The most common cause of poor blood flow out of the foot is varicose veins. This is a very common disorder seen twice as often in women than men, and the prevalence increases with age. Venous insufficiency is a condition in which the veins have problems sending blood from the legs back to the heart.

Causes

Normally, valves in your deeper leg veins keep blood moving forward toward the heart. With chronic venous insufficiency, vein walls are weakened, and valves are damaged. This causes the veins to stay filled with blood, especially when you are standing.

Chronic venous insufficiency is a long-term condition. It occurs because a vein is partly blocked, or blood is leaking around the valves of the veins.

Risk factors for venous insufficiency include:

• – Age
• – Being female (related to levels of the hormone progesterone)
• – Being tall
• – Family history of this condition
• – History of deep vein thrombosis in the legs
• – Obesity
• – Pregnancy
• – Sitting or standing for a long periods.

Symptoms of Venous Insufficiency (poor venous flow)

• – Pain that gets better when legs are raised
• – Swelling of the legs
• – Redness of the legs and ankles
• – Skin colour changes around the ankles
• – Varicose veins on the surface (superficial)
• – Dull aching, heaviness, or cramping in legs
• – Itching and tingling
• – Pain that gets worse when standing
• – Thickening and hardening of the skin on the legs and ankles (lipodermatosclerosis)
• – Ulcers on the legs and ankles
• – Wound that is slow to heal on the legs or ankles.

Generally, the patient’s foot and ankle will be normal in appearance in the morning only, and swell as the day progresses, returning  to normalcy the next morning. The common complaint is the feeling of a dull heavy ache, that develops after long periods of standing.  Occasionally, the symptoms of itching, burning and cramps may also be present. Increased humidity, obesity and the cyclic premenstrual period may intensify the symptoms.

Treatment of Venous Insufficiency

Your doctor may suggest that you take the following self-care steps to help manage venous insufficiency.

• – Wear compression stockings to decrease swelling.
• – Do not sit or stand for long periods. Even slight movement of your legs helps to keep the blood flowing.
• – Care for wounds if you have any open sores or infections.
• – Lose weight if you are overweight.

If your condition is severe, your doctor may recommend the following treatments:

• – Vein stripping –  Small surgical cuts (incisions), are made in the leg near the damaged vein. The vein is removed through   one of the incisions.
• – Bypass – This is surgery to reroute blood flow around the blocked vein. A tube or blood vessel taken from your body is       used to make a detour around, or bypass, the damaged vein.
• – Valve repair – A small incision is made in the leg and the damaged valve is repaired.
• – Angioplasty and stenting – This is a procedure to open a narrowed or blocked vein. Angioplasty uses a tiny medical        balloon to widen the blocked vein. The balloon presses against the inside wall of the vein to open it and improve blood    flow. A tiny metal mesh tube called a stent is then placed inside the vein to it from narrowing again.

Surgery (varicose vein stripping), or other treatments for varicose veins may be recommended if you have:

• – Leg pain, which may make your legs feel heavy or tired
• – Skin sores caused by poor blood flow in the veins
• – Thickening and hardening of the skin on the legs and ankles (lipodermatosclerosis).

Worsening of Venous Insufficiency

In more severe cases of venous insufficiency, the leg can become chronically swollen and inflamed. The leg is now much more susceptible to ulceration and infection.

Deep venous thrombosis is also a medical emergency. This is a blood clot that has occurred in a vein in the leg. The classic example is severe tenderness in the calf upon pressing the area, with the foot simultaneously being dorsiflexed (bent upward).

Other symptoms include persistent or unexplained swelling, usually in only one lower leg. Additionally, the leg may also be red in colour. This should not be confused with intermittent claudication, which generally results in calf pain after walking, and no swelling in the foot and ankle. The diagnosis is usually made with the use of a duplex venous ultrasound. In patients who exhibit shortness of breath, fever, rapid heartbeat or dizziness, a pulmonary embolism also has to be ruled out.

Inspecting the area can give us an idea of the problem, but testing confirms them. These conditions are best diagnosed and treated by vascular surgeons, however, the local treatment of any foot manifestation is usually best in the hands of a podiatrist.

                                             Your feet mirror your general health . . . cherish them!