Before You Light Up, Think About your Feet
By Dr. Bruce Theall
December 22, 2015
Category: Diabetes
Tags: diabetes   smoking   pain in feet  

For many years now, everyone knows that smoking is bad for your health.  Smoking affects your lungs, heart, weight, skin, nails, hair, and it causes many different kinds of cancers.  Most people do not know that smoking can also affect your feet.  Smoking is linked to a disease called PAD, or peripheral arterial disease.  Most patients aged 50 years and older have a higher chance of developing peripheral arterial disease (PAD), especially if they have diabetes and they smoke, opposed to those who only smoke or only have diabetes.  Several risk factors for PAD associated with PAD, which include diabetes mellitus, hypertension, older age, and dyslipidemia.  A higher prevalence of PAD has also been found among older African Americans and Hispanics when compared with whites.  The inadequate recognition of PAD may place many patients at risk of its complications, including ischemic ulceration, gangrene, limb loss, and/or increased cardiovascular morbidity and mortality.

Peripheral arterial disease affects about 12 million people in the United States.  It is a condition that is caused due to the occlusion of arteries due to atherosclerosis, or the hardening of the arteries.  Often called peripheral arterial disease (PAD), this condition occurs due to a result of cholesterol and plaque buildup in the arteries of the lower extremities.  This causes decreased blood flow to the legs.  This condition commonly happens in elderly people as these deposits build up over a long period of time in their arteries.  This is the same type of problem that causes heart attacks and strokes when it affects the arteries to the heart or the arteries to the brain.  All can lead to serious consequences if not evaluated, treated, and monitored properly.

Age, sex, atherosclerosis, hypertension, Diabetes mellitus, smoking, hyperlipidemia, cardiovascular disease, poor diet, alcoholism, renal insufficiency, and family history.  Smokers are particularly at risk for poor peripheral arterial disease.  Every time a cigarette is smoked it causes constriction of the arteries reducing the blood flow.  It can take as long as 20 to 30 minutes after the cigarette for this process to reverse and if smoking goes on for a long enough period of time, sometimes damage is irreversible, meaning it can never go away.  People who are overweight and have high cholesterol levels also are prone to this significant disease.  Diabetics who have PAD from the above factors also have small blood vessels to the feet that are damaged when sugar is uncontrolled and too high over a long period of time.  This is an extra risk for diabetics and if they smoke and have high cholesterol now have three strikes against them.

The earliest symptom of the disease is muscular pain in the leg.  As the disease progresses, patients complain about pain at rest and pain that gets worse with elevation.  In later stages of the disease, arteries are not able to delivery blood to the tissue and this leads to tissue ischemia and eventually the patient is in extreme pain and the foot and toes will appear black from lack of oxygen.   In severe cases, PAD progresses to ulceration and gangrene.  About one third of the patients suffering from PAD require amputation which not only affects the quality of life in these patients, but also affects the life expectancy of the patient. 

A diagnosis of PAD could be a barrier to preventing further cardiovascular risk.18 Increasing physicians’ awareness of the importance of screening patients at high risk for PAD has important benefits. Patients treated early for PAD could have a significantly improved quality of life as well as the decreased likelihood of future cardiovascular morbidity and mortality.

A podiatrist is the only person that is trained in a specialized field in medicine for anything concerning the lower extremity, foot and ankle, that’s why it is vital for you to visit your podiatrist if there are any problems concerning your feet.  In the case of PAD, the most effective treatment is to stop smoking immediately. If there are any other questions feel free to contact Dr. Theall’s Gentle Touch Foot Care office for all your foot and ankle needs and concerns at 973 673 – 3668.