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
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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