Peripheral Arterial Disease (PAD)
Before we focus on neuropathy, let's discuss our circulatory system. There are many cases in which the vascular system may be the predominant cause of your leg pain. The artery, vein, and nerves all course together and ruling out peripheral arterial disease is important. PAD is narrowing or blockage of arteries that results in poor blood flow to your legs. When you walk or exercise, your leg muscles do not get enough blood and you can get painful cramps. Peripheral arterial disease is also called peripheral vascular disease or simply poor circulation. Just like clogged arteries in the heart, clogged arteries in the legs mean you are at risk for having a heart attack or stroke. Plaque buildup in the legs does not always cause symptoms, so many people can have PAD and not know it. People who do experience symptoms, such as pain or cramping in the legs, often do not report them, believing they are a natural part of aging or due to another cause.
One in every 20 Americans over the age of 50 have PAD and it is estimated that over 8 million are undiagnosed. Early detection of PAD has been shown to save limbs and lives, so if you have any of the risk factors you should undergo PAD screening by your podiatrist yearly or more often if symptoms occur.
The exact cause of plaque buildup in the limbs is unknown in most cases. However, there are some conditions and habits that raise your risk for developing poor circulation.
Your risk increases if you:
1. Are over the age of 50.
2. Smoke or used to smoke. Those who smoke or have a history of smoking have up to four times greater risk of PAD.
3. Have diabetes. One in every three people over the of 50 with diabetes is likely to have PAD.
4. Have high blood pressure. Also called hypertension, high blood pressure raises the risk of developing plaque in the arteries.
5. Have high blood cholesterol. Excess cholesterol and fat in your blood contribute to the formation of plaque in the arteries, reducing or blocking blood flow to your heart, brain, or limbs.
6. Have a personal history of vascular disease, heart attack, or stroke. If you have heart disease, you have a one in three chance of also having PAD.
7. Are African-American. African-Americans are more than twice as likely to have PAD as Caucasians.
What are the symptoms of PAD?
Most patients with PAD have little or no symptoms until the disease is advanced; that's why screening exams are so important. Those who do experience symptoms have reported the typical signs and symptoms:
Claudication: fatigue, heaviness, tiredness, cramping in the leg muscles (buttocks, thigh, or calf) that occurs during activity such as walking or climbing stairs. This pain or discomfort goes away with rest or once the activity is stopped and during rest.
Rest Pain: pain in the legs at night that often disturbs sleep
Wounds or sores that heal very slowly or not at all
Color changes to the skin on the feet and lower legs Cold, pale feet and legs Decreased hair and nail growth on the feet
How is PAD Diagnosed?
Your podiatrist will start with checking the pulses in your foot and ankle, examining the skin for changes and wounds that are poorly healing. Often an ABI (ankle-brachial index) is performed which compares the blood pressure in your anus to your ankles. A Doppler exam may be ordered. This test uses sound waves to measure the blood flow in the veins and arteries in your arms and legs. If any of these exams are abnormal, your podiatrist may refer you to a vascular surgeon to discuss options for treatment.
How is PAD Treated? The overall goals for treating PAD are to reduce any symptoms, improve quality of life and mobility, and prevent heart attack, stroke, and amputation. There are three main approaches to treating PAD: making lifestyle changes, taking medication, and in some cases, having a special procedure or surgery. Your physicians will determine the best treatment options for you, based on your medical history and the severity of your condition.
How Can I Prevent PAD?
The cornerstone of prevention is lifestyle changes.
Exercise is very important and you should aim for 30-45 minutes of moderate intensity exercise each and every day.
Stop smoking immediately and ask your doctor for help if you have difficulty with smoking cessation.
Keep your cholesterol and blood glucose levels down. Keep your blood pressure in the normal range.
If you are overweight or obese, aim for a normal weight and again, ask your doctor for help) A diet low in saturated fats, trans fats and cholesterol is also helpful.
More than anything, talk to your doctors about a comprehensive treatment plan that decreases your PAD risks.
One in every 20 Americans over the age of 50 have PAD and the incidence is higher in diabetics. Most patients have little or no symptoms until it is too late! Early detection of PAD has been shown to save limbs and lives, so if you have any of the risk factors you should undergo PAD screening by your podiatrist.
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