come to a close, the sounds of school bells, slamming locker doors and students clamoring into classrooms are heard loud and clear once again. But before each new school year begins, parents eagerly seek out a wide array of school supplies and stylish new fashions for their children. One of the most important purchases on any parent's back-to-school shopping list is a pair of new shoes. For many parents, back-to-school shoe shopping may seem easier than a pop-quiz in gym class - but several important factors should be considered:
Children's feet change with age. Shoe and sock sizes may change every few months as a child's feet grow. Shoes that don't fit properly can aggravate the feet. Always measure a child's feet before buying shoes, and watch for signs of irritation. Never hand down footwear. Just because a shoe size fits one child comfortably doesn't mean it will fit another the same way. Also, sharing shoes can spread fungi like athlete's foot and nail fungus. Examine the heels. Children may wear through the heels of shoes quicker than outgrowing shoes themselves. Uneven heel wear can indicate a foot problem that should be checked by a podiatrist. Take your child shoe shopping. Every shoe fits differently. Letting a child have a say in the shoe buying process promotes healthy foot habits down the road. Always buy for the larger foot. Feet are seldom precisely the same size.
Buy shoes that do not need a "break-in" period. Shoes should be comfortable immediately. Also make sure to have your child try on shoes with socks or tights, if that's how they'll be worn.
Do Your Child’s Shoes Make the Grade?
| Take the 1-2-3 Test: | ||
| 1. | Look For A Stiff Heel Press on both sides of the heel of the shoe. The sides should not collapse. |
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| 2. | Check toe flexibility The shoe should bend with your child's toes. It shouldn't be too stiff or bend too much in the toe box area |
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| 3. | Select a shoe with a rigid middle Does your shoe twist? Your shoe should never twist in the middle. |
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Sincerely,
Drs. Carrel, Davidson, Goldstein, Perelstein and Fitzpatrick
Podiatry Affiliates, PC
Amherst Office
3980 Sheridan Drive
Suite 308
Amherst, NY 14226-1727
716-839-3930
Buffalo Office
403 Main Street
Suite 603
Buffalo, NY 14203-2104
716-852-7800
Niagara Falls
6934 Williams Road
Suite 600
Niagara Falls, NY 14304-3080
716-298-1600
General E-Mail: questions@podiatryaffiliates.com
Web Site: www.podiatryaffiliates.com
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