Not only bones, joints and ligaments form the substance of our legs and feet, which we so urgently need to move and thus change places in our environment. Muscles and skin also form their components. All these tissues require nutrition and thus blood supply. That is why today we will talk here about the most common leg ailments and about the most important vascular diseases of the legs, as far as they are of general interest.
What are arteries and veins?
It has been proven by statistical studies that people suffering from varicose veins often have a general weakness of the connective tissue. As is generally known, blood is distributed throughout the organism by an extensive network of blood vessels. In this blood system, a distinction is made between those vessels that carry blood enriched with oxygen in the lungs to the periphery and others that return blood enriched with carbon dioxide and other metabolic products to the heart. The vessels leading away from the heart are called arteries or arterial arteries, while those leading to the heart are called veins or veins of blood. In the tissues, the capillary system is interposed between them, a fine network of small and tiny vessels in which oxygen and nutrients are delivered to the environment. While the larger arteries are usually hidden by the muscles and run in the depths, a large part of the veins lie just under the skin and are thus accessible to observation. By the course of the blood vessels, one can recognize the large arterial vessel of the leg, the femoral artery, which enters the muscle cuff of the thigh from the abdominal cavity. Below the popliteal fossa, it gives rise to the arteries of the lower leg, which further peripherally divide into the arteries of the foot. In the venous system of the leg, one must distinguish deep and superficial veins. The deep veins roughly follow the course of the arteries. The superficial ones form a wide-meshed network lying in the subcutaneous tissue, from which two main flow paths, one on the inner side of the lower leg and thigh, the other running above the calf, collect the venous blood. Both veins open into the deep venous system of the leg at different heights.
How veins work
You are probably wondering how the blood in the veins is transported back up against the force of gravity. Several factors play a role here, which cannot be mentioned in detail here. However, the valves in the veins are particularly important for venous return. They open only when the flow direction is toward the heart, but normally close automatically when the flow direction is reversed. The venous blood is thus transported from one section of the vein to the other by the pressure of the muscles created during movement. This process can be compared to a system of locks. The more common disorders are those of the veins. We know them under the name of varicose veins, which are a common ailment observed especially in middle and old age. It has been proved by statistical research that people suffering from varicose veins often have a general weakness of the connective tissue. Often at the same time there are buckling, flat or flat feet. When varicose veins appear during pregnancy, the drainage obstruction in the area of the pelvic veins plays a role. At the same time, hormonal influences also play a role. After birth, however, there is usually extensive regression.
Symptoms, complaints, and signs
If the varicose veins are more extensive, there may be heaviness and a feeling of tension in the lower legs after prolonged exertion. At the beginning of the development of varicose veins, there are often no symptoms at all. The varicose veins are noticeable, but only lead to aesthetic problems. As the disease progresses, however, such symptoms as heavy legs, feelings of tightness in the legs, frequent cramps in the calves at night, and generally tired legs may develop. In the course of this vascular disease, there is a dilation and increased tortuosity, especially of the superficial veins of the lower and upper thighs, which significantly bulge the skin when heavily filled. The disease can occur unilaterally, but also bilaterally, and its development can take years. In milder cases, there are initially no symptoms.However, if the varicose veins are more extensive, they may cause heaviness and a feeling of tension in the lower legs after prolonged exertion. Some patients also complain of stabbing pain, itching and burning in the area of the affected veins. Occasional cramp-like pain gave the disease its name. It is considered certain that varicose veins often originate from damage to the described venous valves, which can be caused by hormonal disorders, infectious diseases and other general ailments of the body. In this case, there is a significant slowing down of venous outflow and, in the case of severe changes, congestion, which results in increased stress on the vein walls, gradually widening them. As a result of the outflow disorder, the removal of used blood from the smaller veins of the lower leg and foot is also disturbed. However, these symptoms improve when lying down or moving, because the blood flow in the veins is then stimulated again. Heat, however, leads to an aggravation of the symptoms. Those affected often complain of excruciating itching of the legs. Depending on lifestyle and genetic predisposition, venous weakness can progress even further in some patients. For example, prolonged blood stasis causes edema to form in the legs, as the vascular walls become increasingly permeable due to the constant strain. Legs and feet swell. Furthermore, reddish and itchy skin changes develop, which are called stasis eczema. The skin can thin out in older patients, leading to so-called parchment skin, which is more prone to injury. In the most severe stage, due to a lack of oxygen supply to the tissue, open skin ulcers form on the legs, which are difficult to heal and carry the risk of wound infections. Venous inflammation also often occurs, which can lead to thrombosis and eventually pulmonary embolism.
