Early Treatment Can Limit Impact of Peripheral Arterial Disease

April marks Foot Health Awareness Month and Ankle & Foot Care Centers is spreading awareness of peripheral arterial disease (PAD), which affects more than 18 million people in the United States.

PAD is a vascular disease caused by plaque build-up and the hardening of arteries, limiting blood flow to the legs and feet.

Dr. Mark S. Smesko, a podiatric physician with Ankle & Foot Care Centers, warns his patients to be aware of some common symptoms of PAD because it is crucial to seek early treatment and implement a prevention plan.

Symptoms of PAD

 “Patients with PAD can experience pain, numbness, burning in the legs and feet, cold toes and feet, loss of hair growth on the lower legs and feet as well as wounds on the lower limbs that won’t heal,” Dr. Smesko says. “People with PAD may also experience a condition called intermittent claudication, which is when they get extreme cramping in their legs and feet with activity, forcing them to have to sit down. They can get this from walking just a short distance.”

In more progressive cases of PAD, patients who experience intermittent claudication might also have rest pain.

“Patients can experience rest pain at night, due to a lack of blood flow while laying down,” Dr. Smesko explains. “They have to sit up, stand up and move around to improve blood flow back to the extremity. Rest pain is a sign of more severe disease than intermittent claudication.”

Common Risk Factors

 Individuals with diabetes are more at risk to experience PAD, Dr. Smesko warns.

“One in three patients who have diabetes and are over age 50 are likely to have PAD,” says Dr. Smesko. “A patient with both diabetes and PAD has a ten times greater risk for amputation.”

Other risk factors include smoking, hypertension, kidney disease and increased age.

Prevention and Treatment

Dr. Smesko recommends those at risk to manage their diabetes, get annual foot exams, stop smoking, keep blood pressure under control and stay active.

“If a patient has clinical signs of PAD, I order an arterial exam. This is a noninvasive test that detects blood pressures and wave forms at various levels of the leg, ankle and feet,” says Dr. Smesko. “If that comes back abnormal, I refer the patient to a vascular surgeon for evaluation and treatment.

“Sometimes patients with PAD may end up finding out they also have cardiac issues. About 60 percent of patients with PAD also have coronary artery disease. Therefore, it is crucial for individuals to seek treatment early, as soon as they experience any symptoms.”

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Peripheral Arterial Disease Questionnaire

If you answer Yes to the questions below, you may be at risk for vascular disease. If you or someone you know may be at risk for PAD, contact one of our 20 locations today and make an appointment with a podiatric physician.

Do you experience any pain while at rest in your lower leg(s) or feet?

Yes   No

Do you have foot, calf, buttock, hip, or thigh discomfort (aching, fatigue, tingling, cramping or pain) when you walk, which is relieved by rest?

Yes   No

Do you have an infection, skin wound, or ulcer on your feet or toes that is slow to heal (8-12 weeks)?

Yes   No

Do you have high cholesterol level or other blood lipid problem, or do you take medication to lower your cholesterol?

Yes   No

Do you have high blood pressure or take medication for high blood pressure?

Yes   No

Do you have diabetes?

Yes   No

Have you ever smoked?

Yes   No

Have you previously had a stroke?

Yes   No

Do you have heart disease?

Yes   No

Do your legs hurt at night?

Yes   No

To stop the pain, do you hang your legs over the side of the bed?

Yes   No

Do you raise your legs to stop them from hurting?

Yes   No

 

Watch for These Common Foot Problems in Children

Children are affected by many of the same foot problems adults experience, including flat feet, plantar warts, ingrown toenails and heel pain. Some conditions occur more commonly in kids and are affected by their active lifestyles.

“I sometimes see toddlers because parents are concerned about the way their children are walking,” says Dr. Mark Smesko. “The majority of children are flat footed and toe walkers. I do exams, watch them walk and most times there are no issues. Some may need orthotics in their shoes to realign their feet. On a rare occasion, there may be a problem with a child’s knee or hip that may need to be referred to a pediatric orthopedic specialist.”

The following conditions are common in children.

Plantar Warts

Plantar warts can occur at any age but are very common in children. Caused by a virus, some warts respond to topical acid treatment but most need a laser procedure to eradicate the problem.

“I perform a laser procedure on most warts,” Dr. Smesko said. “This is great for kids because no anesthesia is required. So there is no shot, no wound and, most times, the child can resume activities on the same day.”

