Special Report on Chronic Venous Insufficiency

What is chronic venous insufficiency? Arteries bring oxygen-rich blood from your heart to the rest of your body and veins return oxygen-poor blood back to your heart. When your leg veins cannot pump enough blood back to your heart, you have chronic venous insufficiency (CVI). CVI is also sometimes called chronic venous disease, or CVD. When you are in the upright position, the blood in your leg veins must go against gravity to return to your heart. To accomplish this, your leg muscles squeeze the deep veins of your legs and feet to help move blood back to your heart. One-way flaps, called valves, in your veins keep blood flowing in the right direction. When your leg muscles relax, the valves inside your veins close. This prevents blood from flowing in reverse, back down the legs. The entire process of sending blood back to the heart is called the venous pump. When you walk and your leg muscles squeeze, the venous pump works well. But when you sit or stand, especially for a long time, the blood in your leg veins can pool and increase the venous blood pressure. Sitting or standing for a long time can stretch vein walls because they are flexible. Over time, in susceptible individuals, this can weaken the walls of the veins and damage the vein valves, causing CVI. What are the symptoms? If you have CVI, your ankles may swell and your calves may feel tight. Your legs may also feel heavy, tired, restless, or achy. You may feel pain while walking or shortly after stopping. CVI may be associated with varicose veins. Varicose veins are swollen veins that you can see through the skin. They often look blue, bulging, and twisted. Large varicose veins can lead to skin changes like rashes, redness, and sores. CVI can also cause problems with leg swelling because of the pressure of the blood pooling in the veins. Your lymphatic system may also produce fluid, called lymph, to compensate for CVI. Your leg tissues may then absorb some of this fluid, which can increase the tendency for your legs to swell. In severe cases, CVI and the leg swelling can cause ulcers to form on the lower parts of the leg. What causes CVI? Over the long-term, blood pressure that is higher than normal inside your leg veins causes CVI. This can lead to damage to the valves, which can further worsen the problem. Factors that can increase your risk for CVI include a family history of varicose veins, being overweight, being pregnant, not exercising enough, smoking, and standing or sitting for long periods of time. Although CVI can affect anyone, your age and sex can also be factors that may increase your tendency to develop CVI; women older than 50 most often get CVI. What tests will you need? First your physician asks you questions about your current general health, past medical history, and symptoms. In addition, your physician conducts a physical exam. Together these are known as a patient history and exam. Your physician may measure the blood pressure in your legs and will examine the varicose veins. To confirm a diagnosis of CVI, the physician may order a duplex ultrasound test. Duplex ultrasound uses painless sound waves higher than human hearing can detect. Duplex ultrasound allows your physician to measure the speed of blood flow and to see the structure of your leg veins. How is CVI treated? CVI is usually not considered a serious health risk. Your physician will focus his or her treatment on decreasing your pain and disability. Compression stockings: For mild cases of CVI, your physician may recommend compression stockings. Compression stockings are elastic stockings that squeeze your veins and stop excess blood from flowing backward. In this way, compression stockings can often also help heal skin sores and prevent them from returning. You may need to wear compression stockings daily for the rest of your life. Topical Creams: The dark skin discoloration and thinning of the skin can be treated with topical creams applied to the area daily. This will keep the skin protected and lessen the effect of the discoloration. You can help avoid leg swelling and other symptoms by occasionally raising your legs and avoiding standing for long periods of time to decrease the pressure in the veins. When you do need to stand for a long period, you can flex your leg muscles occasionally to keep the blood flowing. You can also help lessen the symptoms of CVI by maintaining your ideal body weight or losing weight if you are overweight. More serious cases of CVI may be treated with injections, called sclerotherapy, or with surgical procedures. Fewer than 10 percent of people with CVI require surgery to correct the problem. Surgical treatments include ablation, vein stripping, bypass surgery, valve repair, and angioplasty or stenting of a vein. Your podiatrist will send you to a vascular surgeon if surgery is something you need. Committed to you health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Special Report on Athlete’s Foot, Black Toenails and Sweaty Feet

