Peripheral Arterial Disease and Foot Wounds

By Lauren Molchan, DPM R2 - February 24, 2020

Peripheral Arterial Disease and Foot Wounds
By Lauren Molchan, DPM R2 

What is peripheral arterial disease (PAD)? 
·  Peripheral arterial disease or PAD refers to the buildup of plaques on the arterial wall that cause narrowing or blockage of arteries that carry blood to the limbs, most commonly affecting the legs. PAD may occasionally affect the upper extremities as well. 
·  If symptoms do arise, the most common symptom is leg pain that is brought on by activity and goes away with rest. Other symptoms include: cuts or sores on your feet that don’t heal or a toe that turns black and doesn’t heal.
·  Narrowing of the arteries places patients with PAD at a high risk for stroke, heart attack and limb loss. For this reason, if you suspect PAD, it is important to talk to your doctor. 

Are diabetic patients more likely to have PAD? 
·  Yes, diabetes is a risk factor for developing PAD. In diabetic patients, the risk of PAD is increased by: duration of diabetes, age, smoking status, and presence of peripheral neuropathy. 
·  According the American Diabetes Association, 1 in 3 diabetic patients over the age of 50 have PAD, versus 1 in 20 Americans in the general population over the age of 50. 
·  PAD is a major risk factor for amputation in diabetic patients. It is important to establish care with vascular and wound care specialists to treat PAD symptoms and prevent limb loss. 

Why does PAD increase the risk for foot wounds and limb loss? 
·  When the vessels that carry blood to the legs and feet narrow or become completely blocked, patients’ risk of developing non-healing wounds on the lower extremities greatly increase. This is because the blood carries oxygen and other nutrients that are required for wound healing and tissue regeneration. Without adequate blood flow, the body is unable to heal small cuts or breaks in the skin.
·  Additionally, the risk of infection in these wounds is also increased. The body’s natural defenses to bacteria and immune cells are carried to cuts and wounds through the blood. If the vessels are narrowed and blood flow is blocked, the immune cells are unable to reach the wound and fight off infection causing bacteria. 

How can wounds associated with PAD be managed and treated? 
·  There are important steps patients can take to help in their own treatment and improve blood flow and wound healing such as smoking cessation, exercise, maintain a healthy diet, monitor of blood glucose levels and blood pressure. 
·  However, non-healing wounds and symptomatic PAD require treatment from specialists. A visit to the vascular surgeon to properly evaluate the health of blood vessels is important for patients with PAD and foot wounds. Treatment may be required to improve blood flow before healing can be achieved. 
·  It is also important to see a foot or wound specialist such as a Podiatrist to aid in the  treatment. It is also important to maintain close follow up with your general doctor for diabetes management, blood pressure control, cholesterol monitoring and overall health management. 

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