Why are your legs swollen?
One day you are at the grocery store and notice that your legs are hurting as you walk around. In addition, they appear swollen and discolored. Unfortunately, over the next several days, your symptoms don’t improve. Why is this happening? How serious is it? What should you do to fix it?
Definition
Peripheral Artery Disease (PAD), is when the circulation to your limbs is reduced. This is usually from the buildup of fatty deposits (plaques) in your arteries, which restrict the area that your blood has to flow through. This process is known as atherosclerosis. Most people associate this with problems related to heart (coronary) arteries, but when you have atherosclerosis, it affects all of the arteries in your body. Just like coronary artery disease (CAD), several things can place you at a higher risk of developing it, such as, smoking, having diabetes, being obese, having high blood pressure, having high cholesterol, having a family history of circulatory problems and aging.
Since the most common area affected by PAD is your legs, the main symptom is having leg pain when you are walking. This is called claudication and feels like a muscle cramping. It’s triggered by increased activity and will go away after resting for a few minutes. Claudication is most often felt in the calf but can occur in any area of the body, usually limbs, where the artery is narrowed. The severity of pain varies greatly depending on how bad the narrowing is that prevents the oxygenated blood from reaching your cells. Besides claudication, some other symptoms you could experience are numbness/weakness in your legs, coldness to your lower leg/foot (especially one side more than the other), discoloration to your legs, shiny skin on your legs, no or a weak pulse in legs/feet, hair loss on legs, slow growth of hair on legs and sores on your feet or legs that don’t heal. If you have PAD, you are at increased risk for having a stroke or heart attack. This is because the plaque buildup that occurs in atherosclerosis can lead to small pieces breaking off and traveling through your bloodstream resulting in a clot forming. Another issue with PAD is critical limb ischemia. This is when you have an injury or infection to your legs or feet that doesn’t heal, so it causes tissue death (gangrene). The only way to treat this once it has set in is to remove the affected area, which involves amputating that part of the limb.
Treatment
The main goals of treating PAD is to manage symptoms and stop the progression of atherosclerosis. Your doctor can help you achieve this by prescribing different medications to lower your cholesterol level, reduce your high blood pressure, manage your blood sugar (if needed) and prevent blood clots. They can also prescribe medication that specifically treats the symptoms of claudication, such as cilostazol or pentoxifylline. If you are having severe symptoms, your doctor may recommend angioplasty or bypass surgery. Angioplasty involves inserting a tiny balloon into the narrowed artery, inflating it to widen the space and placing a small wire mesh coil, or stent, to keep it open. Bypass surgery means using an artery or vein from elsewhere in your body and using it to replace the affected artery. The other major thing your doctor is going to focus on is lifestyle changes. If you smoke, they’ll recommend that you quit. They will work with you to develop an exercise and healthy eating plan that should help to reduce your symptoms. They will also want you to avoid certain over-the-counter cold medications because they can constrict blood vessels, which will make your PAD symptoms worse. Your doctor will talk to you about taking good care of your feet. Due to the reduced circulation and sensation, you are at increased risk of developing sores that won’t heal properly. Some things you can do include wearing well-fitting shoes with thick, dry socks. It is essential to wash your feet daily, but be sure to dry them thoroughly and moisturize them accordingly. Don’t apply lotion between your toes as this can cause fungal infections. If you do end up having a fungal infection, get it treated promptly. While you are washing your feet, be sure to inspect them for any injuries and if you notice anything, be sure to have your doctor look at it. Be careful when you trim your toenails and have any bunions, corns or calluses taken care of by a podiatrist (foot doctor).
Prevention
The best way to prevent peripheral artery disease is to make lifestyle changes. Don’t smoke and if you do, quit. For individuals with diabetes, maintain good control of your blood sugar. Do everything you can to lower your cholesterol level and blood pressure. A key component of this is to eat a healthy diet, especially avoid foods that are high in saturated fat and salt. Also, it is vital to maintain a healthy weight and you can do this by exercising regularly (be sure to talk to your doctor before beginning any exercise plan).
Peripheral artery disease is not only uncomfortable, but places you at increased risk of having severe complications, like heart attacks and strokes. By doing what you can to manage and improve your PAD symptoms, you will have a better quality of life. If you have any questions or concerns, please speak with your doctor. If you would like more information, please visit the American Heart Association’s Peripheral Artery Disease page at https://www.heart.org/en/health-topics/peripheral-artery-disease