We're discussing these conditions that may cause leg pain separately, but people may have two or more of them at the same time, which complicates diagnosis and treatment. Peripheral artery disease is a form of atherosclerosis, the same condition that leads to most strokes and heart attacks.
Fat- and cholesterol-filled plaque narrows arteries, and blood clots can collect on the plaque, narrowing them further. In peripheral artery disease, the arteries affected by atherosclerosis tend to be the ones that supply the leg muscles. The risk factors are similar to those for heart disease and stroke: smoking, high cholesterol levels, high blood pressure, and especially diabetes. The classic symptom is cramping, tight pain that's felt in muscles "downstream" from the narrowed artery.
It can occur in the buttocks, thigh, calf, or foot, but occurs most often in the calf. The pain tends to come on with walking, gets worse until the person stops walking, and goes away with rest. Similar to angina, the pain caused by peripheral artery disease comes from working muscle cells that are "starved" for oxygen because of obstructed blood flow. The medical jargon for this kind of pain is intermittent claudication, from the Latin claudicatio for limping. Many people with peripheral artery disease have other sorts of pain, though. Sometimes their legs are heavy, or they tire easily.
And it's common for people to cut back on their activity level without realizing it, which can mask the problem. Signs of peripheral artery disease include a diminished pulse below the narrowed artery, scratches and bruises in the lower leg that won't heal, and pale and cool skin. The diagnosis usually depends on the ankle-brachial index, which compares the blood pressure at the ankle to the blood pressure at the arm.
They're normally about the same, but if there's a blockage in the leg, blood pressure will be lower in the ankle because of low blood flow. Peripheral artery disease by itself can be serious and debilitating, but it may also serve as an important warning of even more serious trouble. Atherosclerosis in the legs often means there's atherosclerosis elsewhere, and people with peripheral artery disease are six to seven times more likely to have a heart attack, stroke, or transient ischemic attack than people without it.
A peripheral artery disease diagnosis should prompt a concerted effort to rein in cardiovascular disease risk factors. Walking hurts, so a "just do it" attitude about exercise isn't helpful. But researchers have found that tightly structured, supervised exercise programs can help people increase the amount they can walk before their leg pain kicks in. These programs usually involve walking 'til it hurts which may be only for a few minutes , resting 'til the pain goes away, and then walking again.
These walk-rest-walk sessions are most effective if people do them for about 30 minutes at least several days a week.
Low dose aspirin 75 mg to 81 mg is often recommended to reduce the risk of heart attack and stroke. Clopidogrel Plavix , another drug that makes blood clots less likely by making platelets less sticky, is an alternative for people with aspirin allergy.
Cilostazol Pletal can help people walk longer distances without pain. Serious cases of peripheral artery disease can cause leg pain even when the person isn't walking.
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This "rest pain" most often occurs in the feet. Even more serious are cases when the condition leads to tissue death and gangrene. If peripheral artery disease is serious, or isn't improving with exercise and medication, doctors can reopen the blocked artery with angioplasty or use part of a blood vessel from elsewhere in the body to reroute circulation around the blockage.
But the track record of these revascularization procedures is mixed, and some studies suggest that the results from a structured exercise program can be as good, or even better. Like peripheral artery disease, chronic venous insufficiency is a condition of poor circulation, but it involves the veins and the blood's return trip back to the heart and lungs.
Our arteries are springy and help push blood along, but our veins are relatively passive participants in circulation.
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Particularly in the legs, it's the muscles surrounding the veins that provide the pumping power that drains the vessels near the surface of the skin and then push the blood up through the "deeper" vessels that travel toward the heart. Tiny valves inside the veins even out the pressure and keep the blood from flowing backward. In people with chronic venous insufficiency, the valves are damaged, so blood tends to pool in the legs and feet instead of traveling "north" to the heart. It's often a vicious cycle: if the valves aren't working, pressure from the blood collecting in the veins increases, so the veins stretch out.
As a result, the valves don't close properly, so even more blood flows backward, adding pressure. Symptoms include swelling, inflammation of the skin dermatitis and the connective tissue underneath cellulitis , and ulcerated, open wounds on the bony "bumps" of the ankle. Legs may feel achy or heavy. And when people walk, they may feel a tight, "bursting" pain, most often in the groin or thigh. The leg pain will stop with rest but may take longer to ease up than the pain from peripheral artery disease.
The symptoms from a mild case of chronic venous insufficiency can be helped by lying on your back and using a pillow to elevate your legs so blood flows downhill to the heart. If you're sitting for long periods, pointing your toes up and down several times can flex the vein-pumping leg muscles. More serious cases needed to be treated with compression stockings that squeeze harder at the ankle than at the knee.
For the stockings to work, they must be much tighter than the "antiembolism" stockings people routinely wear in the hospital.
About leg cramps
But because they are so tight, people often have a hard time getting them on. Washing a new pair can help. Some people coat their skin with talcum powder or wear thin, regular stockings underneath. Devices called "wire donners" hold the stockings open so people can push a foot and leg into it. There are no specific medicines to treat venous insufficiency.
Surgical procedures have improved significantly over the years. Nowadays varicose vein therapy has moved very far away from the old-fashioned saphenous vein stripping. That procedure involved making an incision in the groin and leg, inserting a stripping device into the vein, and pulling the vein out of the body. It usually required general anesthesia, an overnight hospital stay and weeks of recovery. Today, physicians usually close the vein permanently rather than remove it. They use one of several minimally invasive techniques, performed through catheters inserted into the veins under ultrasound guidance.
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These treatments are performed in outpatient settings under local anesthesia, and the patient can walk immediately after treatment. Stenosis pronounced ste-NO-sis is a medical term for any kind of narrowing. Official Sites. Company Credits. Technical Specs. Plot Summary.
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