Peripheral Vascular Disease

Peripheral vascular disease — PVD — is the narrowing or blockage of the arteries supplying blood to the limbs, most commonly the legs and feet, due to atherosclerotic plaque buildup within the arterial walls. Reduced blood flow deprives the tissues of the oxygen and nutrients required for normal function, healing, and resistance to infection. The condition affects an estimated 8 to 10 million Americans and becomes significantly more common with age, diabetes, smoking, hypertension, and elevated cholesterol.

The feet are among the first places where the consequences of reduced arterial circulation become visible. The small arteries supplying the foot are among the most distal in the circulatory system — they receive blood last and are affected earliest when supply is reduced. A podiatrist examining the foot regularly observes the clinical signs of vascular compromise before they have produced serious complications: changes in skin temperature and color, reduced or absent pulses, thinning of the skin and loss of hair on the foot and lower leg, delayed wound healing, and nail changes that reflect chronic ischemia. These are not cosmetic changes — they are clinical signals that deserve prompt evaluation.

The most important symptom of PVD from the patient's perspective is often claudication — a cramping, aching, or burning pain in the calves, thighs, or buttocks that develops with walking a predictable distance and relieves promptly with rest. Patients frequently attribute claudication to arthritis, muscle fatigue, or 'just getting older' — and delay evaluation as a result. This delay is one of the most consequential mistakes in vascular medicine. The leg pain that appears after walking a block and disappears with rest is the vascular system signaling that the muscles are not receiving adequate blood flow. It is not normal aging.

More advanced PVD produces rest pain — pain in the foot and toes that is present even without activity, typically worse at night, and partially relieved by dangling the foot over the side of the bed. Rest pain indicates critical ischemia — the circulation is so compromised that the resting tissue cannot be adequately supplied. This is a medical urgency. A non-healing wound, ulcer, or area of tissue breakdown in a patient with PVD is a potential limb-threatening emergency — the impaired circulation that prevents healing creates a pathway for infection that can progress with frightening speed in the absence of adequate perfusion.

Dr. Gunter performs vascular assessment at every foot examination for at-risk patients — including pulse palpation, skin and temperature evaluation, and Ankle-Brachial Index (ABI) measurement when indicated. When the examination raises concern for significant vascular compromise, he does not wait. Prompt referral to vascular surgery for intervention assessment — angioplasty, stenting, or bypass — has saved digits and limbs in patients whose disease was identified and acted upon quickly. The podiatrist and vascular surgeon work together as a coordinated team in the management of PVD — and early communication between them is what produces the best outcomes for patients.