Leg cramps or something more?

Peripheral vascular disease

With peripheral arterial disease (PAD), also called peripheral vascular disease (PVD), deposits of fat build-up in the arteries restricting the blood supply to the leg muscles. This process is called atherosclerosis.

PAD is more common with age and affects around 1 in 5 over 70s. Men tend to develop PAD earlier than women.

AD may not cause any symptoms, but can cause pain in the legs when walking over a distance.

Complications of PAD include heart attack, stroke, or critical limb ischaemia (CLI) where blood flow to the limbs is severely restricted. In these cases patients may have breakdown of tissue, wounds which won’t heal or ultimately gangrene and tissue death. In some cases this can result in amputations. That’s why its really important not to ignore symptoms in the leg and foot. Your podiatrist is best placed to advise you if you have concerns.

Other PAD symptoms

• PAD pain can often be mistaken for something else.
• Other signs and symptoms of peripheral artery disease include:
• Wounds that heal poorly
• Legs are cooler than the arms
• Shiny or ‘waxy’ skin on the legs
• Some say loss of hair on the legs
• Decreased pulses in the feet or pulses which sound abnormal under doppler examination
• Leg ulcers
• Brittle toenails

PAD diagnosis

Your podiatrist should ask about PAD symptoms, carry out a physical examination and may measure the ankle brachial index (ABPI). This is done using a handheld ultrasound probe to measure the blood pressure at the ankle and upper arm. A difference in the readings may suggest PAD.

In some cases a referral to hospital may be needed for further testing. Tests include ultrasound scans or angiograms of the legs to pinpoint blockages in the arteries.
Causes of peripheral vascular disease

The most common type of peripheral vascular disease is peripheral artery disease.
Peripheral artery disease is due to atherosclerosis. This is a gradual process in which a fatty material builds up inside the arteries. The fatty material mixes with calcium, scar tissues, and other substances and hardens slightly, forming atherosclerotic plaques. These plaques block, narrow, or weaken the vessel walls. Blood flow through the arteries can be restricted or blocked totally.


Other causes of peripheral vascular disease include:

• Blood clot: A blood clot can block a blood vessel (thrombus/emboli).
• Diabetes; Over the long term, the elevated blood sugar level of those with diabetes can damage blood vessels. This makes the blood vessels more likely to become narrowed or weakened. Additionally, people with diabetes frequently also have hypertension/ high blood pressure and often hypercholestrolaemia (high fats in the blood), which accelerates the development of atherosclerosis.
• Inflammation of the arteries: This condition is called arteritis and can cause narrowing or weakening of the arteries. Several autoimmune conditions can develop vasculitis, and, as well as the arteries, other organ systems may also be affected.

• Infection: The inflammation and scarring caused by infection can block, narrow, or weaken blood vessels. Both salmonellosis and syphilis have been two infections traditionally known to infect and damage blood vessels.
• Structural defects: Defects in the structure of a blood vessel can cause narrowing. Most of these cases are acquired at birth, and the cause remains unknown. Takayasu disease is a vascular disease affecting the upper vessels of the body and affects (usually Asian) females.
• Injury: Blood vessels can be injured in an accident such as a car crash or a bad fall.

People who have coronary heart disease or a history of heart attacks or strokes generally also have an increased frequency of having peripheral vascular disease. It’s important to remember that only about half of the people with peripheral vascular disease have symptoms. Almost always, symptoms are caused by the leg muscles not getting enough blood. Thats the cramp like pain people get in the calf muscles when walking, or as we call it, intermittent claudication. Whether you have symptoms depends partly on which artery is affected and to what extent blood flow is restricted.

The most common symptom of peripheral vascular disease in the legs is pain in one or both calves, thighs or hips. If you have cramp like pain in your legs when you walk and feel the need to rest frequently to get the pain to subside you may have a blood supply problem.

If you are concerned about any of the points we’ve talked about you should have this assessed by someone who is suitably qualified. Certain podiatrists or your GP should be able to help. We use doppler and blood pressure measuring equipment at our clinic and can advise and assess your vascular status if you are worried.

Gout. A rich man's disease? Read on if you think this is still true.

                                                         GOUT

 

A rich man's disease? 

Afraid not..........

Gout affects around 1–2% of the Western population at some point in their life. Rates of gout have approximately doubled between 1990 and 2014. 

This rise is believed due to increasing life expectancy, changes in diet, and an increase in diseases associated with gout, such as metabolic syndrome and hypertension. A number of factors have been found to influence rates of gout, including age, race, and the season of the year. In men over the age of 30 and women over the age of 50. 

Gout is a disorder of purine metabolism, in english that means that uric acid crystallizes in the form of monosodium urate, precipitating in joints, on tendons, and in the surrounding tissues. 

The triggers for precipitation of uric acid are not well understood.  Other factors believed important in triggering an acute episode of arthritis include cool temperatures, rapid changes in uric acid levels proteins. 

The increased precipitation at low temperatures partly explains why the joints in the feet are most commonly affected. Rapid changes in uric acid may occur due to a number of factors, including trauma, surgery, chemotherapy, diuretics, and stopping or starting allopurinol. Calcium channel blockers  and Lorsartin are associated with a lower risk of gout as compared to other medications for Hypertension.

       Gout may be diagnosed and treated without further     investigations in someone with hyperuricemia (high uric acid    levels). This is normally determined by a simple blood test. Synovial fluid analysis can be carried out if the diagnosis is in doubt. 

Xrays can be useful for identifying chronic gout, but have little use in acute attacks. 

