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.

Diabetes - brace yourself for the diabetes tsunami!

A busy week at the clinic!

We see our fair share of diabetic patients at the clinic most weeks. Sometimes the patients we see are not so sure about just how diabetes affects their feet or just how important it is to have regular foot checks.

So we've put together a few points that everyone should know about diabetes, in plain english so that everyone reading it can understand.

The first thing to note is that diabetes is generally split into two groups called type 1 and type 2 diabetes. Treatment guidelines have changed of late and many people who would have been considered type 2 diabetic now use insulin as part of their treatment plan.

Diabetes is a condition resulting from either, the absence of insulin in the body to help break down and use glucose from the blood, or having some insulin but having too little or poor quality.

Diabetes can have serious implications for your feet and legs. If you have poorly controlled blood glucose particularly over a long period of time changes can happen to the nerve and blood vessel tissues in your lower limbs. So what! you might say.

Well, if the nerve tissue changes and becomes less conductive, this is called peripheral neuropathy. Having peripheral neuropathy increases the risk of injury. Because the feeling can be absent in the foot injuries are common, although often the sufferer is unaware of injury to the foot. The result of this can lead to breakdown of the tissue, or as we call it, ulceration.

Ulceration is complicated because of the hardening of the arteries which is also caused by prolonged poor glucose control. Sufferers will lack the ability to supply damaged tissue with a sufficient blood supply. This prolongs healing, increasing the risk of infection and ultimately leads to gangrene and amputation.

Now heres the scary part...statistically, the mortality rate (chances of death related to the disease) is greatly increased if an amputation has been required. What we find is that, in general, because diabetes is a 'silent' disease', often without any outward signs, people either dismiss it, deny it, or just don't understand enough about it. It is that serious. Diabetes, if poorly controlled or neglected for periods of time can seriously impact on your foot health and ultimately lead to your premature departure.

Finally, the best way that you can prevent these changes happening for as long as possible is to maintain good blood glucose levels. What we mean by that is your average blood sugar levels. Daily readings will fluctuate, this is normal even in a person who doesn't have diabetes. The average blood sugar is measured by HbA1c. Because the recommended level can change sometimes there's little point in writing it down here, but we would encourage all patients we come across in the clinic to discuss their blood glucose levels with the GP. Ask the GP for your HbA1c levels, learn about getting it to the best levels you can, and finally, own your disease, take control of it, don't allow diabetes to control you, or to destroy your quality of life.

If you have diabetes and are worried about your feet, or if you have any other questions about your feet please contact the clinic to arrange your assessment today. We will be happy to advise you and to carry out your diabetic foot check.

For more information about diabetes visit http://www.diabetes.org.uk/

Diabetes and your Feet

A busy week at the clinic!

We see our fair share of diabetic patients at the clinic most weeks. Sometimes the patients we see are not so sure about just how diabetes affects their feet or just how important it is to have regular foot checks.

So we've put together a few points that everyone should know about diabetes, in plain english so that everyone reading it can understand.

The first thing to note is that diabetes is generally split into two groups called type 1 and type 2 diabetes. Treatment guidelines have changed of late and many people who would have been considered type 2 diabetic now use insulin as part of their treatment plan.

Diabetes is a condition resulting from either, the absence of insulin in the body to help break down and use glucose from the blood, or having some insulin but having too little or poor quality.

Diabetes can have serious implications for your feet and legs. If you have poorly controlled blood glucose particularly over a long period of time changes can happen to the nerve and blood vessel tissues in your lower limbs. So what! you might say.

Well, if the nerve tissue changes and becomes less conductive, this is called peripheral neuropathy. Having peripheral neuropathy increases the risk of injury. Because the feeling can be absent in the foot injuries are common, although often the sufferer is unaware of injury to the foot. The result of this can lead to breakdown of the tissue, or as we call it, ulceration.

Ulceration is complicated because of the hardening of the arteries which is also caused by prolonged poor glucose control. Sufferers will lack the ability to supply damaged tissue with a sufficient blood supply. This prolongs healing, increasing the risk of infection and ultimately leads to gangrene and amputation.

Now heres the scary part...statistically, the mortality rate (chances of death related to the disease) is greatly increased if an amputation has been required. What we find is that, in general, because diabetes is a 'silent' disease', often without any outward signs, people either dismiss it, deny it, or just don't understand enough about it. It is that serious. Diabetes, if poorly controlled or neglected for periods of time can seriously impact on your foot health and ultimately lead to your premature departure.

Finally, the best way that you can prevent these changes happening for as long as possible is to maintain good blood glucose levels. What we mean by that is your average blood sugar levels. Daily readings will fluctuate, this is normal even in a person who doesn't have diabetes. The average blood sugar is measured by HbA1c. Because the recommended level can change sometimes there's little point in writing it down here, but we would encourage all patients we come across in the clinic to discuss their blood glucose levels with the GP. Ask the GP for your HbA1c levels, learn about getting it to the best levels you can, and finally, own your disease, take control of it, don't allow diabetes to control you, or to destroy your quality of life.

If you have diabetes and are worried about your feet, or if you have any other questions about your feet please contact the clinic to arrange your assessment today. We will be happy to advise you and to carry out your diabetic foot check.

For more information about diabetes visit http://www.diabetes.org.uk/