Peripheral Vascular Disease (PVD)

This condition is characterized by the arteries in the feet and legs becoming narrow
and hard, which restricts blood supply. As the circulation becomes impaired, oxygen
and other nutrients cannot be replenished in the cells of the legs and feet, contributing
to slowed wound healing, dry skin, reduced skin and nail health, feeling cold in the
extremities, and is more common in people who have diabetes.
The cause of PVD is atherosclerosis, the technical name for hardening of the
arteries. Peripheral arterial disease (PAD) is a type of peripheral vascular disease that
affects the arteries of the extremities, such as posterior and anterior tibial arteries
(arteries behind and in front of tibia, the major bone of the lower leg). The classic
symptoms of PAD are: intermittent claudication and pain in the legs when resting.
Intermittent claudication (IC) is characterized by pain upon movement, due to lack of
blood supply that is relieved by rest. IC is caused by build-up of plaque in blood vessels.
Clients with diabetes and PAD may not have these symptoms if severe peripheral
neuropathy is present. Neuropathy may mask the symptoms of intermittent claudication
in this population, which can lead to worse health outcomes in clients who have diabetic
vs. those without it. As a result, both neuropathy and lack of oxygenation in the tissues,
also called ischemia, leads to formation of foot ulcers in clients with diabetes.
Recommended footwear modifications include: orthopedic footwear with a rocker
sole feature, good mid-foot stability, firm heel counter, and it has to only flex in the
forefoot. Custom orthotics are also greatly beneficial. As to surgery, arterial
reconstruction is an option. Revascularization procedures used are: stenting,
angioplasty, bypass grafts to blood vessels of the feet, and atherectomy.

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