For years, complaints from patients about pain in one leg or both legs that forces the person to stop after walking a certain distance have been accumulating in doctor’s offices. A patient complaining of such pain is sure to receive instructions from the doctor to free both legs and lie down on the examination bed. The physician palpates the tops of the feet, the areas below the inner ankles, the backs of the knees, and the groins.
Causes
He will then instruct the patient to elevate his legs, use his hands to support his legs below the backs of his knees, and to
roll. In this way, it is possible to determine if and when pain occurs in the
Feet or calves occur, as observed by the patient when walking. The physician records the duration of this foot rolling using a stopwatch and
has the patient stand up immediately as soon as he or she can no longer continue to roll due to pain. The feet, which are initially very pale, usually redden in spots before returning to their normal color. This also describes the nature of this disease, which is a circulatory disorder of the legs and their individual parts, muscles, skin, tendons. The vessels are narrowed due to changes in the inner layer and consequently do not have their normal diameter. As a result, insufficient blood reaches the muscles and other dependent organs. Nutrition, especially oxygen supply, is reduced, and cramp-like pain occurs. This pain process can be verified at any time by tying off a finger and moving it at the same time. A constricted vessel can also be roughly compared to an old water pipe in which rust, lime or scale has settled; from such a pipe the water flows only with considerably reduced pressure. Arterial circulatory disorders occur especially in men from the age of forty-five, in some cases even earlier. The main cause is arteriosclerotic deposits, the development of which is promoted by inflammatory and allergic conditions, chronic foci of pus, for example on the tonsils or teeth, or by metabolic diseases. These pathological changes are frequently observed in heavy smokers. This is not surprising, considering that nicotine is a pronounced vascular toxin. The reduced adaptability of the vascular system, which is the result of a lack of physical training and chronic lack of exercise, also has a promoting effect. Disruption of venous return, especially in overweight people and those with varicose veins, can also lead to inflammatory changes in the vicinity of the arteries and affect them. There is a close relationship between arterial circulatory disorders of the extremities and the deficiency of blood flow in the coronary arteries. It is often a disease of the entire arterial vascular system and only in rarer cases vascular occlusions caused by blood clots (emboli and thromboses).
Symptoms, complaints, and signs
Impaired blood flow in the feet and legs is characterized by poor wound healing, tingling, pain, and numbness. The aforementioned symptoms can have a variety of causes and can be signs that the feet and legs are in need of treatment. However, not every symptom that affects the lower extremities necessarily has an arterial circulatory disorder as its cause. Stress, temperature changes or psychological factors also play a role in vascular system contraction. At the beginning, the changes in the vascular system of the legs are already recognizable, but do not cause any discomfort in everyday life and therefore often remain undetected by the patient. The circulatory disturbances usually occur in the femoral arteries, but can also affect the arteries of the pelvis or lower legs. When the first symptoms appear, such as numbness, a feeling of coldness in the extremities, tingling or pain when walking or climbing stairs, a clarification by the doctor should be carried out in any case in order to be able to exclude various diseases of the hematopoietic system. On this basis, a suitable therapy against arteriosclerosis can be initiated, since the symptoms, if left untreated, will become more and more severe in the course of the disease.In this case, it would ultimately lead to constant pain on movement or exertion, such as “shop window disease” in the lower limbs.
Complications
Arterial circulatory disorders in the feet and legs usually progress slowly because the pathological changes in the supplying arteries also change slowly in parallel. However, it is usually a deterioration if the disorders remain untreated and the causes are neither recognized nor eliminated. Sensory deficits often present themselves as one of the first complications. A kind of numbness develops in the legs and feet, and tactile pain sensations are greatly reduced or completely absent. In more advanced stages, complications occur in the form of pain that is particularly severe during exertion, as in the case of the well-known peripheral arterial occlusive disease, also known as window-shopping disease. Because of the lack of supply to the tissues in the legs and feet, wound healing after injury is impaired. Irreversible tissue death can occur as a serious complication. In particularly serious cases, where dead tissue corresponds with the inability to restore adequate blood circulation, it may even become necessary to amputate the affected limb. An imminent poisoning of the entire body, which would be immediately life-threatening, is thus prevented. Irrespective of the treatment of the circulatory disorder, the complications that occur correspond to the respective severity of the arterial supply bottleneck. However, not all complications that occur regress if the threshold for irreversibility has already been exceeded.
