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PVD / PAD / Gangrene


Peripheral vascular disease (PVD) and Peripheral Arterial Disease (PAD) are umbrella terms to describe generalized blood circulation disorders that causes blood vessels to narrow, spasm or become blocked.  PAD/ PVD typically cause pain and fatigue, often in your lower legs, and especially during exercise.  This pain would seem to abate promptly with rest.

  • PAD develops only in the arteries, which carry oxygen-rich blood away from the heart.
  • PVD can affect the arteries and veins; veins carry de-oxygenated blood to the heart.

Pain when walking is the most common symptom; this is termed intermittent claudication.  This pain often stops with rest and returns with activity.  When the pain comes back, it may take longer amounts of time to go away.  Claudication occurs when there’s not enough blood flow to the muscles you’re using.  In PAD, the narrowed arteries can only supply a limited amount of blood.  This causes more problems during activity than at rest.

 

As your PAD progresses, symptoms will occur more frequently and get worse.  Eventually, you may even experience pain and fatigue during rest.  Ask your doctor about treatments to help improve blood flow and decrease pain.

 

Eventually, untreated PAD can cause an affected limb to develop non-healing wounds and become gangrenous.  At this point, limb amputation is often necessary.

 

How can a podiatrist help with PAD/ PVD?

Podiatrists are frequently found to be first line specialists for detecting PAD/ PVD changes in the lower limbs.  If PVD/ PAD is suspected, your podiatrist will perform necessary vascular supply screenings in clinic (doppler/ ABI).  Early diagnosis is the first step to successful treatment, and it can prevent life-threatening complications.

 

Our podiatrists can help with:

  • Assess and diagnose swiftly
  • In-clinic treatment for increasing micro-circulation, when appropriate
  • Care of high-risk feet to ensure reduced risk of wound development
  • Specialized wound care (of skin ulcerations)
  • Keep you active and ambulatory
  • Timely referral for surgical evaluation
  • Post-amputation wound care and return to mobility

Delay in diagnosis and treatment can cause further complications and reduce success for optimal outcome. The main goal of podiatry is to prevent the need for amputation.  If amputation does occur, then podiatry shifts the aim to helping the patient avoid further tissue loss and additional amputations.

Dry GangreneOccurs when there is a disruption of blood supply to the tissues.

Affected area will appear red before turning brown and black.

The skin will appear dry and mummified.

Usually, the tissues will not be infected.

Wet GangreneOccurs when there is a disruption of blood supply with infection

to the tissues.

The tissues will appear soft and moist.

Foul odour present.

Affected areas are cold and brown to black.

Patches of blistering, ulcers and heavy fluid discharge.

Gas GangreneOccurs when there is an infection in the body with gas produced from microbial toxins.

Tissues will swell and appear brown to red in colour.

If your situation is deemed a medical emergency (sudden development of a cold, painful, pale limb with weak or no pulses), your podiatrist would refer you immediately for an emergency vascular assessment.  Loss of oxygenated blood to a limb or area of the body leads to tissue death and patients fighting for their lives.

What are the symptoms of PVD?

PVD/ PAD is a progressive condition that starts slowly.  Discomfort in the legs turns to fatigue and cramping that eventually worsens with any activity due to the lack of blood flow reaching the muscles.  These are not signs of ‘aging’ but are signs of an underlying serious medical condition:

  • Reduced hair growth on the limb.
  • Cramps/ pain in legs, usually with activity (claudication).
  • Thin, pale skin on extremities.
  • Ulcerations or wounds that take a long time to heal or won’t heal.
  • Legs and arms turn reddish, blue, or pale.
  • Severe burning sensations in extremities.
  • Opaque toenails.
  • Weak pulses in the legs and the feet.
  • Gangrene (dead tissue due to lack of blood flow).
  • Feeling numb or heavy in extremities.
  • Tissue death, which can lead to limb amputation.

There are numerous risk factors for PVD/ PAD including:

  • Age over 50
  • Overweight
  • Comorbidities (high cholesterol, stroke, heart disease, high blood pressure, diabetes, kidney disease)
  • Sedentary lifestyle
  • Poor eating habits
  • Smoking
  • Drug use
  • Emotional stress
  • Extended periods in cold temperatures