Podiatric Vein Care
Introduction to Podiatric Vein Care - Evaluation and Management of Lower Extremity Venous Diseases

In order to accurately diagnose venous insufficiency, a thorough history and physical must be obtained. The history should be a comprehensive family history, as there is a high genetic predisposition to venous insufficiencies and associated disorders. During the physical examination, both the arterial and venous systems are evaluated.

A complete history should include identifying any bleeding disorders, liver dysfunction, or previous vein pathology. A family history should be obtained. Pregnancies and births should also be questioned. Any previous trauma or DVT should also be identified. A complete lower extremity evaluation and how all the systems relate to symptomatology is reviewed.

From the muscular standpoint, there will be little signs of pathology. Symptoms, however, include muscle cramping at night. Neurologically, patients may relate a tingling or burning to their feet. This is commonly associated with tarsal tunnel pathology, as the main cause of tarsal tunnel syndrome are varicose veins. A patient that relates neurological findings in the posterior aspect of the leg may have obvious sciatica pathology. However, oftentimes there is no shooting pains down the leg but varicose veins along the posterior aspect of the lower leg into the popliteal fossa.

Typically the common peroneal nerve is not involved. However, the superficial peroneal nerve can be involved as the perforating peroneal vein on the anterolateral aspect of the lower leg can contribute to surface pathology.

Dermatologically, findings include the obvious telangiectasias and bulging varicose veins. However, more advanced pathology includes skin color changes along the lower leg. Erythema is typically visualized first followed by brown skin staining due to hemosiderin deposition, atrophy Blanche, and even patches of psoriatic lesions. As blood pools and the liquid escapes to extravascular spaces, it sits stagnant in the lower leg. The release of hemosiderin and other toxins with an increase in acidity will cause the skin to deteriorate and the dermal layers to become affected from the inside. As the dermal layers breakdown and the vein walls lose their elasticity, caution is noted for potential bleeding and skin ulcerations. These are commonly associated with underlying areas of perforating veins. Edema is present and is typically pitting. This can be unilateral or bilateral. Often these advanced changes are noted with chronic venous insufficiency (CVI).

It should be noted that while the presence of varicose veins DO indicate venous insufficiency, the absence of varicose veins DO NOT exclude a diagnosis of venous insufficiency.