ESCANABA — The years are hard on the harly diagnosis of artery disease rareuman body. Examples of this fact are plentiful, from chronically aching knees to the wrinkled skin of our later years, there being many consequences to the passing years. Some of these changes are blatantly obvious, like aging skin to gray hair, there for all the world to see. But also judge: our culture is fixated on youth, little weight given to the wisdom provided by time.

Some manifestations to our health are not so obvious. One of the most serious but also best hidden is the reduction in blood flow to all the varied cells composing the human body. There are numerous components to this phenomenon, some of which are out of our control. As the cliché goes, you can’t pick your parents, and many Americans are destined to develop some degree of peripheral arterial disease, aka PAD.

PAD occurs when the size of the opening through which oxygenated blood runs becomes narrowed. Although questions remain as to the exact mechanism of this clogging, the effect is a reduction in the amount of life-giving fluid delivered to the tissues of our legs and feet.

Estimates claim over ten million residents of the United States are experiencing atherosclerosis. In those forty years and older, an incidence of one out of twenty is mentioned. Roughly sixty percent of seniors eighty and older are afflicted. Regardless of the specific numbers, this condition is all too common. But, because this is typically a gradually developing situation, the changes are subtle, taking years to occur. And too often missed, ignored, denied. An early diagnosis is uncommon but of great benefit.

The earliest manifestations of the disease are seen farthest from the heart, where the accumulated narrowing results in the greatest reduction in flow. Since skin has such a high metabolic rate, and consequently a significant arterial supply, altered skin health is a common sign of PAD. Changes frequently take place in the toenails, which become misshapen, thickened, and are often mistaken for a fungal infection. Skin becomes thinner, more prone to being injured. Hair disappears since hair follicles are very sensitive to blood flow.

Healing any trauma to the skin is problematic in the presence of PAD. A quote used in the wound care field is “we are held hostage by the blood flow.” Mending any kind of injury, whether superficial or deep, will not be achievable, regardless of the technology utilized or the artificial skin graft applied, without sufficient arterial blood flow. It is for this reason that the services of a vascular surgeon are so valuable in the care of these patients.

When PAD progresses on the spectrum of occlusive arterial disease, Critical Limb Threatening Ischemia, CLTI, follows. The term refers to the afflicted individual’s inability to heal skin injury, often allowing the development of an infection. Again, without an adequate supply of the life-giving fluid which is blood, providing our tissues with nutrients and oxygen, repair will not occur. In the face of CLTI, new tissues cannot be manufactured.

Historically, a definitive assessment of the degree of PAD would not be pursued in the absence of intermittent claudication, whereby pain develops in some muscle group that is being used more. This phenomenon can be summarized in the “Walk-pain-rest-relief” cycle. But intermittent claudication, is present in only 30 percent of the time. Significant clogging may have occurred without this presentation, making this an unreliable diagnostic test. A more consistent sign is rest pain, in which ischemic pain is experienced when the benefits of gravity are lost, which is the case when lying flat in bed. The suffering individual will hang their legs off the side of the bed, re-engaging gravity’s assistance in bringing arterial blood down.

We know many lifestyle issues are important contributors to PAD. Cigarette smoking is certainly one, since nicotine is such a powerful vasoconstrictor (causing arteries to become narrower). Diet is another, with ultra-processed foods, trans fats, unsaturated fats, all identified as culprits in PAD. As they are often associated, obesity and inactivity are both considered risk factors.

Because the region of the body most affected by atherosclerosis is that which is farthest from the heart, podiatrists are in a prime position to identify PAD earlier in its development. If diagnosed before the pain and disability have developed, the course of the disease can be altered. And lifestyle changes can be notably effective as a healthy means of improving the outcome, especially when instituted earlier.

We now know it is possible to grow new blood vessels, bypassing the area of narrowing. This can be manifested with the right type of exercise, but it’s usually not recommended in time. The limitations in activity caused by this condition, the amputations and the mortality, are too common and too dangerous. We need to be better, as a healthcare system, in identifying and treating the ubiquitous ailment termed simply ‘peripheral arterial disease.

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Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with offices in Escanaba, Marquette, and L’Anse. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. His articles on health and wellness appear in multiple local and national publications. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.