A thought for the legs
Dr K K Pandey
The Pioneer
Monday, September 15, 2003
Many a time leg and foot injuries result in a leg ulcer.
If not treated in time, it may result into a situation
where one is left with no option but to get the leg
amputated. Most people in our country are not aware that
leg and foot ulcers that do not heal are caused by
diseases of veins. Veins in our body form a drainage
system of the limbs and other organs. Veins collect
oxygen-deficient impure blood from all organs and carry
it back to heart and lungs for purification, thus
replenishing the blood with oxygen.
If this venous system becomes defective due to any
reason, a large portion of impure blood starts collecting
in the legs, which leads to undue pressure on the veins
of lower limbs. If timely intervention is not initiated,
it may lead to ulcers on your legs and feet. These are
called varocose or venous ulcers. Among venous diseases,
chronic venous insufficiency (CVI) tops the list.
The second most common cause of leg and foot ulcer is the
disease of arteries, which carry oxygen-enriched pure
blood from our heart to various parts of the body,
including the limbs. An arterial disease is the primary
reason in about 20 per cent cases of leg or foot ulcers.
Diseases of the artery lead to narrowing of its diameter.
It results into decreased supply of pure blood, which
translates into inadequate supply of oxygen to various
body organs. In cases where a leg is already deficient in
oxygen, a simple injury may lead to dangerous
complications. A simple-looking ulcer will not heal in
spite of antibiotics and medication, gradually developing
into a larger ulcer and ultimately result in amputation.
In five per cent cases of leg or foot ulcers, diabetes is
the culprit. After venous and arterial diseases, it is
the third most common cause for ulcers. Since there is
decreased sensitivity in diabetic patients, the feeling
of pain due to leg or foot ulcer is much less in them.
They therefore become careless in managing their ulcer
and it assumes dangerous proportions. Besides, diseases
of arteries are by and large known to co-exist in
diabetic patients. This further makes the oxygen supply
to the legs fall to a dangerously low level, and results
in a non-healing ulcer and gangrene of the foot.
Blood pressure, obesity, burn injuries, diseases of
joints (like rheumatoid arthritis), anaemia and infection
also play a major role in the development of leg and foot
ulcers.
If your leg and foot ulcer does not heal completely
within three weeks, you must immediately consult a
cardiovascular surgeon rather than a general or plastic
surgeon. The patient must visit a hospital which makes
active and full-time provisions for the service of a
cardiovascular surgeon. Patients must ensure that the
hospital is equipped with necessary and relevant
investigatory facilities like angiography, venography,
nuclear medicine and doppler study. Patients should
prefer hospitals which offer facilities like hyperbaric
oxygen therapy and where
arterial and venous bypass surgical facilities -
including artificial grafts - are available.
Dr Pandey is a senior cardiothoracic and vascular surgeon
with Indraprasth Apollo Hospital
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