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As blood is pumped through the body, the valves within the veins prevent the blood from flowing backwards. After extensive, prolonged standing, these valves can become weak and eventually fail. When this happens, blood is no longer being prevented from flowing backward. Gravity will pull the blood back into an individual's legs, ankles and feet.
Chronic venous insufficiency (CVI) is a medical condition characterized by blood pooling in the veins, leading to increased pressure and strain on the vein walls. [1] The most common cause of CVI is superficial venous reflux, which often results in the formation of varicose veins, a treatable condition. [2]
Ischemia is a vascular disease involving an interruption in the arterial blood supply to a tissue, organ, or extremity that, if untreated, can lead to tissue death. It can be caused by embolism, thrombosis of an atherosclerotic artery, or trauma. Venous problems like venous outflow obstruction and low-flow states can cause acute arterial ischemia.
Other causes include vasculitis and in situ thrombosis related to hypercoagulable states. [53] Additional mechanisms of peripheral artery disease include arterial spasm and fibromuscular dysplasia. [19] The cause and pathophysiology of arterial spasm are not fully understood, but it is hypothesized that they can occur secondary to trauma. [54]
The blood reaching the extremities is not oxygen-rich and when viewed through the skin a combination of factors can lead to the appearance of a blue color. All factors contributing to central cyanosis can also cause peripheral symptoms to appear, but peripheral cyanosis can be observed in the absence of heart or lung failures. [5]
Critical limb ischemia is diagnosed by the presence of ischemic rest pain, and an ulcers that will not heal or gangrene due to insufficient blood flow. [3] Insufficient blood flow may be confirmed by ankle-brachial index (ABI), ankle pressure, toe-brachial index (TBI), toe systolic pressure, transcutaneous oxygen measurement (TcpO2 ), or skin perfusion pressure (SPP).
The poor blood flow is often a result of atherosclerotic blockages more proximal to the affected area; [3] individuals with intermittent claudication may have diabetes — often undiagnosed. [4] Another cause, or exacerbating factor, is excessive sitting (several hours), especially in the absence of reasonable breaks, along with a general lack ...
In normal patients, the feet quickly turn pink. If, more slowly, they turn red like a cooked lobster, suspect ischemia. Brodie-Trendelenburg test (assessment of valvular competence if varicose veins are present): One leg at a time. With the patient supine, empty the superficial veins by 'milking' the leg in the distal to proximal direction.
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