Peripheral arterial disease (PAD) starts in the feet. This vascular condition is of paramount importance in the lower extremity, and as podiatrists, we see it daily. It is common and underrecognized in many different patient subsets. Bringing awareness to this condition is vital, as the earlier it is identified, the more treatable it can be. This can help prevent future complications.
Peripheral arterial disease is progressive and caused by atherosclerosis, a buildup of plaque inside your arteries. Commonly, this manifests in the legs and feet to varying degrees. Muscle pain, discomfort, and decreased mobility can be early signs. Later signs include intermittent claudication, cold feet, ischemic rest pain, or even wounds and nonhealing ulcerations.
Who is at Risk for PAD?
The people who are at risk are those who smoke, have high blood pressure, high LDL cholesterol, chronic kidney disease, diabetes, obesity or even a sedentary lifestyle. Age is also a risk factor if you are over 65. It is more common in men than in women.
Peripheral arterial disease starts in the feet when plaque, including fat/cholesterol and inflammatory cells, accumulates in the arterial walls. Usually, the blood vessels will compensate for this by dilating to increase flow, but eventually this compensation reaches a breaking point and leads to narrowing of the vessels. This leads to hair loss in the extremities, dry skin, cold feet, and possibly difficulty walking long distances.
Diagnosing PAD
There are a number of ways to diagnose PAD. When you visit us here at Marvel, we conduct a comprehensive foot exam and then make recommendations. Commonly, we will order a screening test such as an Ankle-Brachial Index (ABI). This test is excellent for screening and determining whether further testing or referral to a vascular specialist is needed. This test compares ankle blood pressure with arm blood pressure. A ratio closer to 1 is deemed normal. Should it be abnormal, your podiatrist will make further recommendations.
Once diagnosed with PAD, there are a number of ways to manage and improve the condition. Some of these include lifestyle modifications such as smoking cessation (which is critical!), structured and regular exercise, diet, and weight management. Medically, statins, antihypertensives, and antiplatelet agents can also help you manage and prevent progression. Furthermore, vascular surgeons can utilize interventional and surgical options to treat severe PAD. These include possible endovascular procedures, surgical bypass, or, in critical limb cases, possible amputation.
Overall, patient education on this matter is super important. At Marvel Foot and Ankle, we will be super clear about the condition you have and how best to proceed with treatment and prevention. This can help improve mobility and comfort as well as reduce overall cardiovascular risk. Timely referral is key to treating advanced PAD, so it is very important if you think you have any of these symptoms to get a check-up and screening.