Course
The disorder affects the smallest vessels of the skin and subcutaneous tissue in severely developed varicose veins. Most often, the area just above the ankle is affected. The skin’s nutrition is disturbed by the accumulation of metabolic waste products and it loses thickness and elasticity, so that even minor impacts cause skin lesions. Small cracks can then easily develop into a larger wound area due to infection, which is often very painful. In such cases, the vernacular speaks of “open legs”, referring to the lower leg ulcer caused by the venous outflow disorder. Besides the described formation of a lower leg ulcer, venous dilatation can also cause other more dangerous diseases. In the damaged, dilated wall districts of the veins, surrounded by poorly nourished tissue, mild inflammatory processes develop. These are the so-called phlebitis, which, however, sometimes also occurs in externally unchanged veins. In such a disease, a reddening of the skin is usually found above the inflamed vein, which is accompanied by pressure-sensitive swelling. In addition, there is pain when tightening the muscles. Bacteria entering the bloodstream may also cause fever. If the affected person does not seek medical treatment in time, there is a risk that blood clotting in the diseased vein will cause a vein occlusion, known as thrombosis. This condition usually requires prolonged hospital treatment. In mild cases of varicose veins, medically prescribed compression bandages as well as medicinal and physiotherapeutic treatment can eliminate the discomfort and symptoms and prevent progression of the disease process. Wearing thrombosis stockings or elastic stockings can also bring relief. In severe and progressive cases, the doctor will decide whether sclerotherapy of varicose veins by medical means or surgical removal is an option.
Prevention
As preventive measures, wearing constricting garters, socks and pants should be avoided if varicose veins exist. It is also important to improve venous circulation by wearing shoes that are fit for purpose and healthy. For example, it has been proven that the calf muscles are highly contracted by wearing heels that are too high, and a disturbance in venous outflow results from the lack of alternation between tension and relaxation (flaccidity). Similarly, shoes that are too tight or too narrow have an unfavorable effect on venous circulation in the foot.All the measures recommended by the orthopedist to strengthen the postural and locomotor system, such as foot exercises, cool baths, walking barefoot, etc., serve to promote venous outflow. In addition, as with all circulatory disorders, care must be taken to maintain a regular lifestyle. Abuse of alcohol and nicotine (smoking) always have a harmful effect in the presence of vascular disease.
Symptoms of arteriosclerosis
The promotion of venous outflow is served by all the measures recommended by the orthopedist to strengthen the postural and locomotor system, such as foot exercises, cool baths, walking barefoot, etc. In contrast to venous diseases, arterial diseases do not lead to dilatation, but mostly to narrowing of the vessel diameter. In case of unfavorable course, the arterial blood flow can be almost completely interrupted. The cause of vasoconstriction is often inflammatory processes such as typhoid fever and typhus. In other cases, vascular wall damage results from the deposition of pathological metabolic products (plaque). Such changes are found in arteriosclerosis and gout or, in rare cases, in diabetes. The reduction in blood supply causes a lack of oxygen in the supply area of the vessel, which can trigger severe pain. A typical sign of disturbed arterial blood supply to the leg is the so-called intermittent claudication. The affected person observes that after a certain number of steps, there is increasing pain in the muscles of the lower legs, which intensifies to such an extent that he is finally forced to stand still. After a short rest, the lack of oxygen from the low supply is then compensated for. Some patients also complain of a constant feeling of coldness in the feet and a sensation of feet falling asleep. If the arterial blood supply is severely reduced, poorly healing wounds appear on the toes. The temperature of the skin is usually significantly reduced when arteries in their supply area are narrowed, since the arterial blood of the arms, hands, legs and feet also supplies heat.
When should you go to the doctor?
Occasional circulatory problems in the extremities, such as “feet falling asleep,” do not need medical treatment, especially if they are due to poor posture of the body. However, if such symptoms occur frequently and are accompanied by other symptoms such as heavy and swollen legs, thick ankles or stabbing pain in the lower legs, a doctor should be consulted as soon as possible. If a vein disorder is treated at an early stage, conservative treatment methods can often suffice. Incipient varicose veins are then treated with support stockings, compression bandages or gymnastic exercises for the veins. If the incipient vein condition is not adequately treated in time, there is a risk of serious complications. For example, a venous ulcer can form. In addition, the risk of thrombosis, i.e. vein occlusion, which can be life-threatening, increases. Varicose veins should therefore not be underestimated. At the latest when pressure-sensitive swellings form on the veins or they bulge clearly outward, an expert must be consulted who, together with the patient, decides whether the varicose veins must be sclerosed or surgically removed.
