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By Dr. Kuvent, March 17, 2010 9:49 am

One of the most interesting aspects of the lower extremity is how many systemic diseases tend to show up in the feet, ankles, and lower legs. Diabetes is, of course, an obvious example, but there are also many diseases affecting the blood vessels which tend to show up in the lower limbs either before or during the time that they begin to affect other vital organs of the body. Many of these disorders will demonstrate predictable skin manifestations which help to offer clues about the underlying disease process.

          ‘Vasculitis’ is a general term referring to a state of inflammation or damage to the arteries or veins which transport blood throughout our body. There are many different diseases within this category which can affect different-sized blood vessels as well as different organs. However, many of the disorders result when the immune system causes damage to the walls of a blood vessel which in turn allows blood cells to leak out of these vessels. This can lead to skin lesions of the feet and lower legs which typically involve both extremities and may be severely painful.

          One important thing to keep in mind about vasculitis is that different conditions can present with a variety of different symptoms. Some diseases will involve painful blistering or ulceration of the skin while others will result in skin color changes, pain with walking, or nail pathology. Besides immune system malfunctions, other causes of vasculitis include infections, various types of cancer, and drug reactions. Similarly, the long-term and systemic prognoses of these diseases can vary widely. If left unchecked, some of these disorders may go on to cause blindness or other severe outcomes.

          Unfortunately, it isn’t possible to discuss each of the different vasculitis conditions here. However, if you would like a professional opinion, an appointment with your local Chandler podiatrist is certainly worth your while. He can perform several simple exams and help to sort out the possibilities in order to differentiate your symptoms from other possible skin or blood vessel disorders. Ultimately, he may recommend a biopsy to confirm the diagnosis before deciding on the appropriate therapy.

          While vasculitis may seem like merely an irritating rash of the feet or lower legs, in reality it is a systemic disease which can affect your joints, nerves, heart, lungs, kidneys, or GI tract. Therefore, early screening and detection is very important. The symptoms of the lower extremity may be just the tip of the iceberg.

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By Dr. Kuvent,

There’s a good chance that you’ve heard in passing of “carpal tunnel syndrome” and you may know that it is a painful condition which can affect the hands, wrists, and arms. There’s probably a smaller chance that you have heard of “tarsal tunnel syndrome” which is similar but in fact a completely different problem. Both of these conditions result when important nerves become entrapped or compressed in some way, but while carpal tunnel syndrome affects the upper extremities, tarsal tunnel syndrome affects the ankles, feet, and lower legs.

          Similar to the wiring in a house which must travel a certain distance to supply electricity, the nerves in our body must travel from our central nervous system (the brain or spinal cord) out to the distant parts of our body to supply electrical impulses. To accomplish this, one of the most important nerves must travel down the inside of the lower leg and course behind and below the bump or “malleolus” on the inside of the ankle before it enters the foot. While it’s not usually a problem, this inside area of the ankle also contains many other structures including tendons, ligaments, blood vessels, and bony structures. Occasionally, this congested area may become further compressed by a tumor, fracture, or other entity which creates an irritating pressure on the major nerve in that location.

          From tumors, lesions, and fractures to systemic diseases and biomechanical deformities, there are many possible causes of tarsal tunnel syndrome. Often times, there is no clear and specific cause which can complicate the diagnosis. However, the symptoms are fairly consistent which include burning, tingling, or shooting pains which may radiate either up or down the foot or ankle into the toes. This pain is often made worse with activities such as standing or walking and relieved with rest, although night pain is also not uncommon.

          A visit to your Chandler podiatrist is certainly a good idea if you’re experiencing these symptoms because he can help to determine whether tarsal tunnel syndrome truly is the cause of your pain. Many other etiologies are also possible such as a nerve root problem, peripheral vascular disease, tendon irritation, a heel spur, or a stress fracture. Once these other potential diagnoses are ruled out, you and the doctor can discuss the treatment options which will have the best chance of helping you. These can include certain medications, steroid injections, or specific shoe gear modifications before moving on to consider a surgical intervention to decompress the area.

          If a tumor or fracture is indicated during your evaluation, it may ultimately require surgery for a complete resolution of the problem and is yet another reason to schedule an appointment sooner rather than later.