Conditions & Treatments

Podiatrists that specialize within the lower limb, regularly have patients with mild to severe signs and symptoms of vascular disease. It is their role to take a holistic approach to every patient with the aim of providing optimal care to achieve the best clinical outcomes.

With clinical observations, testing and assessments patients can be referred to specialist vascular doctor accordingly.

These assessments are categorized into two main categories:

• Arterial (blood going away from the heart)
• Venous (blood  returning to the heart)

Diagnosis of the two categories is done so through medical history taking, clinical observations and diagnostic interventions.

History taking includes details, such as; the age of the patient, medical conditions, current medication, previous surgeries, current symptoms if any and social history (smoking, alcohol intake).

Clinical observation includes the signs and symptoms visibly identifiable to the podiatrist.

• Arterial clinical assessment entails comparing both lower limbs with the following:
• Colour of skin
• Pulses – palpable, rate and strength
• Temperature gradient (cold feet indicate arterial disease)
• Skin quality
• Nail quality
• Swelling
• Obvious lesions

Thus, the podiatrist will then take the comparable information to assess the lower limb and foot

Diagnostic interventions assist with categorizing staging of the disease, distinguishing whether further onward referral to a specialist doctor is necessary.  These interventions include:

• Doppler – If a Podiatrist is unable to palpate pulses successfully then an ultrasound doppler can be used to detect a pulse. The clinician listens for 3 types of sound, these include; triphasic, biphasic and monophasic pulses. A healthy person would have a triphasic pulse
• ABPI (Ankle Brachial Pressure Index) compares the blood pressure in the arm to the lower limb and indicates if arterial disease is present

After the diagnostic assessment has taken place, the following staging should be identified:

Stage 0 – No symptoms

Stage 1 – Intermittent claudication (cramping in the leg, induced by exercise)

Stage 2 – Rest pain (burning pain in leg, especially when limbs are elevated whilst sleeping)

Stage 4 – Arterial ulceration of the leg/foot

Stage 5 – Gangrene of the leg/foot

After identification and diagnosis, the following treatment for the arterial disease may include:

• Identifying risk factors
• Exercise/Diet
• Smoking cessation
• Medication (Antiplatelet and vasodilators)
• Patient Education
• Surgery

Podiatrist’s take arterial screening very seriously as the scary factor is that their work can often lead to saving a patient from amputation to potentially saving their life. Their role is to assist in patients’ lower limb health but also to educate, empower and prevent complications.

• Venous clinical observations

Similarly to arterial clinical observations, Venous clinical observation and assessment also entail the comparison of lower limb to foot, but there are additional signs and symptoms to be recognized. Venous vessels have an even more challenging battle with bringing deoxygenated blood against gravity back to the heart. When checking for Venous disease, Podiatrist’s would check for:

• Telangiectasia (Spider veins)
• Varicose veins (bulbous in appearance, can lead to cellulitis or Deep vein thrombosis)
• Haemosiderin (Brown staining of the skin)
• Warm skin
• Colour/absence of hair
• Cyanosis (bluish color)
• Swelling (indent on skin from socks or footwear)
• Varicose eczema (mainly at the skin area and can often lead to venous ulcers due to patient scratching the dry skin).

With onward referral to Vascular Doctor, they can utilize duplex ultrasound or venogram to assess the staging of venous disease and to locate areas within the lower limb with blockages or collapsing of valves.

Treatment for the venous disease may include the following:

• Compression stockings
• Elevation of lower limb
• Avoiding sitting cross-legged
• Medications (Diuretics)
• Surgery (Sclerotherapy)

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