The eyes of the world will soon be on London and the Summer Olympics. With that in mind, this is a special report on a few common problems that athletes have with their feet. So join us in cheering on Team USA and if you have any of these problems let us help to keep you working at peak performance. Athlete's Foot: Athlete's foot is a skin infection caused by fungus. A fungal infection may occur on any part of the body; on the foot it is called athlete's foot, or tinea pedis. Fungus commonly attacks the feet because it thrives in a dark, moist, warm environment such as a shoe. Fungal infections are more common in warm weather when feet tend to sweat more (see below). Fungus thrives in damp areas such as swimming pools, showers, and locker rooms. Athletes commonly have sweaty feet and use the facilities where fungus is commonly found, thus the term "athlete's foot." Athlete's foot usually produces itchy, dry, scaling skin. It is commonly seen on the soles of the feet and in between the toes. In advanced cases, inflammation, cracks, and blisters may form; an infection caused by bacteria can also result. The fungus can spread to other areas of the body, including toenails. Toenail fungus is the same exact fungus as athlete’s foot, so the infection can go both ways. The skin infection can spread to the nails and the nail infection can spread to the skin. This is one reason for treatment failure. Avoiding walking barefoot combined with good foot hygiene can help reduce the spread of the fungus. Feet should be washed every day with soap and water and thoroughly dried, including between the toes. Feet should be kept as dry as possible. Anti-fungal powders, sprays, and/or creams are often utilized to treat athlete's foot. Shoes should also be treated to kill the fungus that lives there. Your foot and ankle surgeon will recommend the best treatment for you. Sweaty Feet: The number of sweat glands is most dense at the feet and hands. Sweaty feet, or hyperhidrosis, is a common disorder in which the sweat glands of the feet produce excessive sweat. Persons with this condition usually have a genetic predisposition or are under stress, which activates the brain to produce more sweat to keep the body cool. Athlete's foot or smelly feet may accompany sweaty feet. Frequent changing of socks, use of acrylic socks or use of antiperspirants often cures this sometimes embarrassing condition. Your foot and ankle surgeon can recommend one of a variety of treatments for this condition. Black Toenails or Runner's Toe: A black, purple, or brownish discoloration under or involving a toenail is frequently due to trauma to the toe nail, such as when something is dropped on the toe. The color results from a blood clot or bleeding under the nail, and may involve the entire nail or just a small portion of it. This can be very painful when the entire nail is involved, and may need medical attention to relieve the pressure caused by bleeding under the toenail. Although it is very rare, a more serious cause of black toenails is malignant melanoma. Since early diagnosis and treatment of melanoma improves the chances for a good outcome, it is important that all black toenails be evaluated by a qualified foot and ankle surgeon to rule out this cause. Other rare causes of black toenails include fungal infections, chronic ingrown nails, or health problems affecting the rest of the body. This condition is sometimes called Runner’s toe because it is so common in runners or long distance walkers. Longer shoes with soft mesh uppers are often all it takes to prevent this painful issue and keep you on the road. Committed to your health, Dr. Craig Conti Sarasota Foot Care Center www.sarasotafootcarecenter.com

Diabetes Awareness Month Is Upon Us

November is National Diabetes Awareness Month. Kind of ironic when you think that you have most of the major holidays in this time of year. The average American gains several pounds and for a diabetic and their family, this can be a very challenging time of year. Staying consistent with your eating habits, limiting the simple sugars and indulgence in alcohol can help to protect the almost 40 million diabetic feet in this country.

For many years we have seen our own patient population in Sarasota, Florida suffer ill affects of this dangerous time of year. Ulcerations, gout attacks, leg swelling all increase as the New Year begins. I know there is a lot of fear and denial about infections, ulcerations and amputations. In order to avoid these horrible complications of diabetes we need to do some simple things and apply some basic discipline.

Step 1: check your sugar frequently and keep your Hemoglobin A1C ( a lab value that your primary care doctor or endocrinologist tests to get an average of your blood sugar over a few month period) in the proper range.
Step 2: see a foot doctor at least yearly and have a neurological test (a test of feeling and sensation in your feet) and vascular test (a test of blood flow to the feet and legs) as recommended by the American Diabetes Association.
Step 3: wear comfortable, well fit shoes with protective inserts when needed. The Medicare Diabetic Shoe Bill allows for one pair of diabetic shoes with 3 pairs of inserts, annually, for those patients who are diabetic with complications and on medicare.
Step 4: check your feet every day for redness, blisters, wounds etc. If you find any of these things on your feet you need to contact your podiatrist right away and take the situation very seriously. Delaying treatment is major obstacle to healing.

This year's theme for Diabetes Awareness month is "it's a family affair." I could not agree more. I would like to extend that definition to your medical "family" as well. Diabetic patients are very complex with many issues that blur the lines of medical specialty. Often a team approach is needed to treat these complicated situations. If we all do our part we can control the disease and take care of all of our loved ones. After all, it is a family affair.

Committed to your health,


Dr. Craig Conti
Sarasota Foot Care Center
http://www.sarasotafootcarecenter.com/