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Venous Insufficiency And Venous Ulcers

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What are the symptoms of a venous skin ulcer?

The first sign of a venous skin ulcer is skin that turns dark red or purple over the area where the blood is leaking out of the vein. The skin also may become thick, dry, and itchy.

Without treatment, an ulcer may form. The ulcer may be painful. You also may have swollen and achy legs.

If the wound becomes infected, the infection may cause an odor, and pus may drain from the wound. The area around the wound also may be more tender and red.

Call your doctor when you first notice the signs of a venous skin ulcer, because you may be able to prevent the ulcer from forming. If an ulcer has formed, get treatment right away, because new and smaller ulcers tend to heal faster than larger ones.

How is a venous skin ulcer treated?

The first step involves improving blood circulation. To do this, you can:

  • Lift your legs above the level of your heart as often as possible. For example, lie down and then prop up your legs with pillows.
  • Wear compression stockings or bandages. These help prevent blood from pooling in your legs.
  • Walk daily. Walking helps your blood circulation.
  • To help your ulcer heal, your doctor may also remove dead tissue from the wound (debridement).

    After your ulcer has healed, continue to wear compression stockings. Take them off only when you bathe and sleep. Compression therapy helps your blood circulate and helps prevent other ulcers from forming.

    If your ulcer doesn't heal within a few months, your doctor may advise other treatment, such as:

  • Medicine to speed healing or get rid of an infection (antibiotics).
  • Skin grafting, which may be needed for deep or hard-to-heal ulcers.
  • Vein surgery, which may keep ulcers from coming back.
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    Why Are My Feet Swollen?

    A person might experience swollen feet for several reasons, ranging from hot weather or pregnancy to more serious health conditions, such as heart disease or a blood clot.

    Here, we take a look at some of the reasons why a person's feet may appear swollen, when they should talk to a doctor, and what the treatment might involve.

    Edema is the medical term for swelling that occurs when fluid becomes trapped in the body's tissues. It usually affects the legs and feet but can also occur in other parts of the body, such as the face or hands.

    Other signs of edema include:

  • shiny, stretched skin over the affected area
  • skin that stays dimpled after pressing it
  • discomfort and reduced mobility
  • coughing or difficulty breathing, if it affects the lungs
  • Treatment

    Edema may go away by itself, or there may be an underlying cause that needs medical treatment.

    Home remedies include wearing support stockings, reducing salt intake, and lying down while raising the legs above the chest.

    If the swelling does not improve, a person should talk to their doctor to check for any underlying causes.

    Trauma to the foot or ankle can cause swelling in this area of the body.

    For example, a sprained ankle, which occurs when the ligaments become overstretched, could cause the foot to swell.

    Treatment

    To treat a foot or ankle injury, a person should elevate the foot when possible and try not to bear weight on the affected leg.

    Using an ice pack or compression bandage can help reduce swelling, and over-the-counter pain relievers can help ease discomfort.

    If the swelling and pain do not go away, a person might need to see their doctor to rule out more severe damage.

    A common symptom of late pregnancy is for the feet and ankles to swell. This swelling is due to fluid retention and increased pressure on the veins.

    Home remedies

    To treat swollen feet during pregnancy, women can elevate their feet where possible, wear comfortable and supportive footwear, and avoid standing for extended periods.

    Staying cool, avoiding salt, and increasing water intake can help reduce fluid retention. Wearing supportive clothing, such as tights or compression stockings, should also reduce discomfort and help the swelling decrease.

    If swelling during pregnancy comes on suddenly and is severe, it could be a sign of preeclampsia. This is a condition that can occur during pregnancy or immediately after the birth. Symptoms include protein in the urine, rapid excessive fluid retention, and high blood pressure.

    This is a severe condition that usually occurs in the latter half of pregnancy and can progress to eclampsia, which is even more dangerous and constitutes a medical emergency.

    Signs of preeclampsia include:

    Treatment

    If a pregnant woman experiences any of these symptoms, she should speak with her doctor or midwife straight away.

    Some lifestyle factors can also lead to swollen feet. These factors include:

    Home remedies

    Exercising regularly and maintaining a healthy weight can reduce the risk of swollen feet.