When should you go to the doctor?
If numbness or sensory disturbances in the limbs are repeatedly noticed, a visit to the doctor is recommended. An arterial circulatory disorder in the feet and legs is also manifested by pallor, muscle weakness, and pain. If these symptoms are noticed – regardless of whether they occur gradually or suddenly – a doctor must clarify the cause. Although it is not always due to disturbed blood circulation, the symptoms at least indicate a disease that must be diagnosed and, if necessary, treated. If the underlying condition is not treated, the symptoms will continue to increase and eventually lead to tissue damage such as the so-called smoker’s leg. At the latest when paralysis symptoms are accompanied by severe pain that never completely disappears even at rest, a medical examination is required. Patients with diabetes or existing arterial disease should talk to their doctor immediately if they experience any unusual symptoms. If dizziness, chest tightness and stabbing pain in the right arm occur, there is an acute danger to life and the emergency medical services must be contacted. Complementary first aid measures must be provided.
Treatment and therapy
Of course, it is recommended to take effective measures at the first signs to prevent the progression of the condition. After a special examination, the treatment plan is determined. If the disease is already advanced, it is now possible to restore peripheral circulation with the help of medication or surgical intervention. To supplement and continue clinical treatment, cures are also suitable, with the help of which the bypass circulation, which is present in all people, can be trained and made capable of bearing weight, so that small vessels are enabled to take over the function of the constricted large veins. However, artificial vascular replacement often proves superior to all these measures. Long-term success can also be achieved without surgery in those patients who come for treatment at an early stage and are prepared to undergo long-term treatment with all its consequences, including for the individual’s lifestyle. The most important thing here is for the patient to work out at home under the guidance of the doctor and to exercise his vascular system daily according to a fixed plan. The best training is exercise. The most beneficial exercise is: foot rolling exercises at least twice a day, three times in a row, until below the pain threshold. To do this, we lie relaxed on our backs and lift our legs slightly bent. With our hands we hold the backs of our knees and move our feet in a circular motion, possibly also the entire lower legs.It is advisable not to do this exercise on a full stomach. If it is considered too strenuous, especially by older people, it is advisable to sit in a comfortable chair, grasping only one leg at a time with both hands, and thus perform the rolling exercises one after the other. In any case, it is important to stand up after the onset of pain and wait until it has subsided and any discoloration has returned to normal. Other effective measures against circulatory disorders are special foot gymnastics, regular walking training, hiking, cycling, jogging and swimming, but the performance limit indicated by the pain must not be exceeded. All exercises must be performed in such a way that we achieve the best possible blood circulation by alternating tension and relaxation. The above exercises can be supplemented with dry brushing. Stroking starts at the bottom of the legs, on the inner sides in each case. The
Do not forget the soles of the feet! Always brush in the direction of the heart, i.e. arms and legs upwards, until a slight reddening and warm feeling occurs. The following scheme has proven effective: right leg to buttocks, left leg to buttocks, right arm and right shoulder, left arm and left shoulder, back and hips from buttocks upwards, abdomen circling clockwise, upper body from shoulder to sternum and along the ribs.
