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Monthly Archives: August 2014

Vascular Assessments

Why is a vascular assessment important?

Poor circulation in the legs and feet is affecting a greater quantity of the population. 20% of leg ulcers are due to arterial disease. This is due to numerous factors as diverse as sedentary lifestyle, aging population and an increase in diabetic population and smoking. The feet are furthest away from the heart and therefore often suffer the greatest reduction in blood flow. The wall of the blood vessels can be damaged due to plaques of cholesterol and fibrin blocking the artery or the vessel’s elasticity can lessen and this can affect the pressure in the ‘network of pipes’. Sometimes arteries become injured resulting in scar tissue which will block the blood flow.

Signs of decreased blood flow to the legs and feet can vary depending on your general health, medication and activity levels. Commonly people complain of thinning of the skin, cold feet, cramps in the calf’s or thighs whilst walking, wounds or ulcers which fail to heal, muscle wasting in the forefoot and rest pain. The symptoms may be different in each foot and may be masked due to medication or a habitual lack of exercise.

How do we assess you?

Your circulation to the feet and legs can be reviewed by the podiatrist using simple clinical techniques. The history and symptoms will be recorded. Your pulses will be palpated in the foot and ankle.

An examination called the buerger’s test will be used to check the capillary refill time in your toes. This is where we evaluate the leg 45 degrees for one minute then measure in seconds how quickly the toes turn red.

In addition an ankle brachial pressure index can be calculated. This is where we compare the systolic blood pressure in the brachial artery of the arm to the posterior tibial or dorsalis pedis artery of the foot. We divide the foot score by the arm score. A good result is 1, but if the value is equal or less than 0.8, blood flow is reduced. The technology used to measure blood flow is Doppler ultrasounds.

How long is the duration of the assessment?

Usually about half an hour. You are required to lie still whilst you are assessed.

Who should have this assessment?

Anyone with a circulation problem or with an underlying medical disorder which may put you at risk. Find the cause, treat it successfully and the problem should improve or even erase the problem altogether.

Patients with poor circulation will usually need to be referred to a vascular consultant for further assessment and treatment if necessary.

Plantar Fasciitis

Plantar Fasciitis means inflammation of your plantar fascia. Your plantar fascia is a strong band of tissue (like a ligament) that expands from your heel to your middle foot bones. It supports the arch of your foot and also performs as a shock-absorber in your foot.

What causes plantar fasciitis?

Repeated small injuries to the fascia are thought to be the cause of plantar fasciitis. The injury is usually close to where the plantar fascia attaches to your heel bone.

You are more likely to injure your plantar fascia in certain situations. For example:

If you are on your feet for a lot of the time, or you do quite a bit of walking, running, standing when your are not use to it. (Plantar Fasciitis may be confused with ‘Policeman’s Heel, but they are different. Policeman’s heel is plantar calcaneal bursitis – inflammation of the sack of fluid under the heel bone. This is not as commonly known as plantar fasciitis.) Also, people with sedentary lifestyle are more prone to plantar fasciitis.

If you have recently started exercising on a different surface – for example, running on the road instead of a track.

If you have been wearing shoes with poor cushioning or poor arch support.

If you are overweight, this will put extra strain on your heel.

If there is overdoing or sudden stretching of you sole. For Example: athletes who increase running intensity or distance.

If you have a tight Achilles tendon ( the big tendon at the bottom of your calf muscles directly above your heel. This can affect your ability to flex your ankle and make you more likely to damage your plantar fascia.

Often there is no apparent cause for plantar fasciitis, particularly in older people. A common wrong belief is that the pain is due to a bony growth or ‘spur’ coming from the heel bone. Many people have a bony spur of the heel bone but not everyone with this gets plantar fasciitis.

What are the symptoms of plantar fasciitis?

Pain is the main indication. This can be anywhere on the underside of your heel. However, frequently, one spot is found as the main source of pain. This is often about 4cm forward from your heel and may be tender to touch.

