Riambau Alonso Vicente
The treatment of peripheral artery insufficiency is, in a great part, a surgical problem, and if it is sufficiently critical, often culminates with an amputation. The conservative measures have a limited value.
Vasodilators may be tried, even though frequently the contraction is owing to organic changes in the wall of the vessel and therefore, the vasodilators are ineffective.
- Osteoarticular problems
Originate from neglecting orthopedic problems of the feet, the legs and the hips, because these can result in poor circulation of the lower extremities, independent of the functional and esthetic changes that they might represent. Insoles when they are necessary or an adequate treatment are essential therapies to avoid greater ills.
- Painful feet
Generally, these are associated with a limitation of movement and spasm of one or more joint. Local sensitivity is often intense in the area of the calcaneocuboid ligament.
Flat foot is subdivided into:
- Acute distention of the foot, when the foot is anatomically normal, but very painful, it is often swollen and sensitive and resists passive movements. This is found in people who are many hours on their feet at work without being accustomed to this.
- Chronic flat foot, is the final result of distention of the foot that has not been treated and appears in waitresses and other workers that are on their feet all day.
- The traumatic flat foot appears after fractures: for instance, fracture of the Dupuytren or fracture of the heel bone.
- Spastic flat foot, or peroneal spasm, is a rare cause of the critical unilateral flat foot seen in children and young adults. Pain occurs after being on the foot, the pain is very flattened and deformed.
Treatment follows a line of common sense. The distended foot is reduced by means of a regimen and rest. Obesity is corrected, and if the patient is dedicated to a job that requires being on the feet for many hours, he should take several weeks of rest.
- Feet with high arches
These are characterized by a great concavity of the arch of the foot, in such a way that the instep becomes very high. This deformity is the cause of the pain. Often the foot with the high arch remains symptom free throughout life. Nevertheless, some patients with the deformity and pain in the plantar region respond favorably to treatment designed to improve the distention of the plantar ligaments.
- Arthritis in systemic conditions
This condition, in particular affects, even though not exclusively, the distal interphalangeal joints and a topographical relationship may exist between the nail and the changes in the distal joint.
The affectedness of these joints accompanied some times by tenosynovitis gives the toe the appearance of a sausage. The distal joints of the toes of the feet are affected in a similar manner.
Rheumatoid arthritis may cause a severe and very persistent pain in the feet including when weight is born on them. The metatarsalphalangeal joints and the toes of the feet frequently become swollen, the feet are sweaty and hot, and sensitivity to pressure exists to pressure on the metatarsals when the tips of them are laterally compressed.
In these instances, it is fitting to rest, to put heat on and to make gentle exercises in order to impede the symptomatology of the flat foot.. Analgesics may be required.
Frequently, gout attacks the first metatarsalphalangeal joint.
The beginning of it is sudden, up until the point, that an acute infection from cocos is suspected.
When it attacks, temperature is elevated. The patient cannot sleep and might sit with the foot elevated and with soft house slippers. Generally, this appears in men who have a tendency to drink.
Normally, the acute attack stops after several days and then leaves the skin to peel off on top of the foot. During the attacks, the joint is completely normal and serous uric acid is elevated during some phase of the illness.
Noisy leg syndrome
When a physician is unfamiliar with this condition, and encounters a patient who presents with this syndrome, he appears to be confused. Commonly, the person that suffers from the condition tells the physician that the symptoms are difficult to describe: some say that their legs feel heavy or light, or agitated or moving. Drs. Boghen and Péyonnard, after observing several patients, define the condition as "imprecise and unpleasant profound sensations in the legs that produce the urgent need to move them". But unfortunately, nothing can be contributed or almost nothing with respect to treatment and it is up to the patient, who through his own experience, has to find the ways to alleviate it.
This is a condition, characterized by a crisis of pain, ruddiness and hyperthermia in the extremities, with absolute integrity of the circulation.
The painful crises are triggered with physical exercise and they worsen with cold. The skin then turns read, the veins expand, including they might have a slight edema and they might present with an increase in local temperature.
Reflex sympathetic dystrophy
This dystrophy consists in a circulatory disorder of limbs as a consequence of something traumatic. It occurs in individuals with a special predisposition to pain of a psychic origen. It is characterized by a persistent and abnormal vasodilation, independent of the inflammatory process.
Clinically, it is expressed by intense pain that increases at the slightest movement of emotive change; it is accompanied by edema, which with pain, can be extended far from the lesions The skin begins to atrophy, the joints stiffen and pain is propagated until the root of the affected limb.
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