Dr K.K. Pandey
In our country, quite frequently, especially among middle-aged people, complaints of pain, tingling sensations, and swelling of the leg are common. When they walk, they feel moderate to severe pain in their legs, especially in the calf region, but when they stop walking, the pain immediately disappears. When they start walking again, a twisting pain reappears. Sometimes, black discolouration appears in the toes. Quite often, they complain of swelling in the leg. Sometimes, they suffer from ulcers on their feet, which are difficult to heal despite applying various creams and ointments. This continues for months and years. A sufferer of foot ulcers keeps trying homemade local concoctions but does not see any benefit. They do not realise why this is happening.
How to recognise decreased blood supply to the leg?
If you feel a tingling sensation in your feet and, at the same time, you are a smoker (cigarette, bidi, or hookah) or a habitual tobacco chewer, believe me, the blood supply to your feet has started decreasing. If you develop pain in your feet while walking, it indicates a significant reduction in blood supply. If you feel pain in your feet while lying down or during sleep, that signifies an alarming degree of severe reduction—up to 90%—and is an indication of impending gangrene. If prompt action is not taken, gangrene of the feet is certain to develop.
Diabetic patients should beware
If you are diabetic and have been suffering from pain and tingling sensations in your feet, but have recently noticed an increase in leg pain while walking, it means the blood flow to your feet has considerably decreased. In diabetics, there is a ongoing process of calcium and cholesterol deposition in the walls of the blood vessels of the leg, resulting in reduced blood supply. Sometimes, the blood vessel in diabetics becomes completely blocked, leading to severe pain in the leg.
Leg swelling may also indicate disturbed blood supply
If there is either constriction or blockage of veins in the leg, deoxygenated blood (blood containing a very low level of oxygen) will fail to ascend towards the lungs for purification (replenishment with oxygen). This results in progressive swelling in the feet. If prompt steps are not taken to correct the problem and restore smooth blood flow, black spots may start appearing on the leg and feet. If timely and effective measures are not undertaken to restore normal blood flow, leg ulcers may eventually develop.
Swelling in the wall of blood vessels causes disturbance in blood flow
In some individuals, inflammatory swelling appears in the wall of a blood vessel. This causes narrowing of the vessel, leading to disturbed blood supply. This condition is medically termed “vasculitis”. If prompt and timely steps to increase blood supply are not taken, the colour of the toes may change to black—a condition known as gangrene of the toes. This condition is more common among females and often occurs due to an autoimmune disease called scleroderma.
Old injuries to the feet also affect blood supply
Frequent injuries, such as fractures in the leg or foot from road traffic accidents, often lead to bone union. However, accompanying injury to blood vessels may result in narrowing or, in some cases, complete blockade of the affected vessel. When this happens, blood flow in the previously injured vessel slows or stops altogether. Symptoms include pain and tingling sensations, with an increased risk of blackening of the feet. Blackening of the skin indicates gangrene has developed.
Backache can also indicate decreased blood supply in the leg
People addicted to smoking or tobacco chewing, or those with diabetes, often complain of back or thigh pain while walking. In many such cases, there is either narrowing or complete blockade of the main blood vessel called the aorta, located inside the abdomen. This blockade reduces blood supply to the back muscles, leading to back pain. Always remember, decreased blood supply to the back also results in reduced blood flow to the feet. In these conditions, walking causes pain in both the back and feet, which can impair a person’s ability to work and affect their livelihood.
How to determine whether blood supply to the leg is decreased?
You will need to undergo a specialised investigation called a Doppler study of the lower limbs. There are two types: arterial Doppler study, which examines the arteries carrying oxygen-rich blood, and venous Doppler study, which examines the veins carrying deoxygenated blood back to the heart. Both tests provide a general assessment of blood flow or obstructions in the vessels. If a complete obstruction is detected, further definitive investigation, such as a CT peripheral angiography of the lower limb, may be required. This will reveal the extent and length of the obstruction and the amount of blood flow. You do not need hospitalisation for this procedure. An echocardiogram should also be performed to assess the heart’s function and exclude the presence of blood clots in the heart chambers, which could dislodge into the leg’s blood vessels.
If there is decreased blood supply to the feet, where should you go?
Nowadays, many new health centres and hospitals offer modern diagnostic facilities. It is crucial to have access to a 24-hour availability of a specialised vascular surgeon, as well as facilities for Doppler studies, echocardiograms, CT peripheral angiography, and MR angiography. A hospital should also have a Digital Subtraction Angiography (DSA) lab, which allows procedures like angioplasty and stenting to be performed. Additionally, a modern operating theatre equipped with necessary machines and instruments for vascular surgery is essential.
How to increase blood supply to the feet?
If there is narrowing or total blockage of the leg’s blood vessel, do not sit idle—take it seriously. Immediately consult a vascular surgeon and follow their advice. For short-length narrowing or constriction, a minimally invasive procedure called stenting can restore blood flow. For longer blockages, bypass surgery may be necessary. Remember, the appropriate treatment depends on factors such as the patient’s age, angiographic findings, and other medical conditions.
Dr K. K. Pandey is a Senior Consultant, Department of Vascular & Endovascular Surgery, Department of Cardiothoracic Surgery, Indraprastha Apollo Hospital, New Delhi.
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