Critical limb ischemia is an advanced stage of artery blockage where too little blood reaches the foot, causing pain at rest, wounds that do not heal or gangrene. Treatment of critical limb ischemia aims to restore blood flow with a catheter procedure or surgery and to care for wounds, to help protect the foot. Dr. Walid Naser assesses these cases in Amman.
Note: This condition needs prompt assessment. If the foot suddenly becomes cold, pale and very painful, or redness spreads with fever or a smelly wound, go to the emergency department straight away.
Symptoms
- Pain in the foot or toes at rest, worse at night, that may ease when the leg hangs over the bed.
- Wounds or ulcers on the foot or toes that do not heal.
- Blackened skin on the toes or foot (gangrene).
- A cold, pale foot that turns red when hanging down.
- Thin, shiny skin and no pulse in the foot.
Causes
It usually develops after years of leg artery blockage caused by atherosclerosis. Risk factors include:
- Smoking.
- Diabetes, where symptoms can be less obvious because of reduced feeling.
- Chronic kidney disease.
- High blood pressure and cholesterol.
- Older age.
Diagnosis
Your doctor examines the foot, any wounds and the pulses, then requests tests to map the blockages and plan treatment quickly.
- Ankle and sometimes toe blood pressure measurement.
- Doppler ultrasound.
- CT angiography or angiography with contrast dye to map the arteries.
- Assessment of the wound and any infection, with blood tests as needed.
Treatment options
The aim is to restore blood flow to the foot and control pain and wounds. Options from the simplest:
Decisions are made after a full assessment. Many people with diabetes benefit from coordinated care through limb salvage.
- Stopping smoking, controlling blood sugar and blood pressure, and medicines prescribed by your doctor to lower the risk of clots.
- Wound care, treatment of infection and taking pressure off the foot.
- Peripheral artery angioplasty to open the artery with a balloon, with a stent when needed.
- Bypass surgery to route blood around the blockage in selected cases.
- When blood flow cannot be restored or tissue damage cannot be reversed, removing the damaged part may be discussed to protect the patient's health.
What to expect on the day and after
Some patients need a hospital stay depending on their condition and the procedure. Your surgeon will explain what to expect in your case.
- Checking the colour and warmth of the foot after blood flow is restored.
- Regular wound follow-up and dressing changes as instructed.
- Taking your prescribed medicines.
- Daily foot care and suitable footwear.
- Follow-up visits and Doppler scans to check the arteries.
When to book an appointment
- Foot pain at rest or pain that wakes you at night.
- A foot wound that is not getting better.
- Toes turning blue or black.
- Diabetes with a foot wound and a weak foot pulse.