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Monthly Archives: November 2011

Circulatory Problems Amongst the Elderly

Poor circulation of the limbs is a common problem and often accompanies the aged population. It can be the source of a whole bunch of health conditions effecting arteries, veins or lymphatics. For the purpose of this blog, the main focus will be on arterial insufficiency.

Poor circulation in the feet and legs, also known as peripheral vascular disease (PVD) occurs when the arteries supplying blood to these limbs are damaged.  This most commonly stems from thickening and hardening of arterial walls, whereby fatty plaques, cholesterol deposits or other material clog the artery walls. This is called atherosclerosis, which promotes narrowing of the artery or in extreme circumstances, complete occlusion. The vascular status of the lower limb bears a direct relationship to tissue viability; furthermore the severity of vascular disease has been shown to be associated with an increase in morbidity and mortality.

Diabetes, lack of physical activity, high blood pressure and high cholesterol, are too associated with atherosclerosis.

Diabetes and atherosclerosis

Diabetes is said to increase the likelihood of atherosclerosis and is considered the most common cause of PVD. Diabetes accounts for 4% of the Australian population and consumes 12% of Australia’s health budget. This is estimated to double by 2030.

Persons suffering from Diabetes for a long period of time often have damage to nerve and blood supply to their feet.  

Furthermore, retinopathy, nephropathy, angiopathy, neuropathy, and infection are common conditions of diabetes that can have detrimental effects.

Other conditions associated with PVD

PVD can also be associated with other conditions such as embolic occlusions, aneurysm disease, vasospastic disorders, inflammation disease, entrapment and cystic degeneration.  Vasospastic disorders include Raynaud’s; a cold induced spasm, marked by constriction and spasm of blood vessels in the extremities. 50% of Raynaud’s is idiopathic and the other 50% is secondary to conditions such as rheumatoid arthritis. Inflammation diseases include buergers, whereby inflamed vessels of hands and feet become blocked. This is commonly associated with smoking.

Sings Symptoms of PVD

The most common signs associated with PVD are changes to skin colour (pallor) trophic changes (nails not growing or have thickened and hair loss), lack of pulses, perishing cold and skin break downs that don’t heal. Further, those will often experience numbness, tingling or burning sensations.

When the deficiency of blood supply is prolonged the tissues eventually suffer irreversible damage and this stage can be recognised by muscle tenderness, mottling and motor or sensory deficit. Continuation of the condition will lead to a chronic state of insufficiency. This is accompanied by pain on exercise, commonly cramping in the calf when walking. This is known as intermittent claudication and is caused by the exercising muscles producing metabolites that are not cleared by the blood. These cause ischaemic pain and stopping for a few minutes causes the pain to go away. The distance walked before the onset of pain is called the claudication distance. If the block of blood supply is in the thigh the person will get calf claudication and if it is in the calf, foot claudication.

It is important to note, however, that diabetics may have damage to nerves, causing a loss of feeling and hence, pain associated with PVD may not necessarily be present.

Foot and Leg Ulcers

Leg ulcers have a tendency to recur in the elderly. Ulcers are breaks in the layers of skin that fail to heal. The most common cause of chronic leg ulcers is poor blood circulation (both arterial and venous). PVD is a crucial factor in determining the outcome of a foot ulcer. Diabetics are particularly prone to ulcers due to poor circulation and or loss of sensation in conjunction with trauma and deformity, leading to pressure ulcers.

Arterial ulcers and intermittent claudication are serious warning signs. 46% of ischaemic ulcers lead to amputation. In fact, every year thousands of people have toes, feet, and legs amputated due to diabetic complications.

Importance of Podiatric management

Complications of PVD, especially amputations can often be prevented with proper foot care. This involves a multidisciplinary approach from podiatrists and nurses, as well as other health care professions. Simple routine procedures such as washing feet regularly, drying in between toes and maintaining general personal hygiene play a vital role. Further, general skin care such as applying an emollient daily to the feet and legs, and ensuring proper footwear and hosiery are worn, in between regular podiatry visits, can have an impact. Specific podiatric management ensures an evaluation and assessment of status of circulation, toenail care as well as corns and calluses, advice on footwear and management of wounds.

Overall, feet are one of the most vulnerable parts of the body, yet they are commonly neglected. Persons suffering from diabetes must be especially careful with feet and same applies for the elderly, due to the poor circulation that usually accompanies. Together as health professions we can provide simple, yet intelligent care of feet, that can add quality and in fact years to one’s life.

Written by

Ashlee Finch

Podiatrist

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