Tag: Foot Pain

PART 2: WHY DO MY TOES, ANKLES, AND FEET HURT AT NIGHT? RAYNAUD’S SYNDROME

Posted on by Michael Kokinos

Last week I wrote the first part of a four-part series about foot pain at night.  Specifically, I talked about venous disease as a cause of foot pain.

Today, I want to talk about another common cause of foot pain at night: Raynaud’s Syndrome. 

As a quick review, last week we talked about the two main types of blood vessels in our bodies: arteries and veins.  Arteries bring blood from the heart to the feet under high pressure.  Veins bring blood back from the foot to the heart under low pressure.

Raynaud’s Syndrome is a disease of the arteries, particularly the small arteries, in the feet.

(Though Raynaud’s can also affect the hands as well). 

Before we dive into Raynaud’s Syndrome though, I need to briefly review another anatomical system in our bodies that is involved in Raynaud’s Syndrome: The nervous system.

In general, we have two broad types of nerves.

  1. There are nerves that are responsible for sensation and for moving muscle and
  2. There are nerves that are responsible for regulation of bodily function.

Diving a little bit deeper into the kinds of nerves that regulate bodily function, there are the

  • Sympathetic nervous system: The sympathetic nervous system, amongst other things, is responsible for opening blood vessels in the legs and arms and increasing blood flow when exercise is necessary
  • Parasympathetic nervous system: The parasympathetic nervous system in similar fashion opens the blood vessels leading to the intestines to allow for the digestion of food.

In patients with Raynaud’s Syndrome, sometimes their sympathetic nervous system does not function properly resulting in the constriction of blood vessels that lead to the hands, fingers, feet, and toes.  When it happens, blood vessels in the fingers and toes typically first turn blue because of the lack of oxygen; then white because of the lack of blood flow; and finally red, once the constriction ends and the blood flow returns to the fingers and toes.  During this constriction of the blood vessels, patients can have significant pain, numbness, tingling, and, in very severe cases, ulcers (defects in the skin with exposure of underlying fat and muscle) and gangrene (black and dead tissue).

Interestingly, environmental and social triggers play a significant role in Raynaud’s Syndrome episodes of vessel constriction.  Factors including stress, caffeine, alcohol or other drugs, and cold temperature can all induce a painful episode with lack of blood flow to the hands and feet.

Not much is known about the cause of Raynaud’s Syndrome or specifically why it happens.  Sometimes, Raynaud’s Syndrome can occur on its own without any other related disease.  In other cases, the patient has another inflammatory disorder like lupus or Sjogren’s Syndrome that is known to be highly associated with Raynaud’s Syndrome.

Though we do not fully understand the causes of Raynaud’s Syndrome there are many treatment strategies that can help.  Starting with behavioral modifications and certain blood pressure medications that can reduce spasm to specific procedures aimed to reduce the spasm of the vessels induced by the sympathetic nervous system, there is so much that I as a vascular surgeon can do to help patients with Raynaud’s Syndrome.  If you think that you might suffer from Raynaud’s Syndrome, please do not hesitate to call our office on 408-376-3626 to schedule an appointment. We Can Help!

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.

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.

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!