Ingrown Toenails

An ingrown toenail occurs when the edge of the nail, usually on the big toe, grows into the skin. This results in pain with activity and shoe gear and can lead to infection.

Often times this problem is hereditary in nature.

“I see quite a few kids with ingrown nails,” says Dr. Smesko. “If there is an infection present, an oral antibiotic is prescribed prior to any procedure. Once the infection is calmed down, I most commonly perform an in-office procedure under local anesthetic to remove the offending nail border.

“Then I use a chemical to kill the root of the nail so that portion of nail does not grow again. Less than 10 percent of the time does that side of the nail grow back after this surgery. Most times, the child can return to all activities after a few days.”

Heel Pain

Heel pain is another ailment that affects kids, most times between the ages of 8 and 14. With kids becoming more active year round in athletic activities, heel pain is becoming more common.

“I commonly see kids who go from one sport to the next, 12 months out of the year,” Smesko states. “Most heel pain is due to Sever’s disease, which is also called Calcaneal Apophysitis.

“As kids get bigger and more active, they put more stress and strain on their bodies. It is common for the growth plate of the heel to become sore and inflamed.”

The growth plate in the back of the heel attaches to the Achilles tendon as well as to the plantar fascial ligament. Tight calf muscles and overuse result in pain.

“The treatment for this consists of activity modifications, stretching exercises and support for the foot,” says Dr. Smesko. “Orthotics are commonly used as well as physical therapy in some instances. In severe cases, the child may need to stop playing sports and other activities for several weeks to calm down the pain.”

While most kids are active and healthy, certain foot issues will not get better on their own. If your child has any of these problems, please contact one of our offices to make an appointment.

Orthotics: A Non-Surgical Solution for Heel Pain

Among the most effective treatments for heel pain is the use of custom-made orthotics, which are foot supports worn in shoes and designed to alleviate pain by supporting natural foot movement.

Orthotic technician Tina Adkins helps set patients up with custom orthotics that can alleviate heel pain.

Many individuals suffer from pain in the heel, knee and lower back and may not realize their pain can be caused by poor foot function. Orthotics provide a non-surgical way to realign the foot and ankle bones to their neutral positions and decrease abnormal motion and pressure.

Tina Adkins, an orthotic technician, has been working with orthotics in Ankle and Foot Care’s diagnostic center in Boardman for over 13 years. She and her colleagues work closely with physicians in a regular process for fitting patients with custom-made orthotics.

A physician will decide if an orthotic device is necessary for a patient.  After Tina receives the patient’s prescription, she starts the fitting process, which is a 45-minute evaluation with the patient.

First, the patient walks in front of her so she can see if there is any noticeable abnormal movement of the feet, such as rolling inward or outward.  (Sometimes the scan doesn’t pick up what the eye can see, she explains.)

Next, the patient walks on a mat that performs a scan of the feet and creates a graph on Tina’s laptop.  The graph shows pressure points in certain parts of the foot, as well as other abnormalities. Tina can then design the fit for the custom orthotics right from her computer.

The orthotics arrive within a couple of weeks and the patient goes in for a final fitting with a physician or licensed orthotist.  He/she leaves the appointment with the foot scan and the custom-designed orthotic device.  If patients do not feel 50 percent better within 3-4 weeks, they are told to come back into the lab so technicians can readjust the orthotics.

Patients can choose among many different kinds of orthotics designed specifically for athletic shoes, work boots, dress shoes or everyday shoes.  One of the newest designs, referred to as the “cobra,” is shaped like a snake with the heel cut out, so that it can fit into a high heel shoe.

Orthotics can also come with heat-resistant material that decreases sweating or silver that decreases smell.

foot scan
This patient had heel pain in her right foot and was rolling on the outside of the foot to compensate, the foot scan shows.

“We have orthotics for everyone,” Tina says, as she explains the difference between orthotics for soccer, football, golf and even hockey.  “There are even orthotics that are waterproof.”

Tina sees about eight patients a day, all with different kinds of pain, but plantar fasciitis and heel pain tend to be the most common.

If you have serious pain or discomfort, schedule an appointment with a foot and ankle physician. He or she will examine your feet and ankles and suggest activity or treatment to improve comfort and function, including custom-made orthotics if appropriate.