Health

Thursday 18 September 2014

Ask the Doctor: I suffer with a problem with my legs

Dr Nina Byrnes
Dr Nina Byrnes
Dr Nina Byrnes
Diabetics need to look after their feet

They feel quite cold all the time and can ache especially if I go out for a walk. I also get cramps in bed at night from time to time. Someone said this could be a sign of poor circulation. Is it something I need to worry about?

A: PVD is as serious as heart disease, yet goes untreated

Recurring or persistent pain or discomfort that occurs anywhere in the body is always worth checking out. In the majority of cases there is a simple underlying cause but a doctor review will help rule out anything more serious.

Cold painful legs can be a sign of poor circulation and seeing as the pain you experience is associated with exercise it is worth looking at this in more detail.

Most people are aware that pain in the chest on exercise can be a sign of angina or narrowing in the arteries of the heart. Well narrowing of the arteries outside the heart can also occur. It is referred to as Peripheral Vascular Disease (PVD) and can be equally serious.

It is estimated to affect at least one in 20 people over the age of 55. Only 20pc of those affected are undergoing treatment despite the fact that the risk of having a heart attack or stroke is increased four to five times.

Just like heart disease a family history of PVD increases your chance of developing the condition. Other factors that increase the risk include smoking, obesity, high cholesterol, high blood pressure and diabetes.

In those who smoke the risk of PVD is increased fourfold and symptoms may develop up to 10 years earlier than in non-smokers. PVD is extremely common in diabetics occurring in up to one third of those with the condition.

PVD is more common in men but can occur in women, especially those with other risk factors. The more risk factors you have the higher your chance of developing the disease.

With PVD, arteries around the body become progressively narrowed by the build-up of plaques called atheroma. This mirrors the process that can occur in the heart and the two often occur at the same time. It becomes more difficult for blood to flow and provide oxygen and nutrients to the tissues.

This causes damage over time. Clots may also form in narrowed arteries. If the clot forms in a limb the blood supply can be cut off and gangrene can occur. This is a medical emergency.

If the blood supply is not restored as a matter of urgency an amputation may be necessary. PVD is most common in the legs but can occur anywhere in the body. Other locations include the neck (carotid artery disease), the kidneys (renal artery stenosis), the abdomen (abdominal aortic aneurysm or AAA) and the arms.

Research suggests that less than 30pc of those with PVD have been diagnosed. This may be due to the fact that it is asymptomatic in up to 50pc of those affected, especially in early disease.

As the plaques enlarge, the blood supply to the limbs may be reduced in times of higher demand such as walking or exercising. This may cause pain in the legs on walking that is eased by rest. If the legs are elevated, such as when lying in bed, pain may also develop.

This is often relieved by standing or dangling the legs. Other signs of PVD may include abdominal pain, erectile dysfunction, reduced hair and nail growth on the affected side, dusky skin colour, cool limbs, and sores or infections that are slow to heal.

If any of the above symptoms are present then further investigations should be arranged. The most common investigation involves measuring the difference in blood pressure between the arm and ankle.

A ratio less than 0.9 indicates the presence of lower limb narrowing. Other investigations may include an angiogram to directly look at the blood flow in the arteries. A scan of the neck may reveal narrowing in the arteries here.

If you are diagnosed with PVD it is especially important to lead a healthy lifestyle. Stopping smoking, keeping blood pressure under control, losing weight and exercising can all help.

Diabetics need to take special care of their limbs and feet as they are particularly at risk of amputations. In more advanced cases angioplasty, stenting or bypass can be performed on the vessels affected. In those with an abdominal aneurysm, surgical repair is often recommended once it approaches 5cm as the risk of it rupturing is very high above this size.

So, if you have any of the risk factors above and your legs are aching don't ignore them or put it down to ageing. I do advise getting it checked out – it could be the smartest step you take.

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