Peripheral Vascular Disease

Like the rest of our body, our feet and legs rely on a good blood flow to deliver oxygen and nutrients to our cells, so all our muscles, joints and tissues keep functioning well and supporting our health and well-being. In peripheral vascular disease, the narrowing or blockage of our blood vessels results in reduced blood flow to both the feet and legs. This can produce a range of consequences for the feet as the cells and tissues suffer, hence those diagnosed with peripheral vascular disease must take special precautions to look after their feet, maintain their foot health, and prevent serious problems like foot ulcers. Peripheral vascular disease is also referred to as peripheral arterial disease.

Without an adequate blood supply to the feet and legs, you may experience:

• Intermittent claudication: muscle pain and cramping in the feet and legs during exercise, whether it be strenuous activity or simple walking. It often affects the calves, and often starts as a niggle or ache before progressing to cripling, limping pain. This is usually the earliest and most common symptom of peripheral vascular disease
• Slower to heal wounds and injuries: when we have a wound or an injury, our body and cells require a healthy blood supply in order to effectively repair, heal and close the wound. This means that both wounds and injuries heal slower in someone with peripheral vascular disease, causing painful symptoms for longer and increasing the risk of complications for our feet.
• Increased infection risk: the slower wounds heal, the longer they stay open and are susceptible to infection. If an infection does take hold, the diminished blood flow will also make it harder for the body to effectively fight and clear the infection.
• Ischaemia: in less common but more severe cases, a person may develop a sudden and serious restriction in blood flow which may cause tissue death or paralysis. This can put you at risk of limb loss, and requires urgent medical attention.

Signs and symptoms that you may have peripheral vascular disease include:

• Cold feet and toes
• Pale or purple skin discolouration
• Weakness in the legs and feet
• Tired, achy legs
• Problems with gait or balance
• Foot and leg pain
• Numbness and tingling

Peripheral vascular disease tends to develop gradually, as a result of plaque building up on the inner walls of a person’s arteries. This narrows the space available in the vessels for blood to pass through, obstructing regular, sufficient and healthy volumes of blood from getting to the tissues of the feet at an optimum rate. 

The plaque is composed primarily of cholesterol and calcium. Those with high cholesterol levels, smokers, and those with diabetes have the highest risk of developing peripheral vascular disease. As many people do not have many distinguishable symptoms in the early stages of the disease, it tends to be diagnosed when routine blood cholesterol checks are completed, and then confirmed with explorative arterial studies or imaging. Aside from the consequences on the feet, peripheral vascular disease significantly increases your risk of suffering a heart attack and stroke. While it is uncommon in young adults, approximately 20% of the UK population aged 55 to 75 years have evidence for peripheral vascular disease (source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513392/ )

The best way to manage your peripheral vascular disease at home is to prioritise a healthy diet and lifestyle while limiting the things known to promote plaque to develop in your vessels. This includes:

• Eating a cholesterol-lowering diet, incorporating plenty of vegetables and omega-3’s while avoiding saturated fats.
• Meeting your daily exercise guidelines, even if it’s low-impact activities like walking or swimming 
• Reducing your stress levels 
• Consistently taking any medications you’ve been prescribed for your peripheral vascular disease

To promote your foot and leg health specifically, make sure that you’re monitoring any cuts or wounds and their healing time. If a wound has not closed and is still open or bleeding after three days, notify your podiatrist. At the same time, look out for any signs of infections such as redness, swelling, increasing pain, a yellow-green-pink discharge, and fevers. Finally, it’s important to keep your feet protected with the right shoes that won’t cause any damage to your feet.

At Matt Raden Podiatry, our goal is to help you maintain your foot and leg (and overall) health while you’re managing your peripheral vascular disease. There is a lot that we can do to minimise your risk of complications, and we’ll discuss this with you after a comprehensive assessment where we understand your medical history, current circumstances, and all your risks. We may recommend:

• Creating a treatment plan for a specific injury (like foot, leg or heel pain) that may be interfering with your ability to manage your ability to stay active and therefore best manage your peripheral vascular disease
• Good, supportive and cushioning footwear that matches your foot type and helps protect your feet from pain and injury
• Providing wound care as needed for slow-healing wounds
• Corns and callus removal, and cracked heel treatment, as these can cause injury to the underlying skin, the healing of which may be complicated with peripheral vascular disease
• Trimming and thinning thickened or elongated toenails, and removing ingrown toenails
• Using custom foot orthotics to offload the feet and offer better support and comfort
• Referring you to other health professions that support your health, such as a dietitian or exercise physiologist