Download ADVANCED FOOT AND ANKLE SPECIALISTS, PA Jay S

ADVANCED FOOT AND ANKLE SPECIALISTS, PA
Jay S. Weingarten, DPM, FACFAS, FACFAOM
Podiatric Physician and Surgeon
Board Certified Physician – Treating Pediatrics to Geriatrics
The Ischemic Foot
The term "ischemic foot" refers to a lack of adequate arterial blood flow from
the heart to the foot. There are a wide variety of possible causes for poor
arterial circulation into the foot including arterial blockage from cholesterol
deposits, arterial blood clots, arterial spasm, or arterial injury. The ischemic
foot is also referred to as having arterial insufficiency, meaning there is not
enough blood reaching the foot to provide the oxygen and nutrient needs
required for the cells to continue to function.
Diagnosis
The result of insufficient blood supply to the foot can manifest itself in a variety
of ways depending upon how severe the impairment to circulation. Early
symptoms may include cold feet, purple or red discoloration of the toes, or
muscle cramping after walking short distances (intermittent claudication).
Later findings may include a sore that won't heal (ischemic ulcer), pain at night
while resting in bed, or tissue death to part of the foot (gangrene).
The diagnosis of ischemia is made by reviewing the patient's symptoms,
examination of the foot, and special testing to evaluate the circulation. The
examination should reveal cold skin temperature, and skin atrophy that causes
the skin to appear shiny or paper thin with loss of normal hair on tops of the
toes and on the lower leg. There is often a color change associated with
ischemic feet. This may show as a purple discoloration of the toes, white
blanching of the toes when the foot is elevated, and red discoloration when the
foot is hanging down. Additionally the two arterial pulses in the foot will not be
as strong as normal, or may be entirely absent. Certainly the presence of a
pale looking ulcer, or black gangrenous toes would be an ominous sign of poor
circulation.
When these findings are present further testing is usually required. This will
often include arterial Doppler testing. This test uses sound waves to listen
to the blood flow through the arteries and is able to record the quality of the
blood flow and also the blood pressure. If the quality of blood flow is poor and
the pressure is greatly diminished, this would indicate a lack of adequate blood
flow.If a patient fails the Doppler study a second test may be required to
further determine where the arterial blockage is located and how much blood is
able to squeeze past the blockage this can be done with an MRA or a CTA , a
blood test is required to verify kidney status prior to administration of
contrastmedia. A third test which is invasive and done in the operating room is
known as an arteriogram. The arteriogram requires the injection of a special
dye into the artery so that the artery will be visible when an x-ray is taken.
This x-ray can then show where the artery is blocked and how much blood can
flow past the blockage.
Treatment
In the early stages of ischemia of the foot, the doctor will often recommend a
program of walking exercises to increase blood flow, protective shoes and
insoles if necessary, to protect the skin from rubbing producing irritations
which may lead to ulcerations. Medications are also available to help improve
the blood flow into the feet.
In more advanced stages of ischemia, a referral to a vascular specialist is
appropriate for further evaluation. Oftentimes, if the patient is in otherwise
good general health, a surgery may be recommended to open the blocked
artery or to clean out the area of blockage. This minor surgery can be done
with angioplasty, stents, arthrectomies (rotor rooters) and laser. If these fail
the patient will need major surgery. Failure to improve the circulation into the
foot may result in gangrene, which may ultimately require amputation of part
of the foot or leg. The surgery is an attempt to save the foot and leg from the
impending amputation. The surgery has improved over the years and the
chances for success are now greater than ever before. However, each
individual needs to be evaluated as to the potential risks and possible benefits
from this type of surgery.
1233 SE Indian St., Suite 102, Stuart, FL 34997
tel. 772-223-8313, fax 772-223-8675
1106 W Indiantown Rd, Suite 4, Jupiter, FL 33458 tel. 561-744-6683, fax 561-744-7033