Whether you’re standing still, running to your next appointment, or dancing the salsa, think about how much time you spend on your feet. Most Americans log 75,000 miles on their feet before they reach age 50, according to the American Medical Podiatric Association (APMA). It’s no wonder that Dr. Sunny Raleigh, a primary care physician at True North Health Center in Falmouth, Maine, says that feet are a vital component to overall health.
“From an osteopathic perspective, we see the feet as our foundation,” said Dr. Raleigh. “When you consider and examine the feet, you can usually unwind many physiological concerns in the rest of the body.”
The fascial, musculoskeletal, nervous, lymphatic, and venous systems in the feet all have intimate feedback connections to the rest of the body, so paying attention to the feet allows Dr. Raleigh to “see the whole person” and assess if something else may be contributing to a problem. She emphasizes the importance of addressing, not just the physical manifestations or symptoms, but also the underlying issues. Her approach is to look upstream for the causes of the downstream diagnosis, continually seeking answers to the question: what is the systemic breakdown that we need to try to repair?
Veins & Feet:
Problems in the feet can be manifestations of arterial or venous concerns. Peripheral arterial disease (PAD) and other related disorders are important to consider when examining the foot. However, the close correlations between foot issues and venous disease- the impairment of blood flow back up towards the heart- also deserve attention.
If venous return is impeded due to damaged valves in the venous system, then the backward flow of blood can pool in the legs and feet. The vein insufficiency, or venous reflux, can cause leg pain and fatigue, spider veins or varicose veins. If left untreated, it can lead to edema, corona phlebectasia and ultimately, ulcers.
Predominantly, most vein issues will present in the medial ankle or anterior shin area. If veins aren’t functioning properly, then edema will often occur. Edema is the venous symptom that is most frequently encountered. People with mild edema in their feet and legs don’t always realize it, but over the years it can create chronic reactions in the skin, such as hemosiderin staining, which is a brown or rusty discoloration of the lower legs. When vein valves fail, regurgitated blood forces red blood cells out from capillaries; those dead cells then release iron, which gets stored in the tissues as a hemosiderin.
The onset of edema can be a prelude to other more serious issues, as the skin becomes susceptible to breakdown and venous ulceration.
“Venous ulcers are always very challenging, and sometimes impossible, to heal,” said Dr. Maisak, a doctor of Podiatric Medicine at Portland Foot & Ankle in Portland, Maine. “Early detection and control of edema will reduce those chronic changes of the skin, greatly lowering the risk of long-term effects.”
According to Dr. Dwight Blease of Casco Bay Podiatry in Brunswick, Maine, some of those long-term effects may include bacterial skin infections or infection of the bone, as well as “all the morbidity associated with those conditions.”
There are a number of minimally invasive treatments of venous disease available, including endovenous laser ablation and sclerotherapy. (North Shore Vein Center Treatments)
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).
Making the Connection:
Because the primary care physician is typically the first encounter a patient with complaints around venous disease and related diseases will have, that initial contact can set the stage for a treatment plan.
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 great.
“Now with these newer techniques in vein treatment, our patients heal quicker and we get an improved functional result,” Dr. Blease said. “We can now see how phlebologists’ skills are expertise can help us do our job better.”
Dr. Masiak 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 contradiction 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 see 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 patients active, independent, working and enjoying their favorite things in life.”
Vein Health News originally published this article by Jennifer Boggs. The article has been edited for space, but the full article can be viewed here: http://veinhealthnews.com/index.php