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The Ischemic Foot
The term "ischemic foot" refers to a lack of
adequate arterial blood flow from the heart to the foot. There are a
wide variety of possible causes for poor arterial circulation into the
foot including arterial blockage from cholesterol deposits, arterial
blood clots, arterial spasm, or arterial injury. The ischemic foot is
also referred to as having arterial insufficiency, meaning
there is not enough blood reaching the foot to provide the oxygen and
nutrient needs required for the cells to continue to function. Diagnosis The
result of insufficient blood supply to the foot can manifest itself in
a variety of ways depending upon how severe the impairment to
circulation. Early symptoms may include cold feet, purple or red
discoloration of the toes, or muscle cramping after walking short
distances (intermittent claudication). Later findings may include a sore that won't heal (ischemic ulcer), pain at night while resting in bed, or tissue death to part of the foot (gangrene). The
diagnosis of ischemia is made by reviewing the patient's symptoms,
examination of the foot, and special testing to evaluate the
circulation. The examination should reveal cold skin temperature, and
skin atrophy that causes the skin to appear shiny or paper thin with
loss of normal hair on tops of the toes and on the lower leg. There is
often a color change associated with ischemic feet. This may show as a
purple discoloration of the toes, white blanching of the toes when the
foot is elevated, and red discoloration when the foot is hanging down.
Additionally the two arterial pulses in the foot will not be as strong
as normal, or may be entirely absent. Certainly the presence of a pale
looking ulcer, or black gangrenous toes would be an ominous sign of
poor circulation. When these findings are present further testing is usually required. This will often include arterial Doppler testing.
This test uses sound waves to listen to the blood flow through the
arteries and is able to record the quality of the blood flow and also
the blood pressure. If the quality of blood flow is poor and the
pressure is greatly diminished, this would indicate a lack of adequate
blood flow. A second test may be required to further determine where
the arterial blockage is located and how much blood is able to squeeze
past the blockage. This test is known as an arteriogram. The
arteriogram requires the injection of a special dye into the artery so
that the artery will be visible when an x-ray is taken. This x-ray can
then show where the artery is blocked and how much blood can flow past
the blockage. Treatment In
the early stages of ischemia of the foot, the doctor will often
recommend a program of walking exercises to increase blood flow,
protective shoes and insoles if necessary, to protect the skin from
rubbing producing irritations which may lead to ulcerations.
Medications are also available to help improve the blood flow into the
feet. In more advanced stages of ischemia, a
referral to a vascular specialist is appropriate for further
evaluation. Oftentimes, if the patient is in otherwise good general
health, a surgery may be recommended to bypass the blocked artery or to
clean out the area of blockage. This can be major surgery, however in
these cases, failure to improve the circulation into the foot may
result in gangrene, which may ultimately require amputation of part of
the foot or leg. The surgery is an attempt to save the foot and leg
from the impending amputation. The surgery has improved over the years
and the chances for success are now greater than ever before. However,
each individual needs to be evaluated as to the potential risks and
possible benefits from this type of surgery.
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