Treatment 

The initial aim of treatment is to settle the symptoms of an acute attack. Repeated attacks can be prevented by different drugs used to reduce the serum uric acid levels. Ice or cold compress applied for 20 to 30 minutes several times a day decreases pain. Options for acute treatment include (NSAIDs), colchicine and steroids. 

Options for prevention include allopurinol lowering uric acid levels which can cure the disease.

PSEUDO- GOUT is a joint problem is caused by pyrophosphate, a calcium salt which is different from uric acid. This may be one of the most misunderstood forms of arthritis. Joint problems seen with these crystals often are mistaken for gout and other conditions.

Do you have diabetes?

We are pleased to announce that from today we are now offering a FREE diabetic foot health check service. 

The Service is completely free, with no obligation. If you would like to know more about how diabetes affects your feet please see our earlier posts about diabetes. As part of your FREE assessment we will carry out a full sensory neurological examination of the feet and advise you of our findings. We will also advise on risk to your feet specifically associated with any pathological changes that we find. 

If you're a diabetic sufferer and would like to take advantage of the service, simply call us at the clinic on 

0141 5623082 or pop in if you're passing.

Top 10 Foot Care Tips

10 Foot Care Tips

1. Inspect your feet daily.
This is one of the most important foot care tips because it can detect changes and problems may be prevented.  If you have any signs of trauma like redness or blisters, cuts, cracks, swelling or
color changes you should have these assessed by a podiatrist immediately. Using a mirror can help you see all areas on the bottoms of your feet, particularly if you have problems with mobility.

2. If the shoe fits?
These foot care tips may seem like common sense but there are many people out there who do not follow them and this can later cause a lot of problems with your feet. Be certain that your shoes fit with room to wiggle your toes. Always look and feel inside your shoes before putting them on, especially if you have diabetes. This is incase there are any foreign objects there, such as gravel, that could cause sores or irritation which could lead to complex problems. Always wear clean and well-fitting socks.

3. Toe the line
Wash your feet everyday and make sure that you dry them thoroughly paying particular attention between the toes. Making sure you have dried between the toes will minimise the risk of cracks in the skin and secondary fungal infection. By following these simple foot care tips you will find that over time your feet will feel and look much better.

Foot Care Tips To Give You Top Feet

4. Nail Care
Always cut your nails straight across and then smooth the edges with an emery board or nail file. If reaching your nails comfortably is a problem, have your podiatrist do this for you. This will also provide an opportunity for an overall foot check, both of services which we offer to our customers at our Podiatry clinic in Bearsden Glasgow.


5. PLEASE! Do not self-treat
Always see a podiatrist for corns, callus or ingrown toenails. Do not attempt to self-treat these conditions. Self treatment can often lead to secondary infections or delays in healing. 

6. Prevent Cracking
Having dry skin on your feet is common. Applying cream daily will help prevent dry skin from cracking but avoid putting cream between your toes. Cream in the crevices can make skin more susceptible to infection. Creams which contain urea will be much more effective in treating dry skin. Some simple steps like these foot care tips can inform people so they can look after their own feet and prevent infections.

Some Simple Foot Care Tips

7. Keep the blood flowing
Gentle daily exercise can help with circulation problems. Using the muscles in your lower leg activates what is known as the ‘muscle pump’ which helps return blood back up the leg. If you experience cramping of your calves while walking you must discuss this with your podiatrist. Lower leg cramping can be a sign of intermittent claudication, which is one of the first signs of impaired circulation.

8. Keeping it moderate
Protect your feet from extremes in temperature. Keep bath water temperate in the 85-90 F degree range (30-32 C). If you have diabetes or know that you have neuropathy, you may not be able to feel if the water is too hot, and you could suffer serious burns. Never use heating pads or hot water bottles if you have loss of sensation of your feet. Protect your feet from temperatures that are too cold if you
already know you have a circulation problem. Prolonged exposure to cold can decrease circulation in your feet even more.

9. Pump It Up
Ask your healthcare professional about an exercise program that's right for you. If you need advice on the right footwear for your chosen activity your podiatrist will be able to explain the differences and help you choose from the vast range of shoes out there. The right shoe for the job is vital to reduce the risk of problems.

10. Last and definitely not least.
It's so important to practice preventative care like the tips listed here, every day. If
you notice anything that does not look normal please arrange an assessment with
your podiatrist immediately. Prevention is always better than cure, so discuss any
concerns regarding your feet with your podiatrist. The Podiatrist will explain why
your feet are the way they are and what you can do to prevent injury and keep you
comfortable for longer.

Hitting the nail on the head

So many people are horrified at the thought of toe nail removal. Well they shouldn't be! Nail removal is not the horrible thing people imagine it to be. Some people still describe and worry about an old fashioned procedure called the zadek's procedure. This involved cutting the toe to access and destroy the nail growth source. This procedure is not commonly used today and having nail surgery is not how it used to be.



Suitably qualified podiatrists are experts in nail surgery and can remove problem nails with minimum discomfort to the patient.

These days nail surgery is carried out under local anesthetic. If you haven't had this before, at the dentist for example, it means that the area where the podiatrist will work will have no feeling while the drug is having an effect meaning you feel no pain - whatsoever! Importantly, it may not always be necessary to remove all of the nail, and your podiatrist would only remove the minimum possible to give you permanent relief from the problem.

Once the nail has been removed, a chemical called phenol is applied. This helps to destroy the nail matrix to ensure the chances of your problem nail growing back are kept to a minimum. 

Please don't worry about nail surgery. It's quick and  relatively painless. If you have nails which have repeatedly ingrown speak to us today to see if you and your nail could benefit from nail surgery. If you have any questions about nail surgery, like who can do it, what’s involved and how long it will take to heal, call us today so we can advise you and if appropriate arrange an assessment for you.