Foot Care for PAD

Peripheral arterial disease (PAD) is commonly known as hardening of the arteries. It occurs when arteries in the legs become clogged with fatty deposits. When leg arteries are clogged, blood flow to the legs is reduced. Some people call this poor circulation.

If PAD becomes severe, the foot does not receive enough blood and can become ischemic, meaning that there is a lack of oxygen to the tissues. This can happen if an artery suddenly becomes blocked or, over time, if PAD progresses to the point that blood is no longer able to carry enough oxygen to the foot. The condition in which the foot becomes ischemic or does not have enough blood is called critical limb ischemia (CLI). Approximately 5-10% of people with PAD develop CLI and, of those, approximately 5% will require an amputation. Major risk factors for critical limb ischemia include smoking, diabetes, age greater than 40, hypertension, having abnormal blood cholesterol levels, and being male.

When a foot becomes ischemic, the skin often becomes thin and the hair disappears (however, these events are not always caused by ischemia). The toes may become slightly blue tinged when the foot is hanging down. The foot may become white (elevation pallor) when elevated and red when dependent (dependent rubor). The foot may be cool to the touch and the nails may become thick. The heel, toes, and other pressure areas on the foot may develop fissures (or cracks) that are painful. The skin may break down between the toes (kissing ulcers) and become very painful. In critical limb ischemia, the blood reaching the foot is so limited or slow that ulcers and gangrene can develop.

When diabetes is present, it is not uncommon for the foot to lose feeling and develop changes in the structure of the foot. This increases the risk of developing sores on the feet. When PAD and diabetes are both present, it becomes very difficult to heal sores.

It is important that you take care of yourself and eat healthy, balanced meals. Nutrition is an important factor for healing in both people with and without diabetes. If you smoke, ask for assistance in stopping. Smoking increases the progression of PAD. If you have diabetes, keep your blood sugar well controlled. Take all your medications that have been prescribed for you. If you think that you need to stop one of your medications, be sure that you discuss this with your health-care provider. Try to continue regular exercise even if you are able to walk only three to five minutes at a time. It will not make your PAD worse and will enable more blood to reach your foot. Do not wait for a scheduled appointment with your health-care professional if you think that your feet are becoming worse. Call for an appointment or go to an urgent care facility. Be sure that your feet are examined at each visit.

About the Author: Carolyn Robinson RN MSN NP is a nurse practitioner in vascular surgery at the VA Medical Center in Minneapolis. Carolyn has a special fondness for veterans and the aging population. She has spent the last 14 years working with patients with lower extremity wounds and is committed to the early identification of critical limb ischemia and aggressive limb salvage.