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Peripheral Arterial Disease (PAD)

June 18, 2018

 

What Is PAD?

PAD is short for Peripheral Arterial Disease. PAD is caused by a blockage or narrowing of the arteries in the legs when fatty deposits called plaque buildup. The buildup of plaque causes the arteries to harden and narrow, which is called atherosclerosis. This results in a reduction of blood flow to the legs and feet. This is commonly referred to as poor circulation.

PAD occurs most often in the arteries in the legs, but it can also affect other arteries that carry blood outside the heart. This includes arteries that go to the aorta, the brain, the arms, the kidneys, and the stomach. When arteries inside the heart are hardened or narrowed, it is called coronary artery disease or cardiovascular disease.

PAD affects 8 to 12 million Americans, and one in every five people over the age of 70 has the disease. People with PAD have a two-to-six times' greater chance of death from a heart attack or stroke. PAD and diabetes are the leading causes of foot or leg amputations in the United States.

 

Causes/Risk Factors

Risk factors for PAD and other conditions that may complicate PAD include the following:

  • Smoking

  • High Cholesterol

  • High Blood Pressure

  • Physical inactivity

  • Obesity

  • Diabetes

Symptoms

The symptoms of PAD include the following:

  • Fatigue, tiredness, or pain in your legs, thighs, or buttocks that always happens when you walk but goes away when you rest.

  • Foot or toe pain at rest that often disturbs your sleep.

  • Skin wounds or ulcers on your feet or toes that are  slow to  heal  (or that do not heal for 8 to 12 weeks)

However, many individuals with PAD do not experience typical leg symptoms such as cramping, pain, or fatigue known as claudication.

When to Visit a Podiatrist

Do not ignore leg pain. It is important to discuss any leg or thigh pain that you are having with your podiatric physician since it could be a warning sign of a serious disease such as PAD. Early detection of PAD can offer an opportunity to treat risk factors that can slow the progression of the disease and decrease the chance of heart attack and stroke.

 

Diagnosis and Treatment

Your podiatric physician can do a simple test to determine if you have PAD. The test is called an ABI, or ankle-brachial index. It compares the blood pressure in your ankles with the blood pressure in your arm. If your ABI is abnormal, your podiatric physician may order other tests to determine the extent of your PAD.

PAD can be treated with lifestyle changes, medicines, and surgical procedures if necessary. Medical treatment options include:

  • Programs to stop smoking

  • Blood pressure control

  • Lowering cholesterol

  • Manage high blood sugar (diabetes)

  • Medications to prevent clotting

  • Healthy diet

  • Exercise program

A variety of surgical treatment options are available depending on the location and severity of the artery blockage. Your podiatric physician can refer you to the appropriate specialist for these procedures.

What is Peripheral Neuropathy?

Peripheral neuropathy is damage of the peripheral nerves. Your peripheral nerves are the nerves that travel to your arms and legs. When the nerves are damaged, they don't function properly. People with peripheral neuropathy have decreased or abnormal sensation in their toes and fingers. Sometimes, they develop problems moving these parts of the body as well.

 

Causes

In the United States, the most common cause of peripheral neuropathy is diabetes. According to the American Diabetes Association, 60 to 70 percent of people with diabetes will develop neuropathy within their lifetime.

Other causes of peripheral neuropathy include:

  • Certain medications, including some chemotherapy drugs.

  • Heredity. Some people have a family history of peripheral neuropathy.

  • Advanced age. Peripheral neuropathy is more common as people age.

  • Arthritis. Certain type of arthritis, especially involving the back, can cause peripheral neuropathy.

  • Alcoholism. According to the US National Library of Medicine, up to half of all long-term heavy alcohol users develop peripheral neuropathy.

  • Neurological disorders. Certain neurological disorders, including spina bifida and fibromyalgia, are associated with peripheral neuropathy.

  • Injury. Acute injury to the peripheral nerves may also cause peripheral neuropathy. 

Symptoms

The most common symptoms of peripheral neuropathy include burning, numbness, tingling, or shooting or stabbing pain in the toes and/or fingertips. Any change in sensation in the fingers or toes may be a symptom of peripheral neuropathy. Be sure to report any abnormal sensations to your doctor. Those sensations may be the first sign of another problem, such as diabetes.

 

Home Care

If you have peripheral neuropathy, it is important to inspect your feet regularly. Because decreased sensation may develop eventually, you might not notice an injury or infection. Someone who has diabetes and peripheral neuropathy with loss of protective sensation, for instance, could step on a tack without noticing it. Regularly inspect your feet so you can note any injuries or infections and seek appropriate medical attention as needed. 

If you're unable to properly inspect your own feet, enlist a family member or friend to help you, or use a mirror. It's absolutely essential that any injuries are caught and treated promptly. Otherwise, an infection can develop and progress.

People with peripheral neuropathy should wear properly fitted shoes and avoid walking barefoot to prevent injury. If you have diabetes, it's important to control your blood sugar as well, because out-of-control blood sugar leads to increased nerve damage. Take your insulin or medication as prescribed and follow the recommended diet.

 

When to Visit a Podiatrist

Everyone with symptoms of peripheral neuropathy of the feet should see a podiatrist. Podiatrists are doctors who are specially trained to preserve the health of the feet.

Diagnosis and Treatment

A podiatrist, family physician, internist, or physician who specializes in diabetes can diagnose peripheral neuropathy. The diagnosis is made on the basis of a physical exam, health history, and your reporting of symptoms. The doctor may order a blood test to check your blood sugar level because high blood sugar levels and diabetes are an important cause of peripheral neuropathy.

There is no known cure for peripheral neuropathy. The goal of treatments are to slow the progression of the disease, to maintain foot health, and to decrease pain (if present) and improve the quality of life.

The podiatrist may prescribe oral medication to help with symptoms. He or she will also perform a thorough foot check to look for any injuries or infections and will teach you how to do the same. Your podiatrist will also show you how to take care of your feet at home. People who have peripheral neuropathy should have their feet examined by a podiatrist at least once per year. 

If you also have diabetes, the podiatrist will work closely with you and other health-care professionals. Controlling the patient's blood sugar levels with diet, exercise, and medication (if needed) can slow the progression of peripheral neuropathy and maintain foot health. 

 

Prevention

The best thing you can do to prevent peripheral neuropathy is to keep your blood sugar levels under control. Peripheral neuropathy is common in people with diabetes, but the degree of neuropathy generally corresponds to the degree of blood sugar control. Someone whose blood sugar is kept under tight control will usually have much better sensation in their fingers and toes than someone with poorly controlled diabetes.

 

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