What are the symptoms and signs?
Patients may feel pain in their calves, thighs, or buttocks, depending on where the blockage is. Usually, the amount of pain you feel is a sign of how severe the blockage is. In serious cases, your toes may turn a bluish color, your feet may be cold, and the pulse in your legs may be weak. In some cases, the tissue dies (this is called gangrene) and amputation may be needed.
Sometimes leg cramps develop when a person walks, and the leg pain usually gets worse with increased activity. This cramping is called intermittent claudication. Like the chest pain of angina, the leg pain of intermittent claudication usually goes away with rest. Cold temperatures and some medicines may also cause leg pain.
Doctors can make a diagnosis by listening to you describe your symptoms and by checking for a weak pulse in the arteries in your feet. Further tests may include ultrasound, which is a test that uses sound waves to produce an image of blood flow through your arteries.
Arteriography, which is a test that may be performed if your doctor thinks your condition is serious enough for a transcatheter intervention or surgery. The test uses a harmless dye that is injected into the arteries. It lets doctors see where and how serious the blockage is.
When the blockages are not severe, this form of PVD can be controlled by losing weight, quitting smoking, and following a regular exercise program that has been approved by your doctor.
A transcatheter intervention (balloon angioplasty or a peripheral stent) may be needed for a severely blocked artery that is causing pain or other symptoms.
Your doctor may also recommend a procedure called a peripheral vascular bypass. This procedure creates a way for blood to flow around one or more of the narrowed vessels. After making an incision in your arm or leg or below your stomach, the surgeon will take an artificial vessel or one of your own veins (called a graft) and connect it to the blocked vessel at points above and below the blockage. This allows blood to flow around, or "bypass," the blockage.
Buerger's disease is related to smoking. The disease causes swelling of the small and medium-sized arteries (and sometimes the veins) in your feet and legs. This rare disorder, which causes the peripheral vessels to tighten or constrict, is more common in men, especially smokers aged 20 to 40.
Smoking causes the blood vessels to tighten in everyone who smokes. But in people with Buerger's disease, there is so much tightening in the vessels that a lack of oxygen to the cells (ischemia) or tissue death (necrosis) may result.
The symptoms may be different for everyone, but the condition most often causes tender, swollen areas over the vessels, followed by coldness of the feet and hands. Pain in the legs during walking (called intermittent claudication) may happen because of an arterial blockage. The most serious cases sometimes cause the tissue to die, and amputation of the fingers and toes may be needed. People with Buerger's disease must stop smoking completely, and circulation usually improves soon after.
Raynaud's phenomenon happens more often in women. It is a circulation disorder that causes the arteries in the fingers and toes to tighten or spasm when they are exposed to cold temperatures, smoking, or emotional stress.
Often, the cause of Raynaud's phenomenon is not known. Sometimes, it is a side effect of other conditions, such as connective tissue disease, trauma, or diseases of the glands or central nervous system. People with the disorder may feel numbness or tingling in their fingers and toes. They may also notice that their skin turns pale or blue, followed by reddening in the affected areas. Attacks may last from a few minutes to several hours and are usually treated with gradual warming of the fingers and toes to restore blood flow. Therapy may also include pain relievers, calcium channel blockers, quitting smoking, and avoiding cold temperatures and emotional upset.
Nearly 6 million Americans have a blood clot in their veins (also called venous thrombus, venous thrombosis, or vein thrombosis). When the clot develops deep within the vein, it is called deep vein thrombosis. The condition can be life threatening if the clot breaks loose from the vein and travels to the lungs, where it can completely block blood flow.
Blood clots in the veins are usually caused by slowed blood flow to the legs and feet, which can cause the blood to clot. Venous blood clots may also be caused by damage to a vein from an injury or infection. Blood flow may be slowed because of physical inactivity, being confined to a bed or having an inactive lifestyle. Some people have slowed blood flow after sitting for a long time, such as on a long plane ride. This is why the condition is sometimes called "economy-class syndrome."
Other factors that lead to slowed blood flow in the legs and feet include smoking, heart disease, diabetes, high blood pressure, and certain tumors. The use of certain hormones, particularly estrogen, and pregnancy have been shown to increase the risk for blood clots in the legs. Genetic disorders may also increase a person's risk for developing venous blood clots.
Blood clots that happen in the veins close to the surface of your skin may cause mild swelling, tenderness, and redness. Symptoms of deep venous clots may include
Swelling of your ankles or calves. Tenderness, swelling, redness, and warmth around the affected area. Pain when your foot is raised upward.
