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Peripheral arterial disease (PAD)

Introduction

Peripheral Arterial Disease (PAD) is a common circulatory problem in which narrowed arteries reduce the blood flow to your limbs.


When you develop peripheral arterial disease, your extremities — usually your legs — don't get enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking — a condition called intermittent claudication.


Of perhaps greater concern is that peripheral arterial disease is likely to be a sign of / part of widespread accumulation of fatty deposits in your arteries (atherosclerosis) else where in other arteries as well. This condition may be reducing blood flow to your heart and brain as well.


You can often successfully treat peripheral arterial disease, at least initially with exercise, with a healthy diet and, most important, by quitting smoking if you smoke. Early diagnosis and treatment are important to stop the progression of peripheral arterial disease and give you a leg up on reducing your risk of heart disease and stroke.



Signs and symptoms

About half of people with peripheral arterial disease have mild or no symptoms. About one-third to one-half develop more severe symptoms, including intermittent claudication.


Intermittent claudication is characterized by muscle pain or cramping in your legs or arms that is triggered by a certain amount of activity, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is most common.


Other signs and symptoms of peripheral arterial disease include:



Leg numbness or weakness - Neuropathy can add to the problem Cold legs or feet
Sores on your toes, feet or legs that won't heal
A change in the color of your legs - initially may become red when hanging down
Hair loss on your feet and legs
Changes in your nails - brittle, distorted
If peripheral arterial disease progresses, pain may even occur when you're at rest or when you're lying down. This is called ischemic rest pain. It may be intense enough to prevent sleep or wake you from sleep. You may be able to temporarily relieve the pain by hanging your legs over the edge of your bed or by walking around your room.


Screening and diagnosis Your doctor may find signs of PAD during a physical examination. These include:
A weak or absent pulse below a narrowed area of your artery
Whooshing sounds (bruits) over your arteries that can be heard with a stethoscope
Evidence of poor wound healing in the area where your blood flow is restricted
Decreased blood pressure in your affected limb
Your doctor may also rely on one or more of the following tests to diagnose PAD:


Ankle-brachial index (ABI). This diagnostic test compares the blood pressure in your ankle with the blood pressure in your arm. To get a blood pressure reading, your doctor uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow. You may walk on a treadmill and have readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking.


Angiography. This form of imaging allows your doctor to view blood flow through your arteries as it happens. By injecting a contrast material (dye) into your blood vessels, your doctor is able to trace the flow of the contrast material using imaging machines. Angiography can be done using X-ray imaging or procedures called magnetic resonance angiography (MRA) or computed tomography angiography (CTA).


Additional tests Beyond the diagnosis of peripheral arterial disease, your doctor will be concerned with identifying your risk for heart attack and stroke. You may undergo a variety of tests aimed at assessing your risk for these problems.
These tests may include:


Electrocardiogram (ECG). An electrocardiogram is a diagnostic test in which electrode patches are attached to your skin to measure electrical impulses in your heart. Your doctor may monitor an ECG during and after the treadmill test. Blood tests. Doctors can check your blood to measure cholesterol and check the level of C-reactive protein, which is a marker for heart disease. Ultrasound. This test is done to make sure you do not have an aneurysm of the aorta or blood vessels.



All the about tests are done at PG Medical Center.


Register yourself for yearly / half-yearly diabetes care Packages at our center.


We offer you specialized diabetes footwear as per your needs.


Information about Diabetes and Neuropathy


Although all diabetics are at risk from neuropathy, the chances of developing this complication increase

•Duration of Diabetes:the longer you have diabetes. Those who have suffered from diabetes for more than 25 years are most at risk from neuropathy and your doctor will provide you with further information about diabetes neuropathy at this stage.
-Long stature/Height
-Smokers
-Patients With Hypertension/dyslipidemia
-Males are more prone

The most effective way to prevent diabetes neuropathy is to maintain a healthy blood sugar level.  This means paying attention to your diet, taking regular exercise and ensuring you are taking your prescribed medicine properly.

What can I do to diabetic foot problems? 
Every person with diabetes - with or without any of these risk factors - should take proper care of their feet. Routine foot inspection and preventive care can minimize or prevent foot problems. Below are things to make sure you ask your doctor about:

  • You should have a thorough foot examination by a professional at least once a year. This includes checking the sense of feeling and the pulses in your feet. (See box.)
  • Ask for a risk evaluation. Specific follow-up and treatment will be based on what risk category your feet are in. Ask for special instructions for people with high-risk feet, if applicable.
  • If you have lost some sensation in your feet, they should be visually inspected at every visit. Take off your shoes and socks at every visit and make sure this happens.
  • Ask your provider to check your footwear to make sure that the style and fit are appropriate for the condition of your feet. Ask if special shoes would help your feet stay healthy.


