Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Circulation

Posted by IreneM on 9/23/00 at 10:43 (028939)

I have pain in the entire arches of both feet, of decades duration, progressively more severe over the years, not worse in morning, not responsive to any of the numerous therapies I have tried.

I read this in a Mayo clinic newsletter:
'Pain due to poor circulation always occurs beyond the obstructed area of an artery. Hip,
buttock and calf pain are most common. Sometimes the location of obstruction leads to pain
in the arch of your foot.'

No doctor has ever mentioned this possibility to me. Could this be the source of my problem even if I have no leg pain? How would I go about investigating this possibility?

Thanks,
Irene

Re: Circulation

Dr. Biehler on 9/23/00 at 12:40 (028950)

If you are not a diabetic, you have an ankle arm index done. They take your blood pressure in your arm and the blood pressure at your ankle. You then devide the ankle blood pressure by the arm blood pressure. An answer of one in normal. If you get below 0.7 you might want a doctor to check you out. It needs to be done on both sides of the body.

Re: Circulation

Bob Ray on 9/23/00 at 13:58 (028953)

Dear Dr Biehler;
Are these blood pressure readings taken while you are sitting or laying down or does it matter?
My understanding is that you take a reading on each arm and each ankle and devide the right side ankle into the right side arm and the same for the left side?
Thanks for being there,
Bob

Re: Circulation

Dr. Biehler on 9/23/00 at 14:13 (028954)

I have always done it with the patient in the chair. You devide the systolic ankle pressure by the systolic arm pressure. Less than 0.6 is inadequate for wound healing. It is unreliable in diabetics because the viens can calcify giving an abnormally high reading.

Re: Circulation

Dr. Zuckerman on 9/23/00 at 15:43 (028959)

That is a great answer. Do you think the patient can use one of the automatic hand held blood pressure ones. You know the one with the battery and you stick you finger in one. You could put your big toe for the ankle index. I am not joking about this. I think the pressure ratio would be lower if you used the finger and toes but I seem to think that there is a specific ratio for the finger and toe. We use to do the ratio between the ankle and the big toe. I want to say it was about 70% of the ankle but I would have to look this up.
Dr. Z

Re: Circulation

Dr. Biehler on 9/24/00 at 10:55 (029019)

The normal toe/arm ischemic index is >0.7 which should be the same as the toe/ankle unless there is a problem above the ankle.

Re: Circulation

john h on 9/24/00 at 11:52 (029032)

i have for a long time had a suspicion that veriocose veins (internal) could be a source of various pains in the feet. when you stand these veins expand and possible put pressure on nerves causing pains in various places. in happens in the tarsal tunnel - why not other places in the foot? this would account for pain while standing and less or no pain while laying down.

Re: Circulation

Dr. Biehler on 9/24/00 at 12:55 (029040)

If you are experiancing those kind of symtoms and if you do not have a heart condiion, a pair of compression hose of around 25 to 30 lb pressure should help. I think they now sell these as 'golfer socks' in some of the pharmacies or sporting goods stores. You should try to put these on in the morning before your legs swell.

Re: Elevation for increased Circulation?

Bob Ray on 9/24/00 at 14:34 (029048)

I went to the drug store and bought a blood pressure monitor. The olod fashion kind, that you pump and then listen to when the beats start and stop. I compared the bicept reading to the tarsal tunnel area. Reading were 130-85 on the bicept and 140-90 on the ankle. The reading on the ankle was barely audible until I lifted my foot up to the same level as my heart. I assume that improved circulation this is why elevation is recommended after an injury to the foot or ankle.
My symptoms have always been that I have pain in the tarsal tunnel and in the back inside of the arch. I've had everything including TTS Release Surgery and ESWT(twice).
These pains have always increased as my level of activity increases.
The only dramatic improvement comes with laying horizontal(sleeping). But then vertical activity causes them to return.
Since the ultimate solution is for the body to heel itself. And increased circulation means accelerated repair. And elevation means increased circulation.
Then why isn't ELEVATION the main recommendation for foot problems?
Thanks for being there.
Bob

Re: Elevation for increased Circulation?

Dr. Biehler on 9/24/00 at 15:16 (029052)

Elevation actually decreases the circulation. Raising your ankle up to your heart level drops the pressure. If you are having trouble hearing the pressure at the ankle it should be listen to through a doppler for this reading. Decreasing the level of the leg if there is a venus problem causes blood pooling and decreased drainage of the lymph glands. This not only causes pressure on the nerves, it make it hard for blood that has been deoxigenated and is full of wastes from the cells to get back to the heart and lungs.The result can be pain and the chemicals that trigger the pain get caught it the area. The muscles in the lower leg are sometimes called the second heart. Exercise is good for blood flow. If there is a venous problem the compression socks help stop the pooling effect.

Re: Elevation for increased Circulation?

judy b on 9/26/00 at 14:11 (029191)

I get a cold/raw feeling in the bottom of my feet after standing on them for a few minutes, also after sitting for a while. If I soak my feet in warm water the sensation goes away and my feet actually feel normal for a while other than my lack of ROM. Could this indicate a circulation problem...my lower legs are very atrophied right now. As I strengthen my lower legs should this improve these symptoms? Might support stockings help in this situation? Thanks for your help!

Re: Elevation for increased Circulation?