Doctors can usually tell if you have a venous blood clot by pressing on a part of your leg. If needed, the veins can be viewed by using ultrasound, which uses sound waves to create an image of the vein on a screen. Clots above the knee may be identified by using a blood pressure cuff around your leg to measure blood flow (plethysmography). Deep venous blood clots in areas other than the leg may be impossible to detect by these methods. Diagnosis may require special techniques such as blood-clotting tests or x-rays of the veins.
Treatment depends on the cause of the blood clot. In most cases, a blood-thinning or anticoagulant medicine will be given. You will need to stay in bed and keep your legs raised for 3 to 5 days. Moist heat and medicines can ease the swelling and pain.
For those who have had a clot in the lungs or those who cannot take anticoagulants, a catheterization procedure may be needed to stop further clots. A tiny filter is placed on the end of a long, thin tube called a catheter. The catheter guides the filter to the vessel that carries blood from the legs to the lungs. Then, the catheter is removed, and the filter is left in the vessel to prevent clots from reaching the lungs.
Pulmonary embolism is caused by a blood clot (pulmonary embolus) that breaks loose from where it formed in a vein and travels to your lungs. Pulmonary embolism may have no symptoms, so it can cause sudden, unexpected death.
When symptoms do happen, they may inclue:
Chest pain.
Shortness of breath.
Coughing up blood.
Dizziness.
Fainting.
Most cases of pulmonary embolism are treated with blood-thinning agents, anticoagulant medicines (which keep your blood from clotting), and clot-dissolving medicines (thrombolytic therapy). Surgery may be needed in rare cases to remove the clot, but most patients respond well to the medicines.
There are two forms of phlebitis. The most common form is swelling of a vein near the skin's surface, usually in the leg. This is called superficial phlebitis. Swelling of the veins inside the leg is less common but more serious. This is called deep phlebitis.
For superficial phlebitis, the area looks reddish and feels painful. The pain of this condition can usually be treated with moist heat, aspirin, or anti-inflammatory medicines.
The more dangerous form of phlebitis, deep phlebitis, usually causes greater pain. People with deep phlebitis tend to have a fever. Nuclear scans, venous Doppler flow studies, or the use of a blood pressure cuff around the leg to measure blood flow (plethysmography) will usually confirm if the deep veins are involved. This type of phlebitis is more likely to lead to blood clots in the veins and a possible blood clot in the lungs (pulmonary embolus). If you are diagnosed with deep phlebitis, doctors will usually give you a week-long treatment with a blood-thinning, or anticoagulant, medicine. During this time, doctors will also check for signs of blood clots in your lungs. Your doctor will probably give you an anticoagulant in pill-form to be taken longer-term.
Varicose veins are swollen, purple veins in the legs that are visible under your skin. They are caused by damage to blood vessels close to the surface of your skin, slowed blood flow, or the damage or absence of normal valves in your veins. Normally, blood flow in the veins is aided by valves, which keep the blood moving upward, against the force of gravity. If these valves are weak or blood flows slowly in the veins, the blood may pool and cause the veins to bulge.
Varicose veins are more common in women than in men. The condition also runs in families. Pregnant women may get varicose veins because of hormonal changes and the extra pressure that the baby puts on the lower-stomach area. Varicose veins may also be caused by being severely overweight or by standing for long periods.
The most obvious symptom is the blue or purple snakelike veins. They happen near the skin and may stand out from your legs. Clusters of flooded capillaries called "spider veins" sometimes surround varicose veins. Varicose veins may cause your legs to ache or have a tingling feeling. You may find that your ankles swell at the end of the day. In most cases, those who seek treatment for varicose veins do so because they find them unattractive.
In the early stages, a supportive, elastic stocking may relieve the aching and swelling, but it does not cure the condition.
Repair may involve injecting a salt solution that causes the veins to shrink. Another option for repairing varicose veins is injecting a fluid (known as a sclerosing agent) that swells the vein wall. Your leg is then bandaged tightly to keep the walls of the veins close together. The scarring that happens in the vein causes the walls of the vein to stick together.
Surgical repair, called "stripping," involves tying the varicose veins at certain points and removing the affected portion of vein. Your body responds by creating new pathways for blood to flow.
Remember that foot pain is not normal. Healthy, pain-free feet are a key to your independence. At the first sign of pain, or any noticeable changes in your feet, seek professional podiatric medical care. Your feet must last a lifetime, and most Americans log an amazing 75,000 miles on their feet by the time they reach age 50. Regular foot care can make sure your feet are up to the task. With proper detection, intervention, and care, most foot and ankle problems can be lessened or prevented. Remember that the advice provided in this page should not be used as a substitute for a consultation or evaluation by a podiatric physician.
Disclaimer: Portions of this web page were copied from the American Podiatric Medical Association's (apma.org) web site. NEOFASA, Inc. makes no claims as to being the orginial author of some portions of this web page. Please feel free to visit the apma.org web site for further infomation on this subject.