Components of a good foot exam:

At least once a year, everyone with diabetes should have a thorough foot examination. It should include an assessment of:

  • Protective sensation - using a monofilament or vibratory sensation test
  • Foot structure
  • Biomechanics - including any limits in joint mobility or problems with gait and balance
  • Vascular status - including questions about painful walking and determination of pulses in your feet
  • Skin integrity - especially between your toes and on the ball of your foot
  • Increased pressure on the soles of your feet; areas of warmth, redness, or callus formation may be indicative of tissue damage

Many diabetes treatment programs operate regular foot clinics to help patients with routine foot care and to make sure that preventive measures are taken. Some pharmacists specializing in diabetes care offer similar programs. Be sure to take advantage of any foot care programs that are available to you.

Preventive foot care - for all 
Of course, the best way to prevent foot problems is to keep your blood glucose under control. But there are also specific things you should do EVERY DAY to make sure your feet stay fit. Here are some of them:

  1. Examine your feet EVERY DAY to look for cuts, sores, blisters, redness, etc. If you have anything of that nature, and it doesn't heal in a day or two, notify your doctor. If you have trouble seeing or reaching your feet, ask someone to help, or use a mirror to help you see better.

  2. Wash your feet EVERY DAY with lukewarm water and mild soap. Dry them carefully and thoroughly with a soft towel. Dust your feet with talcum powder, which will help keep them dry.

  3. Don't soak your feet - this will make your skin too dry.

  4. If you have dry skin on your feet, use a moisturizing lotion to prevent cracking - but NEVER use a lotion or cream between your toes, as this can lead to infection.

  5. If you have corns or calluses, DO NOT cut them, don't use corn plasters or liquid corn and callus removers - they can damage your skin. Check with your doctor or foot care specialist who may advise you to use a pumice stone to smooth calluses or corns.

  6. Keep your toenails trimmed. Trim them with toenail clippers after you have washed and dried your feet. Trim the nails following the shape of your toes, and smooth them with an emery board or nail file. Don’t cut into the corners of the nail, which could trigger an ingrown toenail. If your nails are very thick or yellowed, have a foot care specialist trim them.

  7. Don't go barefoot - not even indoors. Always wear socks, stockings, or nylons with your shoes to help avoid blisters and sores. Choose soft socks made of cotton, wool, or a cotton-polyester blend, which will help keep your feet dry. Avoid mended socks or those with seams, which can rub to cause blisters.

  8. Avoid wearing socks or hose that are too tight around your legs. Knee-high or thigh-high stockings as well as elasticized men's dress socks can constrict circulation to your legs and feet.

Choose the proper footwear - for all
Choosing the right footwear is an important part of foot care, since poorly fitted shoes are involved in as many as half of serious foot problems. Here are some tips for choosing the best footwear:

  1. Wear well-cushioned walking shoes or athletic shoes. If you have foot deformities such as hammertoes or bunions, you may need extra-wide shoes or depth shoes. Depth shoes have more room in them to allow for different shaped feet and toes or for special inserts made to fit your feet. If problems are severe, custom-molded shoes are available. Medicare provides coverage for some special shoes; your doctor or foot care specialist can help determine if you qualify.

  2. Don't wear shoes with high heels or pointed toes. They can create pressure, which might contribute to bone and joint disorders as well as diabetic ulcers.

  3. Don't wear open-toed shoes or sandals with a strap between the first two toes. They increase the chance that you'll injure a toe.

  4. When you buy new shoes, be sure your feet are properly measured and fitted. Your feet can change size and shape, so an experienced shoe fitter should measure them whenever you get new shoes. Shoes should fit both the length and width of your foot, with room for your toes to wiggle freely.

  5. Your new shoes should be sturdy and comfortable. They should have leather or canvas uppers, which breathe to keep your feet from getting sweaty. Avoid vinyl or plastic shoes, because they don't stretch or breathe.

  6. When you get new shoes, break them in gradually so you won't get blisters.

Shake your shoes before you put them on. Even a small pebble in your shoe can lead to problems.
Special care for high-risk conditions
If you do have any of the high-risk conditions, there are specific things you should do to keep your feet healthy.

  • If you have neuropathy or evidence of increased pressure on the soles of your feet, wear well-cushioned walking shoes or athletic shoes.
  • If you have lost some sensation in your feet, be sure to carefully inspect them often to identify any problems early.
  • If you have calluses, have a foot care specialist treat them.
  • If you have bony deformities such as hammertoesor bunions, you may need extra-wide shoes or depth shoes. In extreme cases, custom-molded footwear may be needed.
  • Promptly treat minor skin conditions such as dry skin or athlete's foot to keep them from progressing.
  • Have a complete foot examination every 3 to 6 months.

A formal, comprehensive program has been developed at the Gillis W. Long Hansen's Disease Center in Carville, LA, known as the "LEAP program" for Lower Extremity Amputation Prevention. It consists of 5 relatively simple activities:

  • Annual foot screening to identify people who have lost protective sensation
  • Patient education in self-management, with emphasis on proper foot care
  • Daily self-inspection of the foot
  • Appropriate footwear selection
  • Management of simple foot problems such as dry skin, nail and callus care, and basic wound management

In a number of large clinical centers where formal preventive care programs such as this have been implemented, the rate of amputations has been reduced by as much as 85%.