Outlook and prognosis
Arterial circulation disorders in the feet and legs have a good prognosis outlook. Medical treatment provides for various options that lead to resolution of the disorder. However, it should be taken into account that without medical care, the course of the disease can be fatal. If a thrombus clogs the blood vessels, there is a risk that it can break loose and be transported via the bloodstream to another location. There it can obstruct various supply lines and cause blood stasis. Congestion of the blood causes damage to the vessel walls. In severe cases, there is a threat of stroke, which can lead to lifelong impairments or result in death. If the circulatory disorder in the feet and legs is diagnosed at an early stage, however, there is a good chance of recovery. The vasoconstriction can be eliminated by administering medication or by surgical intervention. Within a few days or weeks, the patient is free of symptoms. There is a normal blood supply and the symptoms are eliminated. To prevent recurrence of vasoconstriction, the cooperation of the affected person is important. Sufficient exercise, a healthy lifestyle and measures to promote blood circulation should be taken on one’s own responsibility. If the legs are hardly moved over a longer period of time or a rigid posture is adopted, the risk of health problems increases.
Alternating baths according to Kneipp
Other measures that promote blood circulation are Kneipp’s tempered alternating casts, which are performed on the healthy leg or arms. We start with a cast of about 36 to 38 degrees, follow with a cold cast of about 20 to 24 degrees, and finish the cast warm. After that, we go to bed. Only with progressing training and after improvement of the complaints – one
This can be felt in the faster rewarming – another cold shower is added and followed by a run. Rising partial baths, also on the healthy leg, or if both legs are affected, on the arm, as well as rising sitz baths are recommended. The legs should be covered with blankets. These baths are generally started at 36 degrees and the temperature is increased over the course of 20 minutes to a maximum of 41 degrees. Afterwards, a rest of at least 30 minutes is recommended. These measures – as simple as they may seem and as easy as they are to perform – have proven to be beneficial and effective. However, the patient must visit his doctor at regular intervals, who will work out a fixed daily schedule with him and constantly urge him to carry it out regularly. Only if the treatment is followed consistently for months, perhaps even years, and if all harmful factors are strictly avoided, can success be expected with this disease. The decrease in symptoms is the reward of consistent treatment and regular vascular training. The person concerned will notice that he can cover longer and longer distances without pain.However, the ultimate goal is to maintain vascular performance and functionality.
Follow-up
If there is an arterial circulatory disorder in the feet and legs, certain aftercare should be followed. It is important that after diagnosis and therapy, specific attention is paid to the doctor’s instructions. The doctor will tell the affected person how to behave in order to alleviate the symptoms as much as possible. In addition, it should be ensured that the so-called support stockings are always worn. These ensure that the blood is properly distributed in the legs and feet. To that should be attached to a sufficient liquid supply value. Drinking a lot is important to distribute the blood well in the body. Regular walks in the air and light sporting activities also get the circulation going again. If affected persons are prescribed medication, it is essential that they take it. And do so exactly as prescribed by the doctor. If these things are observed in the aftercare of the circulatory disorder, nothing stands in the way of alleviating the symptoms. However, if these are not observed, this can lead to a deterioration of the state of health.
This is what you can do yourself
In the case of complete occlusion of vessels, measures that do not involve surgery or medication are usually of no help. This is also true in the case that the circulatory disorder is due to an embolism or inflammation. However, sufferers of a lower extremity circulatory disorder can do many things to slow the progression of arterial stenosis and promote the formation of new capillary vessels. If the condition is caused by arteriosclerosis, sufferers can often achieve improvement by adopting a healthier lifestyle. For example, factors that promote arteriosclerosis should be eliminated wherever possible. Cigarettes and excessive alcohol consumption should be avoided. The same applies to eating large amounts of fat. Instead, a healthy diet rich in vitamins, minerals and low in fats should be achieved. Sufficient fluids are also important, as they improve the flow of blood. To maintain blood flow to the affected extremities, exercise is essential. Walking for at least thirty minutes a day prevents further narrowing of the arteries, is good for the circulation and makes you feel better. Other sports are also suitable. Along with the healthier diet and more exercise, there should be a reduction in any excess weight.
