Dr. Raleigh will listen to each patient’s medical
story to begin to hone in on the potential
culprits behind any suspected disease. Treating
venous reflux can often improve foot-related
problems. As a pedorthist, you can look for
these same symptoms and refer the patient to
their primary care physician for treatment. We
are dealing primarily with the lower limb and
are likely to be the first medical professionals to
take notice of these issues. This is an excellent
opportunity to help a patient and build your
relationship with a referral source.
Dr. Kenny Maisak, a Doctor of Podiatric
Medicine (DPM) at Portland Foot & Ankle in
Portland, Maine, also sees every day how health
issues can manifest in the foot. He describes it
as a “closed chain,” meaning the motion of the
foot directly relates to the motion of the ankle,
knee, hip and back. For example, if a patient is
favoring one foot, it may be due to a pinched
nerve in the lower back. Likewise, if a patient is
having foot issues, it may contribute to, or even
create, knee, hip, or back problems.
Veins and Feet
Problems in the feet can be manifestations of
arterial or venous concerns. Peripheral arterial
disease (PAD) and other related disorders are
important to consider when examining the foot.
However, the close correlations between foot
issues and venous disease— the impairment of
blood flow back up towards the heart— also
deserve attention.
If venous return is impeded due to damaged
valves in the venous system, then the backward
flow of blood can pool in the legs and feet. The
vein insufficiency, or venous reflux, can cause
leg pain and fatigue, spider veins or varicose
veins. If left untreated, it can lead to edema,
corona phlebectasia and, ultimately, ulcers.
Predominantly, most vein issues will present in
the medial ankle or anterior shin area. If veins
aren’t functioning properly, then edema will
often occur. Edema is the venous symptom
that Dr. Maisak encounters most. He said that
people with mild edema in their feet and legs
don’t always realize it, but over the years it
can create chronic reactions in the skin, such
as hemosiderin staining, which is a brown or
rusty discoloration of the lower legs. (When
vein valves fail, regurgitated blood forces red
blood cells out of capillaries; those dead cells
then release iron, which gets stored in tissues as
hemosiderin.)
The onset of edema can be a prelude to other,
more serious issues, as the skin becomes
susceptible to breakdown and venous ulceration.
“Venous ulcers are always very challenging,
and sometimes impossible, to heal,” said Dr.
Maisak. “Early detection and control of edema
will reduce those chronic changes of the skin,
greatly lowering the risk of long-term effects.”
According to Dr. Dwight Blease of Casco Bay
Podiatry in Brunswick, Maine, some of those
long-term effects may include bacterial skin
infection or infection of the bone, as well as “all
the morbidity associated with those conditions.”
There are several minimally invasive treatments
of venous disease available, including
endovenous laser ablation (EVLA) and
sclerotherapy.
Current Pedorthics | July/August 2018
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