Tag: Leg Pain at Night

PART 3: WHY DO MY TOES, ANKLES AND FEET HURT AT NIGHT? PERIPHERAL ARTERIAL DISEASE

Posted on by Michael Kokinos

In part one- and two of our four-part series on “Why do my feet hurt at night”, I discussed Venous disease and Raynaud’s Syndrome. In today’s discussion I want to focus on an even more common reason for why patients may suffer from leg pain at night: Peripheral arterial disease (otherwise known as PAD.)

As we’ve discussed in our earlier blogs, there are two kinds of blood vessels: Arteries and veins.

  • Arteries bring blood from the heart to the foot and toes under high pressure while
  • Veins bring the blood back from the foot to the heart under low pressure.

Over the course of anyone’s lifetime, blockages may build up in the arteries between the heart and the feet, especially in the pelvis and the legs.  Risk factors that increase the risk of formation of these blockages include:

  • Obesity
  • High blood pressure
  • High cholesterol
  • Diabetes
  • History of smoking tobacco.

As you may imagine, the tissue within the foot needs a certain amount of blood to supply the nutrients and oxygen necessary to keep the cells within the foot living.  Though a single, short segment blockage of the arteries in the leg may not result in any problems, multiple blockages from the pelvis to the foot may can make it difficult or even impossible for the cells within the foot to survive this lack of nutrients and oxygen.

What Does PAD Feel Like?

Typically, patients notice a gradual onset of pain in the forefoot and toes over the course of a few weeks to months.  As their blockages worsen, their pain becomes more severe.  Pain from PAD occurs in the forefoot and toes because those parts of the body are the furthest away from the heart and thus any blockage along the way from the heart to the toes can contribute to the lack of blood flow. One classic symptom of PAD pain is a burning, tingling, or numb sensation that can be partially relieved by hanging your foot off the bed or a chair.  In this position with the foot hanging down, gravity assists the flow of blood to the foot and toes and relieves the pain.  Typically, patients complain that when they lay flat at night, the pain in the forefoot and toes or just the foot in general will wake them up.  I always specifically ask patients if they are woken up at night by the pain.  If they are woken up by the pain, then I know the PAD must be very severe.

In some patients, the lack of blood flow is so diminished that there is also the development of ulcers, or defects in the skin with exposure of underlying fatty tissue, bone, and muscle or gangrene, the death of the tissue itself.

Even though PAD is a very severe and life limiting disease, specially trained vascular surgeons have many tools to combat it!  We can do a minimally invasive procedure called an angiogram that I described in an earlier blog post that you can access here!  Essentially, I access the diseased blood vessel with a needle and through that needle use contrast and x-ray to see where the blockages are.  Then, using balloons, stents, or self-expanding metal tubes, it is possible to re-open the blockages to re-establish blood flow to the impacted area.  For severe blockages, I also use a device called atherectomy that allows me to cut through and to remove the plaque responsible for blocking this vessel.  The procedure on average takes 1.5 to 2.5 hours and most patients can go home the same day.

Does foot pain wake you up at night? If you are experiencing pain in your foot or toes, please do not hesitate to contact my office at 408-376-3626 to schedule a clinic appointment today!

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.

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!

FOOT PAIN AT NIGHT: IT MIGHT BE MORE SERIOUS THAN YOU THINK

Posted on by Michael Kokinos

Many patients over the age of 65 who have a history of smoking, diabetes, high blood pressure, and/or high cholesterol wake up at night with pain in their foot or toes. Some believe this is arthritis or gout; others think it is the result of just spending too much time on their feet during the day.  Patients often self-adapt to this problem, as it usually develops slowly over time, but when questioned about their sleep habits, they will sometimes tell you that they sleep in a recliner or they sleep with their leg hanging over the side of the bed to make their pain go away.

It is very common for elderly patients to get up at night to go to the bathroom. Sometimes, however, it’s actually foot pain that wakes them up.  Once up, they get out of bed because that makes their feet feel better (again due to gravity) and after walking to the bathroom they can go back to sleep, pain -free for a couple of hours.  Even that small amount of walking helps to get their blood flowing again and makes it easier for them to go back to sleep.

Sometimes, foot pain at night is the sign of a more serious condition.

  • Foot pain at night may be related to having poor circulation in the foot. The name for this in medical terms is “rest pain”. This is not “pain at rest” but rather pain that happens because the circulation cannot support the tissues even when they are at rest.

Foot pain at night may be an early warning sign of critical limb ischemia.

  • Chronic Limb Ischemia is another term for lack of blood flow;  if you experience this rest pain at night and it goes away after hanging your foot over the side of the bed or chair you are sleeping in, immediately call and speak with your doctor to set up an appointment for them to evaluate your symptoms. Although it may come on slowly, the arteries in your feet may be so blocked that they cannot even deliver the minimal amount of oxygen the tissues in the foot and toes need to keep them nourished. Left untreated, this blockage can lead to a more serious problem, amputation or even death.

What’s important for the patient to realize is that chronic limb ischemia causes the foot and leg to get swollen, so the patient is often MIS-DIAGNOSED with a vein problem, not an arterial problem

If this sounds like something you or someone you love is experiencing, it is important to tell your primary care doctor OR schedule an appointment DIRECTLY with a vascular surgeon. These symptoms are a sign that your body is giving you that you may need immediate help. This truly is a sign that your foot is starving for oxygen and blood and that if left untreated, might lead to an unnecessary amputation. Help is possible, however and if treated early enough, those suffering from these symptoms can be helped significantly.

