Tag: Diabetes and Non healing wounds

PART 4: WHY DO MY TOES, ANKLES AND FEET HURT AT NIGHT? DIABETIC FOOT DISEASE

Posted on by Michael Kokinos

Over the past month, I have discussed why venous and arterial disease as well as Raynaud’s Syndrome may cause pain in the feet and toes at night. Today, I want to discuss another one of the most common causes I see in my clinic for pain in the feet at night: Diabetic foot disease.

Interestingly, diabetes mellitus has Greek etiology and literally means sweet (mellitus) urine (diabetes).  Diabetes is a condition in which the body loses its ability to limit the amount of sugar in the blood.  The high concentrations of sugar result in the formation of harmful chemicals that can hurt the eyes, kidneys, and nerves all around the body, especially in the feet.  Once the sugar levels become high enough, they overload the kidneys—the organ that creates urine—and sugar overflows into the urine, hence the Greek etiology of diabetes mellitus.

Diabetes causes pain in the feet via two main pathways: Neuropathic pain and pain from ulcers. 

Neuropathic Pain:

For neuropathic pain, the high blood sugar levels damage the small nerves in the feet responsible for sensation.  As a result, patients often complain of burning, cramping, tingling, and at the very worst end of the spectrum, numbness.  Sometimes only the toes have these symptoms, but often times the symptoms can encompass the entire foot!

Ulcerative Pain:

The way diabetes results in the formation of ulcers is multifactorial.

  • First, the damage to the nerves can result in numbness or lack of sensation.  Thus, when a person injures their foot, that person does not feel it and protects it from further injury.
  • Second, in addition to damaging the nerves responsible for sensation, diabetes also damages the nerves that innervate muscles responsible for moving.  The damage to the muscle nerves occurs in such a way that irregular contractions of muscles within the foot push the bones of the foot outward creating pressure points that ulcerate easily.  Once the ulcer is formed, infection of the ulcer or exposure of the raw tissues beneath the skin can cause pain.  In patients who otherwise have numb feet, an infection can spread to an area that does have sensation and cause pain there.

Given that diabetes is so common, patient education is vitally important to those impacted by this disease.  If you or anyone you love suffers from diabetes, my hope is that this blog will help you to better understand some of the underlying factors that may be contributing to your foot pain at night.  As a rule of thumb, always remember to share with your primary care physicians all symptoms of pain that you experience during your regularly scheduled appointments and if you think your condition may be getting worse, please do not hesitate to call my office to schedule an appointment for a second opinion! We can help.

408-376-3626

Dr. Ignatius H. Lau

Vascular Surgeon

Dr. Ignatius Lau grew up in Portland, Oregon. He attended the University of Washington in Seattle for college and Stony Brook University in Long Island for medical school. He then went on to train in vascular surgery at Mount Sinai Hospital in New York City. During his time in New York, he performed over 1600 cases involving aortic, peripheral, venous, and carotid surgery. He has a special interest in limb salvage and treating patients with peripheral arterial disease and has extensive training and experience in treating the full spectrum of vascular diseases. Dr Lau was also very active in medical research during his training, ultimately finishing with twelve peer reviewed manuscripts. During his training in New York he met his wife, Lisa, who is a practicing endodontist. Together they love to hike, try new restaurants, and travel.

To see what our patients are saying about us, follow the link below to read our reviews.

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PART 1: WHY DO MY TOES, ANKLE, AND FEET HURT AT NIGHT? VENOUS DISEASE

Posted on by Michael Kokinos

One of the many questions I receive as a vascular surgeon is why do my feet hurt at night?  Though this question may seem simple, every person is different. Before I can provide you with “real” solutions to what’s causing this pain and what can be done to stop it, I need to evaluate multiple factors to understand “Why” this pain exists.  Over the next few weeks, I am going to explore the most common reasons for foot pain at night and why people can have pain in their feet at night caused by venous disease.

For the majority of patients Raynaud’s syndrome, Arterial disease, and Diabetic foot disease explain most of the reasons why people experience pain in their feet at night.  Though pain from problems with bones and muscle can play a role, pain due to these causes usually worsens during the day and with use, not when a patient is resting or lying flat.

In part one of this four-part series, I am going to discuss pain at night caused by VENOUS DISEASE.

Let’s start with a refresher on our bodies “plumbing” (Specifically, how does blood circulate around my body.)

  • Veins are blood vessels that bring blood BACK from the feet to the heart.
  • Arteries on the other hand are the blood vessels that bring blood FROM the heart to the feet.

