Many podiatric physicians undervalue the relationship between the podiatry practice and the vein specialist. There is a significant overlap of patients between these two disciplines. Many of the vein patients present with lower extremity venous insufficiency that leads to edema and varicosities. A large percentage of podiatry patients complain of either lower extremity edema or venous issues. The relationship between podiatrists and vein specialists can flourish with very little overlap in treatment and services as both practices work in the lower extremity.
Venous stasis, resulting from poor blood flow in the legs, affects approximately 1 percent of the U.S. population.1 This can lead to venous thrombosis and many subsequent lower extremity complications. The excess fluid retained from either venous valve incompetence or simple stasis because of muscle inactivity causes dilation in the small and large venous structures. As the venous tissue expands, fluid leaks into the surrounding soft tissue. This causes chronic edema, discoloration and possibly ulceration. Possible causes of venous ulcers include inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation and intracellular edema.
Interestingly, venous stasis ulcers account for 80 percent of lower extremity ulcerations.2 The traditional treatment for venous insufficiency has been compression of some sort. Segmental compression garments or dressings support the weakened valves by applying distal pressure in order to combat the pull of gravity. Simple elevation of the lower extremity or avoiding a dependent position can also help reduce the swelling. Anticoagulant and antiplatelet aggregation medications can assist in decreasing the blood's viscosity.
Surgical treatments include venous ablation and stents for venous obstructions. Additionally, the removal of incompetent superficial veins via phlebectomy, vein stripping, sclerotherapy or laser therapy has shown favorable results.3
The connection between podiatry and vein specialists is strong. As we expand our referrals to include vein specialists in our diagnosis and treatment of vein disease, we will be offering our patients a beneficial service. We will be including an additional skilled specialist in their treatment plan.
1. Collins L, Seraj S. Diagnosis and treatment of venous ulcers. Am Fam Phys. 2010; 81(8):989-996.
2. Callam MJ, Harper DR, Dale JJ, Ruckley CV. Chronic ulcer of the leg: clinical history. Br Med J (Clin Res Ed). 1987; 294(6584):1389–1391.
3. DeAraujo T, Valencia I, Federman DG, Kirsner RS. Managing the patient with venous ulcers. Ann Intern Med. 2003; 138(4):326–334.