Current Pedorthics | July-August 2018 | Vol.50, Issue 4 | Page 46

Veins and Feet Dr. Raleigh suggests that there may also be a role for osteopathic manipulative medicine in treating vascular and venous insufficiency. A 2012 study showed that adding myofascial manipulation to venous treatment increased venous return in post-menopausal women (when compared to direct venous treatment alone)1. Making the Connection Because the pedorthist is often eye level with the client’s lower limb, we are often able to ask some questions regarding the patient’s symptoms and identify people who may benefit from additional work up to investigate whether they have venous disease. After that, a referral to their primary care physician is in order. According to Dr. Raleigh, a good diagnostic exam often leads to a referral for further studies and intimate care with specialists: “We all have our role to play in supporting the overall health of each patient, with the PCP acting as QB, making sure the plays are going off as desired. It’s our priority to make sure that the patient is getting the best possible care by using specialists and adjunct providers optimally.” Dr. Blease has been practicing podiatry for more than 25 years. He explains that when he was in podiatry school there was an emphasis on the arterial system, with little study of the venous system. He also recalls having a patient who was told she could never have surgery done on her foot because she’d had her veins stripped and the potential for severe swelling and delayed healing were too great. “Now with these newer techniques in vein 44 Pedorthic Footcare Association | www.pedorthics.org treatment, our patients heal quicker and we get an improved functional result,” Dr. Blease said. “We can see how phlebologists’ skills and expertise can help us do our job better.” Dr. Maisak concurs. If he sees that a patient has venous insufficiency, he will consult a vein specialist for possible treatment. Vein insufficiency (often accompanied by edema) may be a contraindication to surgery, because of the likelihood that the skin will have trouble healing. He also recognizes that podiatrists can play a role in early detection for venous or vascular issues. “We see a lot of lower extremities, so we can be a good source for identifying vein-related problems,” said Dr. Maisak. Even the APMA, the leading professional organization for podiatrists in the U.S., has acknowledged the link between podiatry and phlebology. In 2013, the APMA joined the “Rethink Varicose Veins” campaign to raise awareness of venous disease diagnosis and treatment. Dr. Blease sees the “Rethink” campaign as a step in the right direction. He believes this is an issue that goes undiagnosed and untreated in many situations, and he encourages all physicians to learn more about it: “We all share the same goal— keeping our p