Veins have specialized structures called one-way valves that allow blood to go up towards the heart but not back down towards the feet.  As we age, veins become dilated (start to leak) because the valves no longer seal properly. These leaky valves allow blood to fall back towards one’s feet which results in an increase in pressure within the veins at the ankle and just above the legs. Gravity tugs on the blood in our veins bringing it down to our feet which causes this increase in pressure

Interestingly, because of the curve that the veins take at the level of the ankle to enter the foot, the increase in pressure is not transmitted directly to the foot and toes.  The increase in venous pressure at the ankle typically results in

  • Varicose veins,
  • Swelling,
  • Dark skin discoloration from the leaking of red blood cells into the skin, and, in the worst cases
  • Ulceration.

Even without ulceration, however, the pain related to swelling and discoloration can be very severe.

People during their normal daily lives spend most of their days either standing or sitting.  Because of this, during the day gravity works in both positions to facilitate the pooling of blood around one’s ankles.  When patients come to me with pain in their feet, I always ask specifically if the pain is localized in the calves and ankles.  When pain is localized to the calves and ankles, I confirm a venous etiology by performing a physical exam and finding varicose veins, swelling, dark skin discoloration and/or ulcers between the ankle and the knee.

Pain that is reported in the foot and/or toes without the physical exam findings of varicose veins, swelling, dark skin discoloration, and/or ulcers between the ankle and the knee is NOT likely to be from a venous cause!  Though vein problems may sound or seem like a rare disease for those who have never had venous disease, patients with vein problems are one of the most common consults I see as a vascular surgeon.  Does foot pain wake you up at night? If you have any of the symptoms or appearance of the leg that I described above, please do not hesitate to call our office on 408-376-3626 to schedule an appointment.

One Final Note:

Though causes from the bones and muscles can play a role, foot pain that worsens at night is rarely due to these causes.  Often pain related to problems with bones and muscles worsen during the day and with use, not when any given patient is resting or lying flat.

Clues that can guide me as a vascular surgeon to the cause include throbbing and aching pain versus numbness and tingling associated with tenderness or pain located in the toes versus pain located in the ankle or just above the ankle in the leg.

 

Dr. Ignatius H. Lau

Vascular Surgeon

Dr. Ignatius Lau grew up in Portland, Oregon. He attended the University of Washington in Seattle for college and Stony Brook University in Long Island for medical school. He then went on to train in vascular surgery at Mount Sinai Hospital in New York City. During his time in New York, he performed over 1600 cases involving aortic, peripheral, venous, and carotid surgery. He has a special interest in limb salvage and treating patients with peripheral arterial disease and has extensive training and experience in treating the full spectrum of vascular diseases. Dr Lau was also very active in medical research during his training, ultimately finishing with twelve peer reviewed manuscripts. During his training in New York he met his wife, Lisa, who is a practicing endodontist. Together they love to hike, try new restaurants, and travel.

WHY DIABETES IS BAD FOR YOUR FEET

Posted on by Michael Kokinos

Everyone knows that diabetes, otherwise known as high blood sugar, is bad for you.  What most people don’t realize, however, is just how many people in the US have diabetes and the impact diabetes has on their feet. In 2021 the CDC released the following info graphic:

 

As a vascular surgeon the primary issue I see in patients with diabetes is foot infection.  But how does diabetes specifically make it more likely for patients to develop foot infections?  My hope in writing this blog today is to give patients a complete understanding of what happens to the feet of people with diabetes.

High concentrations of sugar in the blood lead to what physicians call an inflammatory state in the arteries, or blood vessels that take blood from the heart to the rest of the body.  The inflammatory state results in scarring and narrowing in the arteries.  However, only smaller blood vessels such as the ones in the eyes, toes/feet, and kidneys are affected significantly.  In the feet, the scarring affects both arteries that supply the feet and toes themselves as well as the arteries that supply the nerves.

With a lack of blood flow to the nerves of the feet, patients lose sensation in their toes and feet.  Thus, when a patient has an accidental injury like a scratch or a bruise, no pain is registered, and the area continues to be traumatized and unable to heal.  In addition, the muscles of the foot lose their ability to contract, and they then relax into positions that create bony prominences that erode through the skin and cause ulcers.  Finally, the nerve damage also results in the loss of natural oils in the skin that then makes the skin dry and prone to cracking.  This cracking then increases the chance of ulceration and foot infection.

As you can see, diabetes is very bad for the foot!  If you are diabetic and see an ulcer on your foot or have either pain or numbness, do not hesitate to call our office at 408 376-3626 to schedule an appointment today! Visit our website at www.southbayvascular.com to learn more. We Can Help!

FOOT PAIN AT NIGHT?

Posted on by Michael Kokinos

As vascular surgeons, many of the consultations and questions we receive revolve around one issue: foot pain!  As people age there can be many sources of foot and leg pain and I want to shine some light onto a few of the most common causes that I see.  They include peripheral vascular disease, chronic venous insufficiency, diabetic foot disease, and sciatica.

