Member Comments are provided by individuals and reflect their personal opinions only. Under NO circumstances should you act on any advice or opinion posted in this forum. ALWAYS check with your personal physician before taking any action regarding your health! MedHelp International and our partners, sponsors and affiliates have no obligation to monitor any comments posted on this site, or the content and/or accuracy of such exchanges. MedHelp International does not endorse the views of any user.
Peripheral Arterial Disease (PAD) (Expert Forum)
I have PAD and DVT my problem hot swelling feet
Answered by
Lee Kirksey, MD - Peripheral Arterial Disease, PAD, Cardiovascular Disease, stroke, treatment, angioplasty, spider veins, laser ablation, wound treatment, surgery, leg pain, Prevention, Varicose veins
Penn Presbyterian Medical Center of the Univ. of Pennsylvania Healthcare Clinical Assistant Professor at The University of Pennsylvania School of Medicine
Philadelphia - PA
Questions in the Peripheral Arterial Disease forum are answered by Dr. Lee Kirksey, associate professor at The University of Pennsylvania School of Medicine. Topics covered include abdominal aortic aneurysm , amputation, arteriovenous fistula, atherectomy, carotid artery surgery , cholesterol , claudication, deep vein thrombosis (DVT) , endovascular aortic stent graft (EVAR), stent placement , stroke prevention, varicose veins , and venous insufficiency .
I have PAD and DVT my problem hot swelling feet
by Scott52, Apr 08, 2009 01:41PM
Doctor, I am seeing a DR. for this problem but having hard time getting results, here's my latest:
I had ultrasound for my vessels and they diagnosed (mild peripheral artery disease in left leg), then
I had another for my veins and they found (chronic DVT in left calve). I DO NOT HAVE any swelling
nor have I had swelling in my left leg from DVT. My main problem is I have a circulation problem
in the BOTTOM OF MY FEET all the time except when sleeping. I went to an ankle and foot doctor
and she sent me for a MRI of my right foot. She told me she was NOT supposed to see my vessels
in my feet on an MRI and see says that is PAD. My problem is when I am on my feet they get HOT
swell just on the bottom. My Doctor is treating me for My DVT with coumadin and not treating me
for the PAD. I don't seem to be having a problem with my DVT because my leg doesn't swell from
that. Should I be on Pletal for my PAD and not taking the coumadin? How can I subside the redness
and swelling in the bottom of my feet or am I going to have to live with that? My Doctor has not
sent me to a Vascular expert yet, shouldn't he? thank you in advance for your time. Scott(USN)ret
I had ultrasound for my vessels and they diagnosed (mild peripheral artery disease in left leg), then
I had another for my veins and they found (chronic DVT in left calve). I DO NOT HAVE any swelling
nor have I had swelling in my left leg from DVT. My main problem is I have a circulation problem
in the BOTTOM OF MY FEET all the time except when sleeping. I went to an ankle and foot doctor
and she sent me for a MRI of my right foot. She told me she was NOT supposed to see my vessels
in my feet on an MRI and see says that is PAD. My problem is when I am on my feet they get HOT
swell just on the bottom. My Doctor is treating me for My DVT with coumadin and not treating me
for the PAD. I don't seem to be having a problem with my DVT because my leg doesn't swell from
that. Should I be on Pletal for my PAD and not taking the coumadin? How can I subside the redness
and swelling in the bottom of my feet or am I going to have to live with that? My Doctor has not
sent me to a Vascular expert yet, shouldn't he? thank you in advance for your time. Scott(USN)ret
Doctor's Answer
by Lee Kirksey, MD, Apr 13, 2009 10:19PM
, Apr 13, 2009 10:19PMTo: Scott52
Scott
First let me say thanks your your service. Without knowing any of the specifics of your age and risk factors for PAD including cholesterol, diabetes, hypertension and smoking it is hard to make the diagnosis in this format. I can however share with you some facts and you can tell me if they apply.
When I evaluate a patient for PAD, my first questions inquire about your walking distance. Early, mild PAD is frequently associated with symptoms of claudication which is cramps in the calves or thighs with exertion usually around 2,3 or 4 blocks. The symptoms are usually worse with brisk walking. The cramping should resolve promptly with rest. The fact that your feet bother you all of the time is inconsistent with early PAD and is more frequently associated with neuropathy or dammage to the nerves of the feet.
The best test to assess the presence of PAD initially is called and ABI or ankle brachial index which is a measure of blood pressure at the ankle compared to blood pressure at the elbow. the normal value in a non affected person is greater than .9. This test should easily determine if you have PAD, how severe it is and if you need further testing or treatment.
