Poor arterial circulation in the legs (limping)

What is limp?

Poor circulation in the legs is caused by the narrowing or blockage of one or more arteries. We speak of peripheral arterial disease or arteritis of the lower limbs.

An artery is a blood vessel that carries blood from your heart to your tissues and organs. A vein brings blood back to the heart. When an artery becomes blocked, part of your leg does not get enough blood, and therefore not enough oxygen. It can cause damage.

An artery can become blocked or narrow suddenly (acute) or gradually (chronic) (see below).

Claudication

When you exercise, your muscles need more oxygen and therefore more blood. If one or more arteries are narrowed or blocked, your muscles are not getting enough blood and oxygen. You may then feel pain in your legs when you walk. This pain goes away with rest. So you often stop while walking. This is called intermittent claudication.

Sudden obstruction (acute ischemia)

An artery can suddenly be blocked with a blood clot.

  • When a blood clot forms in place in a blood vessel, it is called thrombosis.
  • When a blood clot forms in another blood vessel, breaks loose, is then carried away by the blood stream, and eventually gets stuck in a narrower artery, it is called an embolism.
Progressive obstruction (chronic ischemia)

An artery can gradually become blocked. We speak of arteriosclerosis, atherosclerosis or atheromatosis.

Atherosclerosis is caused by deposits of fat (atheromatous plaques) and calcification of the walls of blood vessels. The blood circulates less well in the artery and the muscles receive too little oxygen. This lack of oxygen acidifies your muscles. You then feel pain that looks like a cramp.

Risk factors

You are at greater risk of developing poor circulation in your legs if:

  • you smoke ;
  • people in your family suffer from cardiovascular disease;
  • you are older;
  • you have diabetes ;
  • you have high blood pressure ;
  • you have too high cholesterol ;
  • you are overweight;
  • you don’t exercise a lot and you often sit still.

Do you suffer from poor circulation in your legs?
It is then likely that other arteries in your body are also affected. This is why it is very important to prevent other cardiovascular diseases, such as a heart attack or stroke.

So try to reduce the risk factors mentioned above by adopting a healthy lifestyle .

What is its frequency?

Sudden obstruction

Every year, 14 in 100,000 people suffer from a sudden lack of oxygen in their legs 1 .

Progressive obstruction

A progressive lack of oxygen in the legs occurs in 7% of people over the age of 55 and in 56% of people over the age of 85.

In most cases, the condition progresses slowly. However, 15% of people with progressive artery blockage develop very severe oxygen deficiency. Within 10 years of diagnosis, 2% undergo amputation 1 .

In addition, the risk of other cardiovascular diseases is 3 times higher 1 .

How to recognize an obstruction of the arteries of the legs?

Sudden obstruction

Sudden obstruction of one or more arteries in the legs is characterized by what are called the 5 Ps:

  • sudden pain at rest (pain is called “pain” in English);
  • absence of pulse in the feet (without pulse is said to be “pulseless” in English);
  • feet pale and cold to the touch (for “palor” in English);
  • numbness (“paresthesias”);
  • muscle weakness (for “paralysis”).

Your whole leg may feel cooler to the touch. You feel a distinct difference between the cold areas and the hot (unaffected) areas of your skin. Some areas, especially your toes, may turn blue.

Progressive obstruction

A lack of oxygen in the legs can be mild, moderate, or severe. The feet are cold at all stages. The other most common symptoms vary depending on the stage:

  • mild oxygen deficiency causes few or no symptoms;
  • moderate oxygen deficiency causes intermittent claudication:
    • you have pain in your legs,
    • you usually have pain in the calves, sometimes in the buttocks, thighs or feet,
    • the pain appears when you walk and decreases when you rest for 5 to 10 minutes,
    • The pain happens more quickly when you walk uphill or when you walk faster.
  • a serious and critical oxygen deficit also causes pain at rest:
    • you experience severe pain, especially in the forefoot or toes,
    • at first the pain only happens at night,
    • when you let your leg hang out of bed or stand up for a while, the pain decreases.

Other possible symptoms at all stages are:

  • numb feet;
  • nail abnormalities;
  • hairs that grow slower on the toes and lower legs;
  • skin wounds that heal poorly.