    Other ways to alleviate swollen feet include:

    Taking certain medications can result in the feet swelling, especially if they cause water retention.

    Medications that may cause the feet to swell include:

    Anyone who thinks that their medication is causing their feet to swell should speak with a doctor, who may be able to alter the dosage or prescribe a different type of medication.

    Alcohol can cause the body to retain excess water, causing the feet to swell. If the swelling continues for more than 2 days, a person should make an appointment with their doctor.

    Recurrent swelling of the feet after drinking alcohol may be a sign of an underlying issue with the heart, liver, or kidneys.

    Home remedies

    Elevating the feet above the heart, drinking plenty of water, and reducing salt intake may all help minimize swelling. Soaking the feet in cold water can also relieve symptoms.

    During hot weather, the feet can swell because their veins expand to cool the body. This process can cause fluid to leak into the surrounding tissue. Fluid can also collect in the ankles and feet.

    Home remedies

    Drinking plenty of water and wearing well-fitting, comfortable shoes that allow some ventilation can help prevent the feet from swelling in warm weather.

    An infection can cause swelling in the feet and ankles. People with diabetes have an increased risk of infection affecting their feet, so they should remain vigilant for any changes to this part of the body, such as blisters and sores appearing.

    Treatment

    A doctor will typically prescribe antibiotics to treat infections.

    Venous insufficiency occurs when a person's blood cannot flow around the body properly. This is due to damaged valves causing blood to leak down the vessels and fluid retention in the lower legs, particularly around the feet and ankles.

    Signs of venous insufficiency include:

    Treatment

    A person experiencing any signs of venous insufficiency should make an appointment with their doctor as soon as possible.

    To treat venous insufficiency, a doctor may recommend making some lifestyle changes, such as taking up exercise to help keep the blood pumping around the body efficiently. Compression stockings and medication to prevent blood clots can also help.

    In some cases, a doctor may suggest surgery to try to repair the damaged valves.

    Blood clots occur when the blood fails to flow around the body correctly, causing platelets to stick together.

    If blood clots develop in the leg veins, they may prevent the blood from moving back to the heart. This can cause the ankles and feet to swell.

    Deep vein thrombosis (DVT) occurs when blood clots form deep in the legs. DVT is a serious condition that can cause a blockage in the major leg veins. In some cases, the clots may break loose and move to the heart or lungs.

    Signs of DVT include:

  • swelling in one leg
  • pain or discomfort in the leg
  • low-grade fever
  • color changes in the leg
  • Treatment

    If a person notices any signs of DVT, they should seek urgent medical attention. A doctor may prescribe blood-thinning medication to treat blood clots.

    People can help prevent blood clots by wearing tights, compression stockings, or clothing that is loose-fitting around the ankles.

    Other prevention methods include keeping active and reducing salt intake. It is also best to avoid standing or sitting still, especially with crossed legs, for extended periods.

    The lymphatic system helps the body get rid of unwanted substances, such as bacteria and toxins. Lymphedema occurs when lymphatic fluid gathers in the tissues as a result of problems with the lymph vessels.

    If the lymph vessels are damaged or absent, lymphatic fluid can build up and lead to infection, slow wound healing, and even deformity.

    People who undergo radiation therapy or lymph node removal have a higher risk of lymphedema. Anyone who has undergone cancer treatment and experiences swelling should contact their doctor immediately.

    As well as swelling of the feet, signs of lymphedema include:

  • recurrent infections
  • impaired motion
  • aching
  • a feeling of tightness or heaviness
  • thickening of the skin
  • Treatment

    Treatment options for lymphedema include exercises and targeted massage, which can both help drain the excess fluid. Wearing bandages or compression garments may also be beneficial.

    Swelling of the feet could be a sign of heart disease or heart failure. If the heart is damaged, it cannot pump blood to the heart efficiently.

    Right-sided heart failure can cause the body to retain salt and water, resulting in swollen feet.

    As well as swelling of the legs, ankles, and feet, symptoms of heart failure include:

    Treatment

    If a person experiences any of the above symptoms, they should seek immediate medical attention.

