The effects of arteriosclerosis are most likely to appear first in your legs or feet. In one of its forms, arteriosclerosis obliterans, the major arteries that deliver blood to your legs and feet become narrowed and blood flow decreases. Smaller blood vessels assume some of the load, but the physical activity of walking a block or two can produce cramps in your legs or feet; the cramps disappear within a few minutes after you discontinue the exercise. This sequence of walk, pain and rest is also termed intermittent claudication.

When some of the blood vessels actually become blocked (occluded), your foot may become pale, cold, and painful. Sometimes the final blockage develops gradually and your foot becomes vulnerable to even minor injury and infection. Gangrene consists of the actual death of tissue and usually appears as a spot or area of black, shrunken skin near the tips of your toes or about your heel.

If the occlusion happens suddenly, as when a fragment of plaque or a clot lodges at a fork of your leg artery (commonly, at your knee), there is sudden and severe pain as well as paleness and coldness below the level of the blockage. The limitation in blood supply often will cause inflammation and damage to the nerves (neuritis) which is manifested by burning, pain, and numbness.

These circulation problems are common in persons with diabetes; they also may have diabetic neuropathy. The decreased sensation that often accompanies diabetic neuropathy makes the person more likely to incur injury to the affected foot.

Signs and Symptoms:

1. Leg pain, especially in the calves and feet, which develops during activity and resolves shortly after the activity is stopped (intermittent claudication).
2. Numbness or pain in the foot or toes when at rest;
3. Ulcers or gangrene on the foot or toes.

Diagnosis:

The key aspect to diagnosis is the nature and timing of your discomfort. Does the pain occur only with exercise? Is it relieved by rest? Does it recur when activity is resumed? If so, your physician may suspect arteriosclerosis of your extremity.

Your physician may take your blood pressure and pulse in the vicinity of the pain. The pressure and pulse there may become too low to measure during exercise. Other tests, including an ultrasound scan of the area, also may be ordered. An angiogram (the injection of a dye into the affected area during an x-ray examination) will tell your physician exactly where the blockage is and whether surgical repair can be attempted.

Complications:

For many people, arteriosclerosis of the leg is not a serious problem. For most, conservative care will prevent severe disability or loss of a limb; among diabetics, the problem occurs somewhat more often. If gangrene develops, surgical amputation may be necessary

Treatment:

Lifestyle Changes:

In most cases, physical activity is a useful element in treat- ment of limited arterial blood supply to the legs. Your physician will help you devise an appropriate regimen of daily walking or other exercise. The basic principle is to intersperse periods of exercise long and hard enough to produce pain with periods of rest.

Over time, the amount of activity required to cause pain will increase. The circulation can improve with time because collateral vessels that bypass the blocked segment will develop.

Smokers are at particular risk for arteriosclerosis. Smoking also decreases the blood’s ability to carry oxygen to your tissues and constricts the size of your smaller arteries. Smoking also encourages the deposition of platelets on microscopic areas of damage on the inner layer of arteries. Cholesterol then accumulates. If you have limited arterial circulation, stop smoking ( choose your cigarette or your leg).

Proper Foot Care: If you have diabetes as well, foot care is essential. Wear shoes that fit properly. Even minor cuts or scrapes require immediate attention because the decreased circulation means that the tissues heal slowly. If left untreated, even a minor injury to the skin of your lower leg or foot can lead to infection, gangrene, and amputation.

Medication:

Your physician may prescribe aspirin or another analgesic if the pain continues even at rest. Your physician also may prescribe a drug called to improve the blood flow to your limbs.

Surgery:

A surgical approach may be appropriate if one of the larger arteries in your leg becomes blocked. In some cases, a balloon device to expand the narrowed artery (balloon angioplasty) may be used (the procedure is similar to that used in heart surgery.

Occasionally, lasers and other devices are used to open blocked arteries. Surgery to remove the damaged artery or to bypass it with an artificial vessel made of Dacron may be required. Surgery is usually reserved for persons with severely impaired walking ability, pain, or breakdown of skin or who have the potential for loss of a limb.