If you suffer from painful feet in the middle of the night, WE CAN HELP

contact us today  at 408-376-3626 to learn more about PAD and how Dr. Kokinos can help, click here.

South Bay Vascular Center and Vein Institute: We Offer Hope When Others Say There Is None.

 

 

NOT JUST VASCULAR CARE, EXCEPTIONAL VASCULAR CARE

Posted on by Angelica Rodezno

Your health care is complicated enough… finding the right Vascular Surgeon shouldn’t be!

Experience counts when it comes to your health

Polyxene (Polly) Kokinos MD. RPVI. Board Certified in Vascular and General Surgery

Silicon Valley’s Most Trusted Vascular Surgeon.

Dr Kokinos…The Confidence of knowing you made the Right choice for your Vascular care.

  • The confidence of knowing that your vascular surgeon has been taking care of South Bay patients with vascular disease for almost 30 years.
  • The confidence of knowing that your surgeon built her private practice one patient at a time for almost a quarter of a century…BECAUSE referring PHYSICIANS TRUST Dr Kokinos to deliver the best possible outcomes for their patients: even in the most difficult of circumstances.
  • The confidence of knowing that your surgeon delivers both world class and compassionate care. That Dr Kokinos is the only Vascular surgeon in the South Bay who has built an independent, nationally accredited, state of the art Vascular Surgery Center of Excellence where SHE takes care of her patients…where cutting edge care is at the heart of everything that she does.
  • The confidence of knowing that your surgeon has earned the trust of local physicians. More independent local physicians refer their vascular patients to Dr Kokinos than to any other vascular surgeon in Silicon Valley.
  • The confidence of knowing you will receive the most Advanced and Innovative Care found anywhere in the world…No other vascular surgery practice in Silicon Valley offers a combination of the imaging, device and care options that South Bay Vascular Center can offer to their patients in their private, AAAASF nationally accredited ambulatory surgery center dedicated entirely to the treatment of complex vascular disease. “We offer hope when others say there is none”
  • The confidence of knowing you will receive Personalized Care…” One Doctor, One Patient, One Nurse” …We’re NOT a hospital; we are more. That’s why we provide individualized care. At South Bay Vascular Center, we care for you as a person, not just as another patient. Our job is to understand the “why” so that you have real solutions to living a healthy life.
  • The confidence of knowing you will receive Simplified Care: ALL your vascular care under one roof. Clinical care, Vascular Ultrasound care, and Surgical care. All your care in a single facility.

South Bay Vascular Center and Vein Institute. Silicon Valley’s Vascular Surgeon.

ARE YOU AT RISK FOR PERIPHERAL ARTERIAL DISEASE (PAD)?

Posted on by Angelica Rodezno

WHAT IS PAD?

Peripheral Artery Disease (PAD) is a common and often underdiagnosed circulatory disease where blood flow to the legs and feet is restricted by the narrowing of blood vessels due to plaque buildup.

ARE YOU AT RISK FOR PAD?

  • Smoking is the most powerful predictor of PAD: Are you a current or former smoker?
  • 1 in 10 Americans over the age of 40 have PAD
  • Do you or your loved one have diabetes?
  • Struggle with high blood pressure or cholesterol?
  • Suffer from kidney disease?
  • Risk for amputation is 10 times greater in patients with both PAD and diabetes vs PAD alone

THE GOOD NEWS IS THAT PAD CAN BE TREATED!

With an early diagnosis, you may have more treatment options and may have a better chance to reduce or eliminate your symptoms. Left untreated, however, PAD can lead to amputation and put you or your loved one’s quality of life and long-term health at serious risk.

Dr. Polly G Kokinos, a board certified Vascular and General Surgeon in Campbell, CA. is recognized as one of the regions foremost authorities in the diagnosis and treatment of PAD. With offices in both Campbell and Gilroy, CA. Dr. Kokinos has dedicated her 24 year career to serving the South County community as a Vascular Surgeon and is a pioneer in the evaluation and treatment of patients suffering from Peripheral Arterial Disease.

Unlike other Vascular Surgeons in the region who do their work at a local hospital or in shared facilities, Dr. Kokinos’ does her surgeries in a private, nationally accredited Vascular Surgery Center of Excellence. She focuses entirely on treating patients suffering from complex vascular disorders and unlike a traditional hospital she has the most advanced imaging and device technology available anywhere in the world. Most importantly, unlike a Univeristy or community hospitals, Dr. Kokinos’ patients experience the individualized care of “One Patient, One Doctor and One Nurse” rather than the cold, informal “production” environment of a typical hospital.

If you or anyone you love suffers from any of the conditions listed above, please call our office at 408-376-3626 to schedule an appointment. Most insurances are accepted and our staff typically can schedule an appointment within a few days for an initial consulation and non-invasive vascular ultrasound study. All ultrasound testing is done in our on-site Vascular Ultrasound Lab, The Institute for Vascular Testing making it significantly easier for our patients to be fully evaluated in a single visit and in a single facility.

South Bay Vascular Center and Vein Institute: We Offer Hope When Others Say There Is None