Absent or decreased pulses may be noted during assessment due to lack of adequate blood flow to the lower extremities. A doppler should be used to detect pulses before determining that they are absent.
Intermittent claudication, or intermittent cramping pains, are usually caused by exercise or physical activity and typically go away within 10 minutes or less. These cramping pains are often mistakenly attributed to aging; however, unlike joint pain, these cramps occur in the muscle.
Sharp lower limb pain associated with peripheral artery disease varies in quality and intensity. In severe cases, pain can occur at rest.
This occurs when the leg/foot becomes red (reactive hyperemia) while in a dependent position. Blood flow to the lower limbs is compromised, so the body compensates by dilating the arteries in the leg to achieve maximal blood flow and oxygen delivery. When elevated; however, the leg will become pale (elevation pallor).
The boundaries of arterial ulcers are well defined; these ulcers appear round and smooth.
Arterial ulcers occur on bony prominences, such as the toes, heels, and outside of the ankles, where the skin is most likely to rub on shoes, bed sheets, etc. Improper cutting of toenails, or removal of an ingrown toenail can also initiate an ulcer in the nailbed.
Reduced blood flow to the lower limbs can result in thickened, brittle nails, and thinning of the skin. Patients with peripheral artery disease often have shiny, smooth skin and hairless legs, feet, and toes. Edema is absent.
Arterial ulcers commonly occur in areas likely to lose blood supply when arterial blood supply is compromised, such as the toes, heels, and lateral lower legs. In these areas, the skin is also more likely to rub on shoes, bed sheets, clothing, etc, causing breakdown. Paresthesia and peripheral neuropathy can develop in patients with long-standing ischemia, especially noted in patients with diabetes.
Coolness of the skin is evident during assessment, due to decreased arterial blood flow to the lower extremities. The leg typically gets cooler as it gets closer to the foot.
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