    Treatment options for heart failure include medications, medical devices to help support the heart, and surgery.

    Liver disease can inhibit the production of albumin. Albumin is a protein that helps stop the blood leaking from blood vessels. A lack of albumin means that the blood may leak, causing fluid to pool in the legs and feet, which can result in swelling.

    Symptoms of liver disease include:

    Treatment

    To treat liver disease, a doctor may prescribe medication. They may also suggest lifestyle changes, such as losing weight or reducing alcohol intake.

    In more severe cases of liver disease, surgery may be necessary.

    Below are some frequently asked questions about swollen feet.

    When should a person be concerned about swollen feet?

    If swollen feet occur alongside shortness of breath, chest pain, or pressure in the chest, call the emergency services immediately.

    How does a person get rid of swollen feet?

    Tips for getting rid of swollen feet include drinking plenty of water, soaking the feet in cool water, massaging the feet, raising the feet above the heart regularly, and staying active.

    Many cases of swollen feet tend to resolve without medical care, although home remedies and lifestyle changes can help reduce the swelling.

    If the swelling does not go away or it occurs repeatedly, it is essential to make an appointment with a doctor to determine whether there is an underlying cause.

    If swollen feet occur alongside shortness of breath, chest pain, or pressure in the chest, call the emergency services immediately.

    Read this article in Spanish.


    Dear Doctor: Who Can Get Help From Compression Socks, And Who Should Avoid Them?

    DEAR DR. ROACH: Would you please address how to use compression socks? I sit most of the day, so wearing the socks helps my legs to feel less heavy and tired by the end of the day. Are there people who should not wear them? And what about wearing them during exercise? -- C.S.

    ANSWER: Compression stockings are most commonly used in people with chronic venous insufficiency, a common condition in middle-aged to older people, whose major symptom is swelling in the feet and lower legs. The swelling is usually minimal or gone in the morning and gets worse during the day, especially with prolonged standing and even sitting.

    The underlying problem is that the veins, which carry blood from the legs back to the heart, get leaky over decades, and the fluid accumulates in the legs under the force of gravity. Your doctor can prescribe the right size, length and strength of stocking based on your personal condition.

    The fact that you feel better with compression stockings suggests that you might have venous insufficiency, but it's still a good idea to ask your doctor about them. Compression stockings are pretty safe, but should not be worn by people with serious reduction in arterial blood flow to the legs.

    Arterial disease is completely different from venous insufficiency and caused by blockages in the arteries, which carry blood from the heart to the legs. An expert, such as a vascular surgeon, is an appropriate consultant for a person with arterial insufficiency before considering compression stockings.

    Unless you have moderate to severe arterial disease (in which case you should check with your doctor if you aren't sure), there is no harm from wearing compression stockings during exercise. There may even be some benefit.

    Compression stockings should also not be worn by those with an acute clot in a major leg vein (a deep venous thrombosis). Once the clot is stabilized for a few days with medication, compression stockings can help treat and even prevent swelling in the affected leg.

    People with moderate to severe heart failure should exercise care before using compression stockings, which put the leaked-out fluid back into the circulation and can worsen heart failure. Again, this is an issue to discuss with your regular doctor or cardiologist prior to using compression stockings on your own.

    Finally, severe venous insufficiency can cause breakdown in the skin. A person with ulcers or open wounds, or with any kind of acute infection, should be evaluated and treated prior to using compression stockings. A wound care nurse is an ideal consultant in this case.

    DEAR DR. ROACH: I have a friend who is 75 years old and has large blue veins directly under the skin on her hands, arms, feet and calves. What causes them, and can they be treated? They are noticeable, and I think she is unhappy because of this issue. -- P.G.

    ANSWER: In fair-skinned people, it is common to see blue veins under the skin. This is not a problem. (The blood isn't really blue. The color is due to light scattering.)

    People with enlarged veins, such as varicose veins, may have more noticeable veins, but they do not need to be treated unless they are symptomatic or if it is cosmetically important to the patient. There are many different types of treatments available, and an expert, such as a vascular surgeon, can discuss these options.

    Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.Cornell.Edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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