The pain is often at its worst when you take your first steps on getting up out of bed in the morning, or after extended periods of rest where no weight is placed on your foot. Gentle exercise may ease things a little as the day goes by, but a long walk or being on your feet for a long time often makes the pain worse. Resting your foot usually eases the pain.

Rapid stretching of the sole of your foot may make the pain worse, for example, walking up stairs or on tiptoes. You may limp because of pain.

How is plantar fasciitis diagnosed?

Your doctor can usually diagnose plantar fasciitis just by talking to you and examining your feet. Rarely, tests are needed if the diagnosis is uncertain or to rule out other possible causes of heel pain. These can include X-rays of the heel or an ultrasound scan of the fascia. An ultrasound scan usually shows thickening and swelling of the fascia in plantar fasciitis.

What is the initial treatment for plantar fasciitis?

Usually, the pain will ease in time. Fascia tissue, like ligament tissue, heals quite slowly. it may take several months or more to go. However, the following treatments may help. Collectively, these initial treatments are known as conservative treatments for plantar fasciitis.

Rest your foot

This should be done as much as possible. Avoid running, excess walking or standing, and undue stretching of your sole. Gentle walking is fine.


Do not walk barefoot or on hard surfaces. choose shoes with cushioned heels and good arch support. A laced sports shoe rather than an open sandal is probably best. Avoid old or worn shoes that may not give good cushion to your heel.

Pain relief

Painkillers such as paracetamol will often ease the pain. Sometimes anti-inflammatory medicines such as ibuprofen are useful. These are painkillers but also reduce inflammation and may work better then ordinary painkillers. Some people find that rubbing a cream or gel that contains anti-inflammatory medicine on to their heel is helpful. An icepack held to your foot for 15-20 minutes may also help to relieve pain.


Falls Prevention

Falls  are a major cause of injury for older people. They are most common cause of injury-related hospital admissions in people aged 65 years and over. In that same year, 70 percent of those aged 65 years and over and admitted to hospital as a result of a fall were women.

Falls are common among older people

Is it estimated that at least one-third of people aged 65 years and over fall one or more times a year. Although many of these falls do not result in injury, they can cause:

– Hip and wrist fractures

– Hip and shoulder dislocates

– Head injuries and abrasions

– Bruising and sprains

– Fear of falling that can result in loss of confidence and restriction of activities

Avoid falls

To avoid falls and injuries from falls:

– Exercise to increase you balance, strength and flexibility. Home or group exercise programs and tai chi are good examples.

– Wear shoes that are comfy and fit well – they should be wide enough in the toe area, have low or no heels, and have slip-resistant soles.

Improve safety inside

To increase safety in the home:

– Have sufficient lighting. Replace light globes with CFL energy efficient light globes of 12 watts or higher. Use plug-in night-lights and have movement sensitive lights near stairs and the bathroom. These lights are available from most leading hardware stores.

– Remove clutter and make sure walkways and corridors are kept clear and well lit.

Repair or replace carpets with worn areas, holes or long threads.

– Check that mats and rugs are secure and have no tears or wrinkles. Put adhesive strips on all mats and rugs, including those in the bathroom.

– Make sure that chairs and beds are sturdy an easy to get in and out of, and that tables and benches do not have sharp corners.

What do to if you fall at home

If you happen to have a fall at home:

– Don’t panic – stay still for a few minutes and try to calm down

– Call for help if you can

– Dial Triple zero to telephone emergency services or call your local doctor for help – Keep your telephone in easy reach of the floor, for instance on a low table

– Decide whether you can get up yourself

If you can get up yourself

– Roll over onto your stomach and try to get into a crawling position

– Crawl to a stable piece of furniture, like a lounge chair

– Try to get up onto your knees

– Push up, using your strongest leg and arms, still firmly holding onto the furniture

– Sit down on the furniture

If you cant get up yourself

– Try to crawl or drag yourself to somewhere on carpet and find anything warm, such as bedclothes, a towel or clothing while you wait for help

– Use your personal alarm, if you have one

– If you don’t have a personal alarm, use and object that you can bang to make a loud noise, like a walking stick against the wall, to alert a neighbour

– If you know no one will hear you, keep warm and try to get up again later