Treatment of circulatory disorders
With the help of medical measurements of pulse fluctuations in several places of the leg with the so-called oscillograph or computer tomography, characteristic records can be obtained, according to which the doctor can assess the strength of arterial blood flow. Changes in venous and arterial vascular pathways can also be visualized and precisely localized using special X-ray diagnostic procedures. In the case of arterial circulatory disorders, it is possible to dilate the constricted vessel or the accompanying vessel lying in the vicinity by means of a variety of drugs, so that the circulatory distress and thus the lack of oxygen to the tissues is remedied. Modern vascular surgery has long been engaged in the development of procedures that make it possible to replace diseased vessel sections by transplantation or by inserting vascular prostheses (stents). All these methods show that even in late stages of impaired arterial circulation our legs still have possibilities of help.Unfortunately, in some cases (e.g. smoker’s legs) the only option is amputation and replacement of the leg with a well-fitting prosthesis. However, it is more important for the large number of people to keep the blood supply of the legs in order through their healthy lifestyle, especially through a suitable diet and regular exercise and sports.
Aftercare
In the case of circulatory disorders and varicose veins in the legs, there are usually only a few measures or options for aftercare available to the affected person. In this case, the affected person is primarily dependent on a quick and, above all, an early diagnosis so that no further complications occur. For this reason, a doctor should be contacted and an examination performed at the first signs of circulatory problems and varicose veins in the legs. Self-healing cannot occur with this disease. The treatment of circulatory disorders and varicose veins in the legs usually always depends on the exact underlying disease, so that no general prognosis can be given. In many cases, patients have to take medication, so that the correct and, above all, regular dosage must be ensured. Furthermore, with these complaints, overweight should be avoided in any case, while a healthy lifestyle with a healthy diet is also very important. Prolonged standing should also be avoided in case of circulatory disorders and varicose veins in the legs. Whether this disease results in a reduced life expectancy cannot be universally predicted in this regard.
Outlook and prognosis
With the circulatory disorders and varicose veins in the legs, the patient can achieve a good prospect of recovery with cooperation and medical treatment. Regular exercise and sufficient sports activities can alleviate the circulatory problems. Existing varicose veins can be treated and removed in one procedure. This procedure is essential for a good prognosis. Afterwards, the affected person should change his or her lifestyle to prevent the formation of new varicose veins. Without treatment, the symptoms increase over a longer period of time. The varicose veins multiply and pain sets in. This makes it impossible for the affected person to move to the necessary extent. In addition to a lack of exercise, an unhealthy diet, obesity, circulatory problems, anemia and the consumption of nicotine promote circulatory disorders. The prognosis in these cases is considered unfavorable. In severe cases, a thrombus forms. If it detaches, the patient is at risk of a heart attack or stroke. There is a chance of recovery as soon as the patient is willing to change his habits after the removal of varicose veins. Through measures such as alternating showers, massages or targeted training of the legs, the affected person can independently stimulate the blood circulation at any time. There is a possibility of achieving freedom from symptoms.
This is what you can do yourself
Every excess kilo exerts pressure on the body and thus on the legs. Switching to a high-fiber, low-fat diet promotes blood circulation in the veins and provides relief. Smoking constricts the blood vessels and thus promotes the formation of varicose veins. It is therefore advisable to give up smoking. Regular exercise such as cycling or walking strengthens the leg muscles. Special vein gymnastics such as the toe stand or toe bobbing promote blood circulation. It is recommended to elevate the legs whenever possible. When sitting, keep your legs side by side at a 90-degree angle. Crossed legs, on the other hand, inhibit blood flow. Footwear should be comfortable. Shoes with too flat heels have a straining effect on the leg muscles just like too high heels. Compression or support stockings are suitable for varicose vein treatment. They exert pressure on the tissue and veins and massage them. To support the return flow of blood at night, it helps to raise the bed by 15 cm at the foot end, while the head end remains straight. Kneipp applications with alternating showers and treading water train the elasticity of the veins. Herbal remedies such as horse chestnut or vine leaves support the process. Brush massages are not recommended, as they lead to spider veins. Sunbathing and hot baths should be avoided.