Dr. Biehler on 9/26/00 at 18:25 (029208)

Support stockings is not what you would want to use. These help with vienus stasis which causes an increase in temperature. You might be having some kind of arteriol problem which can be evaluated with a plestimogrph and or a doppler. Stenghthening the lower muscles does help with general circulation but might not have any effect on this.

Re: Circulation

Dr. Biehler on 9/23/00 at 12:40 (028950)

If you are not a diabetic, you have an ankle arm index done. They take your blood pressure in your arm and the blood pressure at your ankle. You then devide the ankle blood pressure by the arm blood pressure. An answer of one in normal. If you get below 0.7 you might want a doctor to check you out. It needs to be done on both sides of the body.

Re: Circulation

Bob Ray on 9/23/00 at 13:58 (028953)

Dear Dr Biehler;
Are these blood pressure readings taken while you are sitting or laying down or does it matter?
My understanding is that you take a reading on each arm and each ankle and devide the right side ankle into the right side arm and the same for the left side?
Thanks for being there,
Bob

Re: Circulation

Dr. Biehler on 9/23/00 at 14:13 (028954)

I have always done it with the patient in the chair. You devide the systolic ankle pressure by the systolic arm pressure. Less than 0.6 is inadequate for wound healing. It is unreliable in diabetics because the viens can calcify giving an abnormally high reading.

Re: Circulation

Dr. Zuckerman on 9/23/00 at 15:43 (028959)

That is a great answer. Do you think the patient can use one of the automatic hand held blood pressure ones. You know the one with the battery and you stick you finger in one. You could put your big toe for the ankle index. I am not joking about this. I think the pressure ratio would be lower if you used the finger and toes but I seem to think that there is a specific ratio for the finger and toe. We use to do the ratio between the ankle and the big toe. I want to say it was about 70% of the ankle but I would have to look this up.
Dr. Z

Re: Circulation

Dr. Biehler on 9/24/00 at 10:55 (029019)

The normal toe/arm ischemic index is >0.7 which should be the same as the toe/ankle unless there is a problem above the ankle.

Re: Circulation

john h on 9/24/00 at 11:52 (029032)

i have for a long time had a suspicion that veriocose veins (internal) could be a source of various pains in the feet. when you stand these veins expand and possible put pressure on nerves causing pains in various places. in happens in the tarsal tunnel - why not other places in the foot? this would account for pain while standing and less or no pain while laying down.

Re: Circulation

Dr. Biehler on 9/24/00 at 12:55 (029040)

If you are experiancing those kind of symtoms and if you do not have a heart condiion, a pair of compression hose of around 25 to 30 lb pressure should help. I think they now sell these as 'golfer socks' in some of the pharmacies or sporting goods stores. You should try to put these on in the morning before your legs swell.

Re: Elevation for increased Circulation?

Bob Ray on 9/24/00 at 14:34 (029048)

I went to the drug store and bought a blood pressure monitor. The olod fashion kind, that you pump and then listen to when the beats start and stop. I compared the bicept reading to the tarsal tunnel area. Reading were 130-85 on the bicept and 140-90 on the ankle. The reading on the ankle was barely audible until I lifted my foot up to the same level as my heart. I assume that improved circulation this is why elevation is recommended after an injury to the foot or ankle.
My symptoms have always been that I have pain in the tarsal tunnel and in the back inside of the arch. I've had everything including TTS Release Surgery and ESWT(twice).
These pains have always increased as my level of activity increases.
The only dramatic improvement comes with laying horizontal(sleeping). But then vertical activity causes them to return.
Since the ultimate solution is for the body to heel itself. And increased circulation means accelerated repair. And elevation means increased circulation.
Then why isn't ELEVATION the main recommendation for foot problems?
Thanks for being there.
Bob

Re: Elevation for increased Circulation?

Dr. Biehler on 9/24/00 at 15:16 (029052)

Elevation actually decreases the circulation. Raising your ankle up to your heart level drops the pressure. If you are having trouble hearing the pressure at the ankle it should be listen to through a doppler for this reading. Decreasing the level of the leg if there is a venus problem causes blood pooling and decreased drainage of the lymph glands. This not only causes pressure on the nerves, it make it hard for blood that has been deoxigenated and is full of wastes from the cells to get back to the heart and lungs.The result can be pain and the chemicals that trigger the pain get caught it the area. The muscles in the lower leg are sometimes called the second heart. Exercise is good for blood flow. If there is a venous problem the compression socks help stop the pooling effect.

Re: Elevation for increased Circulation?

judy b on 9/26/00 at 14:11 (029191)

I get a cold/raw feeling in the bottom of my feet after standing on them for a few minutes, also after sitting for a while. If I soak my feet in warm water the sensation goes away and my feet actually feel normal for a while other than my lack of ROM. Could this indicate a circulation problem...my lower legs are very atrophied right now. As I strengthen my lower legs should this improve these symptoms? Might support stockings help in this situation? Thanks for your help!

Re: Elevation for increased Circulation?

Dr. Biehler on 9/26/00 at 18:25 (029208)

Support stockings is not what you would want to use. These help with vienus stasis which causes an increase in temperature. You might be having some kind of arteriol problem which can be evaluated with a plestimogrph and or a doppler. Stenghthening the lower muscles does help with general circulation but might not have any effect on this.