For the purposes of this discussion, I want to focus on poor circulation related to the arteries, or blood vessels that bring blood to the foot. Another component of poor circulation includes the veins, or blood vessels that bring blood from the foot back to the heart. When veins become diseased, the leg and foot can swell, and varicose and spider veins can develop. The added fluid in the legs from the veins' inability to return blood back to the heart effectively can be a source of pain and discomfort, but this does not threaten the health of the leg in the same way that poor artery flow does. That is why I will concentrate on poor artery circulation, as it is much more serious and causes more significant pain.
Again, arteries bring blood to the foot. Blood contains vital oxygen and other nutrients that the tissue in the legs and feet need to survive. When the leg and foot is deprived of this nutrient source, the tissue begins to deteriorate and eventually, if the circulation is bad enough, will die. Poor arterial circulation is due to a number of different factors. Numerous conditions like high blood pressure, high cholesterol, obesity, diabetes, heart attacks, stroke, kidney disease, and smoking can lead to or indicate a higher risk for the development of blockages in the leg arteries. When these blockages occur, the body must find alternate channels for the blood to get to the feet. Sometimes there are 'side' channels the body can use to get the flow down. However, when these alternate routes do not exist, or when they themselves are blocked, the foot has no way of getting adequate blood flow. A little bit can trickle in, but not enough to cover the needs of the foot tissue. Slowly over time the tissue begins to die, and numerous symptoms begin to appear. Externally, the skin becomes thin, and the toes will develop a red-purple discoloration. The foot can feel cool to the touch, and foot hair will disappear. Wounds can develop out of minor injuries to the skin. Foot pain during this stage is only minimal to moderate in intensity, with most pain being felt in the calf or leg after exerting a mild amount of activity, like walking around the block. When the condition advances, the toes can turn a blue-black discolor, or develop a hard black crust, indicating the start of gangrene. It is during this time that the circulation must be surgically restored, or else the leg may be lost to amputation. The pain associated with these later stages of circulation loss can be excruciating. This pain becomes worse with elevation of the leg, and even a horizontal position in the bed can cause pain, forcing one to have to lower the leg off the bed. Even narcotic pain killers rarely help decrease this pain, and it is constantly felt. The pain can be described as searing, knife-like, and crushing. Only restoration of blood flow and nutrients will relieve the pain, outside of amputation.
People often associate certain pains, like tingling, burning, and numbness of the feet as being circulation related. Even the sensation of the feet falling asleep is mistakenly attributed to circulation. In actuality, these pains are usually related to disease of nerve tissue. This can be due to nerve 'pinching', pressure around a nerve, or nerve tissue disease itself such as seen in diabetes. Circulation problems rarely have anything to do with this type of pain, and attributing these less serious pains to poor circulation decreases the urgency of actual circulation-based pain.
A simple test can determine if poor arterial circulation is present, and if found early enough treatment can be performed well in advance of the pain developing. If you have any of the above risk factors, a simple examination to determine if this screening test is necessary can save a lot of pain from developing, and may even save your leg.
Until next time,
Scott R. Kilberg DPM
Serving the communities of Indianapolis, Fishers, Noblesville, Fortville, Carmel, and Westfield Indiana.