Foot problems are a common complication in people with diabetes, most of these complications can be prevented with careful foot care. If complications do occur, daily attention will ensure that they are detected before they become serious.
Causes of Peripheral Vascular Disease
Long Standing high blood sugar can damage blood vessels, decreasing blood flow to the foot. This poor circulation can weaken the skin, contribute to the formation of ulcers, and impair wound healing. This condition is called Peripheral Vascular Disease. Peripheral Vascular disease (PVD)is the name given to an occlusive disease that occurs in the peripheral or outer arteries of the body, such as the legs.
One of the first symptoms of the peripheral vascular disease that you may experience is an ache or cramp in your leg muscles when you're walking. Most commonly this occurs in the calf muscle,but can also occur in the thigh or buttock muscles. In some people, as the disease progresses the amount of blood able to go down the leg is not enough to supply the nutrients and oxygen to their feet. In cases like this, the individual will get pain in their feet even when they're not moving. This is known as rest pain and is a symptom of critical limb ischaemia. Without nutrients and oxygen getting down into the foot, the skin is unable to function properly and can break down into an ulcer. If an individual has rest pain or skin breakdown they are at risk of losing their foot or leg by amputation.
- Ankle Brachial Pressure Index (ABPI): This is a method of assessing the blood supply to your feet by comparing your blood pressure in both of your arms.
- Treadmill Exercise Test: This test combines the ankle brachial pressure index with a treadmill test. The ABPI is performed before and after you walk on a treadmill.
- Duplex Ultrasound: Duplex ultrasound is a non-invasive investigation that uses a probe and jelly on the skin to look inside your leg and gives a picture of the anatomy of your arteries.
- Angiogram: This is an invasive test that requires dye to be injected into your arteries. Once the dye is in your legs, x-rays are taken to give a picture of your legs showing where all the arteries are.
Management of PVD
- Exercise is key to vascular health
- Postural Corrections while standing, sitting and sleeping
- Managing your risk factors, including high blood pressure and diabetes
- Anti-platelet medication(prevents forming blood clots inside your arteries)
- Peripheral vasodilators(medication to relax your blood vessels and allow blood to flow more easily)
- Statins (drugs used to lower cholesterol levels)
- Invasive therapy: For some people with severe vascular disease, invasive therapy such as balloon angioplasty or stent insertion may be considered. Bypass graft would also be an option.