How is the diagnosis made?

Physical examination

Your doctor will usually think of poor circulation based on your typical symptoms and their findings during a physical exam. He or she will feel the pulse in your feet.

Doppler examination

The doctor will confirm the diagnosis with a Doppler examination. This test can determine the narrowing of your arteries by determining the ankle-arm index or tibio-brachial index (ITB). This is the ratio of the highest blood pressure measured in your ankles to that in your arms. This report gives an indication of the degree of blood circulation in your lower extremities:

  • an ITB greater than 1 indicates good blood circulation;
  • an ITB of less than 0.4 indicates very poor circulation.
Other examinations

If your doctor is considering surgery, the following tests may be necessary:

  • a duplex ultrasound; this is a special ultrasound that examines your blood vessels;
  • an angiogram; this exam allows you to see your blood vessels via an MRI or a CT scan, possibly using a contrast medium.

In addition, your doctor will assess your risk for other cardiovascular diseases. This assessment requires a blood test to find out, for example, your blood sugar (blood sugar) and fat levels.

What can you do ?

Healthy lifestyle

Exercise and a healthy lifestyle are very important.

  • Try to quit smoking , this is the most important step!
  • Get enough movement. Walk an hour a day if possible. If that’s not possible, every little bit counts.
  • Watch your weight.
  • Eat healthy and varied.
  • Moderate your alcohol consumption.
Foot care
  • Avoid injuring your feet.
  • Avoid baths that are too cold or too hot.
  • Take care of your feet.
  • Wear suitable shoes, especially if you also have diabetes.
Exercise program

Ask your doctor if you can follow an exercise program and gait training (see below), supervised by a physiotherapist preferably specialized.

What can you do with your physiotherapist?

Walking training is the best treatment for claudication:

  • You follow this training preferably under the supervision of a physiotherapist specializing in the field of claudication. This physiotherapist has therefore undergone specialized training to support you in this training.
  • Walking training supervised by a physiotherapist certified in limping is the best guarantee of obtaining good results.

You will find more information about physiotherapy in the event of limp in the guide ‘ Poor arterial circulation in the legs: physiotherapy ‘.

What can your doctor do?

Sudden obstruction

If there is a sudden or critical lack of oxygen in the legs, your doctor will send you to the hospital as soon as possible (within 6 hours). The blocked blood vessel should preferably be opened there immediately. Several methods are possible.

Sometimes an amputation is inevitable. This often happens immediately to unhealthy people who can no longer move on their own or when at least half of the foot is necrotic.

Progressive obstruction

The treatment of claudication (moderate oxygen deficit) is primarily conservative. This means that there will be no surgery.

Exercise program and gait training

The main purpose of an exercise program and gait training (see below) is to improve blood circulation.

  • This is preferably done through an exercise and walking program supervised by a specialized physiotherapist. Your doctor can prescribe it for you.
  • Walking stimulates the production of new blood vessels in your legs. It will allow you to walk further and further without pain. This way you can avoid an operation.

You can find more information on physiotherapy for poor arterial circulation in the legs (limping) in the section “What can you do with your physiotherapist?” and in the guide ” Poor arterial circulation in the legs (limping): physiotherapy “.

Vascular surgery

If conservative treatment does not work and your symptoms bother you too much, the doctor will refer you to a vascular surgeon:

  • a tube (stent) can be implanted at the level of the stenosis of the blood vessel;
  • another option is bypass. This procedure helps bypass the blocked part of the artery. This is a deviation of the blood.

Your doctor will also refer you to a vascular surgeon if:

  • the diagnosis is uncertain;
  • your complaints increase rapidly or if they are permanent;
  • your symptoms are intolerable after 6 months of conservative treatment and supervised walking training.
Decrease the risk of cardiovascular disease

The condition is usually not confined to a single artery. Usually, other parts of the body are also affected, such as the heart and brain. Your doctor may initiate treatment with medicines to reduce this risk. For example :

  • of anticoagulants (such as aspirin or clopidogrel);
  • medicines that lower cholesterol (cholesterol lowering drugs) (statins);
  • medicines to lower blood pressure (antihypertensives), if necessary.

Sources