To diagnose PAD, the foot and ankle surgeon obtains a comprehensive medical history of the patient. The surgeon performs a lower extremity physical examination that includes evaluation of pulses, skin condition and foot deformities to determine the patient’s risk for PAD. If risk factors are present, the foot and ankle surgeon may order further tests. Several noninvasive tests are available to assess PAD. The ankle-brachial index (ABI) is a simple test in which blood pressure is measured and compared at the arm and ankle levels. An abnormal ABI is a reliable indicator of underlying PAD and may prompt the foot and ankle surgeon to refer the patient to a vascular specialist for additional testing and treatment as necessary.
General Treatment of PAD
Treatment for PAD involves lifestyle changes, medication and, in some cases, surgery.
PAD & Foot Problems
- Lifestyle changes - These include smoking cessation, regular exercise and a heart-healthy diet.
- Medications - Medicines may be used to improve blood flow, help prevent blood clots or control blood pressure, cholesterol and blood glucose levels.
- Surgery - In some patients, small incision (endovascular) procedures or open (bypass) surgery of the leg are needed to improve blood flow.
Simple foot deformities (hammertoes, bunions, bony prominences) or dermatologic conditions, such as ingrown or thickened fungal nails, often become more serious concerns when PAD is present. Because the legs and feet of someone with PAD do not have normal blood flow—and because blood is necessary for healing—seemingly small problems, such as cuts, blisters or sores, can result in serious complications.
Having both diabetes and PAD further increases the potential for foot complications. People living with diabetes often have neuropathy (nerve damage that can cause numbness in the feet), so they do not feel pain when foot problems occur. When neuropathy occurs in people with PAD, ulcers can develop over foot deformities and may never heal. For this reason, PAD and diabetes are common causes of foot or leg amputations in the United States.
Once detected, PAD may be corrected or at least improved. The foot and ankle surgeon can then correct the underlying foot deformity to prevent future problems should the circulation become seriously restricted again.
Avoiding PAD Complications
Getting regular foot exams—as well as seeking immediate help when you notice changes in the feet—can keep small problems from worsening. PAD requires ongoing attention. To avoid complications, people with this disease should follow these precautions:
- Wash your feet daily - Use warm (not hot) water and a mild soap. Dry your feet—including between the toes—gently and well.
- Keep the skin soft - For dry skin, apply a thin coat of lotion that does not contain alcohol. Apply over the top and bottom of your feet but not between the toes.
- Trim toenails straight across and file the edges - Keep edges rounded to avoid ingrown toenails, which can cause infections.
- Always wear shoes and socks - To avoid cuts and abrasions, never go barefoot—even indoors.
- Choose the right shoes and socks - When buying new shoes, have an expert make sure they fit well. At first, wear them for just a few hours daily to help prevent blisters and examine the feet afterward to check for areas of irritation. Wear seamless socks to avoid getting sores.
- Check your feet every day - Check all over for sores, cuts, bruises, breaks in the skin, rashes, corns, calluses, blisters, red spots, swelling, ingrown toenails, toenail infections or pain.
- Call your foot and ankle surgeon - If you develop any of the above problems, seek professional help immediately. Do not try to take care of cuts, sores or infections yourself.