The best management of mild PAD is to control your risk factors mentioned above with medications and to quit smoking if you smoke. Also an exercise program is helpful. I generally dont use pletal because its quite expensive and in the best case scenario, studies show that it only improves walking distance by 20% ie 2 blocks to 2.5 blocks. Not very much for over $2.00 day in cost
Get to a vascular specialist and put any questions to rest about the severity of your problem. Also realize that the presence of blockages in your legs increases the likelihood that you have them in your heart.
Best of health
First let me say thanks your your service. Without knowing any of the specifics of your age and risk factors for PAD including cholesterol, diabetes, hypertension and smoking it is hard to make the diagnosis in this format. I can however share with you some facts and you can tell me if they apply.
When I evaluate a patient for PAD, my first questions inquire about your walking distance. Early, mild PAD is frequently associated with symptoms of claudication which is cramps in the calves or thighs with exertion usually around 2,3 or 4 blocks. The symptoms are usually worse with brisk walking. The cramping should resolve promptly with rest. The fact that your feet bother you all of the time is inconsistent with early PAD and is more frequently associated with neuropathy or dammage to the nerves of the feet.
The best test to assess the presence of PAD initially is called and ABI or ankle brachial index which is a measure of blood pressure at the ankle compared to blood pressure at the elbow. the normal value in a non affected person is greater than .9. This test should easily determine if you have PAD, how severe it is and if you need further testing or treatment.
The best management of mild PAD is to control your risk factors mentioned above with medications and to quit smoking if you smoke. Also an exercise program is helpful. I generally dont use pletal because its quite expensive and in the best case scenario, studies show that it only improves walking distance by 20% ie 2 blocks to 2.5 blocks. Not very much for over $2.00 day in cost
Get to a vascular specialist and put any questions to rest about the severity of your problem. Also realize that the presence of blockages in your legs increases the likelihood that you have them in your heart.
Best of health
Member Comments (7)
by Scott52, Apr 14, 2009 08:02PM
To: Ulnar nerve pain
If i have ulnar nerve pain in my hands could that make my feet red and hot while I am on my feet throughout the day?...I believe that is what is happening..I am 52 years old white male. I am riding the bike everyday, do not smoke anymore but my Doctor says he is going to get me off coumadin in 2 months for my DVT. I have both DVT with no symptoms and PAD with no walking symptoms...I can walk as far as I want with no pain at all anywhere.
by Lee Kirksey, MD, Apr 14, 2009 09:17PM
, Apr 14, 2009 09:17PMTo: Scott52
If you can walk unlimited by pain, it is unlikely that you have any substantial degree of PAD. I suspect that you have neuropathy. Ulnar nerve pain (the ulnar nerve is in your arm). Should not make feet red and hot. Best of Health
by Scott52, Apr 15, 2009 12:01PM
To: Thank you
My Doctor is telling me that the ulnar nerve is somehow making my feet red hot and swelling. I had a neurologist test me already and everything on the bottom part was fine just found ulnar nerve problem. I can't figure this out, I'm still trying to get my Doctor to send me to a Vein and Vascular specialist. thank you again Dr Kirksey, appreciate the help.
by Scott52, Apr 15, 2009 12:02PM
To: Dr Kirksey another quick question
Do you believe I should be on coumadin the rest of my life just because I have mild PAD in my left leg?...My doctor says he is going to take me off of it in 2 months, I have chronic dvt in left leg but no symptoms.
by Scott52, Apr 15, 2009 02:17PM
To: One last question
I am wondering why I am on coumadin if I don't have any symptoms from DVT in left leg and only have a neuropathy in both feet , only when I an on my feet..when sitting around or in bed they are fine. The problem is I cannot tak motrin for my foot pain or ever when I am on coumadin.
by Lee Kirksey, MD, Apr 16, 2009 07:02PM
, Apr 16, 2009 07:02PMTo: scott52
I suspect that you are on coumadin for your dvt because it was felt to be acute. acute dvt has a risk of embolizing (breaking off) and floating to your heart. . That risk diminishes after the dvt becomes chronic, usually 3 months or so. I agree that you need to see a vascular specialist to assess your legs for chronic venous insufficiency and PAD. Coumadin is not a treatment for PAD. PAD forms because of cholesterol from you diet, diabetes and smoking. Coumadin will do nothing to prevent these things
Related discussions
-
Woman and Heart DiseaseEarly Warning Symptom for the #1 Killer of Women Is U...[more]
-
26 male previous DVT in right leg, now maybe another in ... (2 replies):I am a 25 year old male. I was diagnosed with a DVT in m...[more]