Peripheral Vascular Disease:

In all people there are two main kinds of blood vessels, arteries, and veins.  Arteries bring blood from the heart to the feet.  Veins bring blood back from the feet to the heart.  In individuals who have a history of

  • High blood pressure,
  • High cholesterol,
  • Diabetes,
  • Obesity,
  • Smoking

The arteries that lead to the feet can develop blockages, otherwise known as Peripheral Vascular Disease.  When too many blockages develop, the feet do not receive the amount of blood they need to stay alive, and they become very painful.  When this happens, patients tend to hang their feet in dependent positions off the side of the bed at night to allow gravity to help the blood travel through the blockages to the feet.  The pain tends to concentrate on the forefoot and toes where the blood vessels are the smallest.

Chronic Venous Insufficiency

With vein disease, patients tend to have swelling in the legs below the knee including the ankle and feet.  Normally, there are structures in the veins called valves that allow blood to go to the heart but not to go back down towards the feet.  In patients with vein disease, these valves leak and cause blood to pool in in the legs below the knees.  After patients are standing or sitting upright for extended periods of time, the pressure in the veins of the legs builds resulting in an aching pain as well as also causing varicose veins, dark discoloration of the skin, and, in the worst cases, ulcers on the leg.

Diabetic foot disease

Diabetic foot disease is one of the most common problems I see as a vascular surgeon.  These patients describe numbness much more often than pain.  This numbness is a result of the inflammatory damage that high sugar levels in the blood can inflict on the nerves of the foot.  Sometimes, even when these patients develop ulcers, they do not feel any pain because the nerve damage is so severe.  As such, patients with diabetic foot ulcers, though they can experience pain, often experience numbness as well.

Sciatica

Lastly, sciatica can also be a cause of leg and foot pain.  The nerves that detect sensation from the legs and foot originate from the spinal cord in the back of the pelvis and abdomen.  As such, when these nerves are pinched they tend to cause the patient to feel a pain radiating from the lower back or buttock down the leg and sometimes even to the foot.  This radiating pain can be easily distinguished from the pain of peripheral vascular disease and venous insufficiency which is concentrated in the legs and feet.

 

If you or anyone you know suffers from leg pain at night and if any of these stories seem to fit the pain or discomfort that you may be having in your legs, please call one of our South Bay Vascular Offices in either Campbell or Gilroy CA at 408 376 3626 today to schedule an appointment! We Can Help!

GILROY CA. NON-HEALING LEG WOUNDS AND VASCULAR SURGERY

Posted on by Angelica Rodezno

Chronic wounds (wounds that do not heal after four weeks) are a silent epidemic in the United States and affect almost 7 million people. If not healed in a timely fashion, they can lead to loss of limb and in some instances can lead to amputation or death.

Many patients suffering with non-healing leg wounds are seen in wound care centers for the treatment of their foot and leg ulcers but unfortunately, many times the physicians in these wound care centers are quick to put on expensive savs or other advanced treatment options without treating the underlying circulatory issue.

The best wound care centers treat by guidelines rather than simply treat the symptom of what might be a deeper,underlying condition. Guidelines are a scientifically proven set of steps that have been shown to help wounds heal faster.

For EVERY non-healing wound on the leg or foot, the very first step must be to assess BLOOD FLOW. This means that every patient with a leg or foot wound that hasn’t healed in four weeks MUST be seen by both a vascular surgeon AND a podiatrist (foot specialist).

A vascular surgeon will assess the circulation and order appropriate diagnostic tests, such as vascular ultrasounds to look at the blood flow. This is important to examine, as a large number of the patients who have ulcers, have not previously been diagnosed with an arterial or venous problem. Without fixing the underlying cause of the ulcer, even if it does heal initially, it will soon recur, and cause further problems. It is important for patients to take an active role in asking for these referrals so that the problem does not progress and become a wound that can lead to an amputation.

Recognized as one of the most experienced and respected vascular surgeons in Northern California, Dr. Kokinos is focused on restoring the circulatory health of their patients thereby helping them heal their wounds and return to a normal way of life.

With offices in both Gilroy and Campbell, CA, South Bay Vascular’s Board Certified Vascular Surgeons bring cutting edge wound care treatment to the South Bay communities of Gilroy, Hollister, Salinas and the Hwy 152 corridor to the Central Valley. With a state of the Art Vascular Ultrasound Lab now located in Gilroy at our 8420 Church Street office expert vascular care is simplified as patients can now get world class care in their own community.

If you or anyone you know suffers from a Non-Healing leg wound or ulcers of the foot and leg, call our offices at 408-376-3626 to schedule an appointment.