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Gangrene of the Foot: Clear and Present Danger of Impending Limb Loss and Death (Part 2)

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gangrene right foot

 

BY AZEEZ ADEWOLU POPOOLA ADEDUNTAN

B.SC (HONS), MBCHB**, MD, RVT, FACS, FICS

CONSULTANT VASCULAR SURGEON

CONSULTANT GENERAL SURGEON

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In this edition, we will turn our attention to the SYMPTOMS and SIGNS of one of the many causes of chronic pain in the legs, called by physicians-Peripheral Vascular Disease (PVD) or interchangeably PAD (Peripheral Arterial disease).

  1. CLAUDICATION

This ispain in the calf muscles that is brought on, by walking or exercise and spontaneously relieved by rest. Over the years, plaques made of cholesterol and debris gradually obstruct the arteries (the pipe that supplies blood to our body from the heart).When these plaques narrow the long arteries of the legs, blood-flow to the leg muscles becomes inadequate when the muscles are working. Muscle pain, called intermittent claudication, can result. Claudication typically comes on with exercise, and is relieved with rest. It is different from the pain of arthritis of the knees or the back, which is constant and has no relationship to walking, nor does it get relieved by stopping walking or exercise.

Depending on the arteries that are affected and where the blockage is, different muscle groups can be affected:

Buttock and hip

Thigh

Calf (most common)

Foot (less common)

There are two kinds of claudication

1) Intermittent (Tolerable) Claudication: Where the patient can walk more than one city block (100yards), before the pain starts; and it is on and off.

II) Disabling Claudication: Where the pain in the calf muscles is so bad that the patient can hardly walk up to a city block (100yards) without waiting or resting.

This difference is important when we talk about treatment of Claudication in future series.

  1. REST PAIN

This is pain in the feet and toes that tend to wake up patients at night and it is worse than claudication.This kind of pain is a red signal to the Doctor that the blood flow in the extremity is so bad, and so critical, and something needs to be done to prevent limb loss.

  1. ULCERS

diab-foot1-s

This is a breakdown of the skin in the legs, feet, or toes that refuse to heal due to lack of critical blood flow. It is much more serious than rest pain and is also a red signal, that some treatment must be given by your physician to prevent toe, foot, or limb amputation.

GANGRENE

This is tissue death in addition to bacteria infection.It is the most serious sign of lack of blood flow in the extremities and it is a signal for emergent or urgent intervention to prevent blood stream infection, major limb amputation or death.This sign is worse in Diabetics.

 

 

  1. Other signs and symptoms of peripheral artery disease include:

Wounds that heal poorly

Brittle and atrophic nails

Shiny skin over the legs

Loss of hair on the legs

Decreased pulses in the feet

We will discuss the Diagnosis, Risk factors modification and Treatment of this type of pain in the legs, in our next edition, as PAD is now on the rise in Sub-Saharan Africa, exemplified by Nigeria, due to the aping of white men diet, life styles and dietary habits evidenced by Pizza restaurants, Hamburgers restaurants, that have dotted our major towns and cities in recent time.

Don’t forget to ask your doctors to check the blood flow in your groin and feet, if you present with pain in your legs/feet as PAD can be misdiagnosed as Arthritis by your Doctor.

Thank you and best wishes for good health, from “NIGERIAN ALERT “to our readers, as a Healthy Workforce, is a Productive and Wealthy Workforce.

 

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