Tag: Foot and ankle wounds

PART 2: WHY DO MY TOES, ANKLES, AND FEET HURT AT NIGHT? RAYNAUD’S SYNDROME

Posted on by Michael Kokinos

Last week I wrote the first part of a four-part series about foot pain at night.  Specifically, I talked about venous disease as a cause of foot pain.

Today, I want to talk about another common cause of foot pain at night: Raynaud’s Syndrome. 

As a quick review, last week we talked about the two main types of blood vessels in our bodies: arteries and veins.  Arteries bring blood from the heart to the feet under high pressure.  Veins bring blood back from the foot to the heart under low pressure.

Raynaud’s Syndrome is a disease of the arteries, particularly the small arteries, in the feet.

(Though Raynaud’s can also affect the hands as well). 

Before we dive into Raynaud’s Syndrome though, I need to briefly review another anatomical system in our bodies that is involved in Raynaud’s Syndrome: The nervous system.

In general, we have two broad types of nerves.

  1. There are nerves that are responsible for sensation and for moving muscle and
  2. There are nerves that are responsible for regulation of bodily function.

Diving a little bit deeper into the kinds of nerves that regulate bodily function, there are the

  • Sympathetic nervous system: The sympathetic nervous system, amongst other things, is responsible for opening blood vessels in the legs and arms and increasing blood flow when exercise is necessary
  • Parasympathetic nervous system: The parasympathetic nervous system in similar fashion opens the blood vessels leading to the intestines to allow for the digestion of food.

In patients with Raynaud’s Syndrome, sometimes their sympathetic nervous system does not function properly resulting in the constriction of blood vessels that lead to the hands, fingers, feet, and toes.  When it happens, blood vessels in the fingers and toes typically first turn blue because of the lack of oxygen; then white because of the lack of blood flow; and finally red, once the constriction ends and the blood flow returns to the fingers and toes.  During this constriction of the blood vessels, patients can have significant pain, numbness, tingling, and, in very severe cases, ulcers (defects in the skin with exposure of underlying fat and muscle) and gangrene (black and dead tissue).

Interestingly, environmental and social triggers play a significant role in Raynaud’s Syndrome episodes of vessel constriction.  Factors including stress, caffeine, alcohol or other drugs, and cold temperature can all induce a painful episode with lack of blood flow to the hands and feet.

Not much is known about the cause of Raynaud’s Syndrome or specifically why it happens.  Sometimes, Raynaud’s Syndrome can occur on its own without any other related disease.  In other cases, the patient has another inflammatory disorder like lupus or Sjogren’s Syndrome that is known to be highly associated with Raynaud’s Syndrome.

Though we do not fully understand the causes of Raynaud’s Syndrome there are many treatment strategies that can help.  Starting with behavioral modifications and certain blood pressure medications that can reduce spasm to specific procedures aimed to reduce the spasm of the vessels induced by the sympathetic nervous system, there is so much that I as a vascular surgeon can do to help patients with Raynaud’s Syndrome.  If you think that you might suffer from Raynaud’s Syndrome, please do not hesitate to call our office on 408-376-3626 to schedule an appointment. We Can Help!

Dr. Ignatius H. Lau

Vascular Surgeon

Dr. Ignatius Lau grew up in Portland, Oregon. He attended the University of Washington in Seattle for college and Stony Brook University in Long Island for medical school. He then went on to train in vascular surgery at Mount Sinai Hospital in New York City. During his time in New York, he performed over 1600 cases involving aortic, peripheral, venous, and carotid surgery. He has a special interest in limb salvage and treating patients with peripheral arterial disease and has extensive training and experience in treating the full spectrum of vascular diseases. Dr Lau was also very active in medical research during his training, ultimately finishing with twelve peer reviewed manuscripts. During his training in New York, he met his wife, Lisa, who is a practicing endodontist. Together they love to hike, try new restaurants, and travel.

DIABETIC WOUND CARE IN SAN JOSE-TREATMENT FOR DIABETIC WOUNDS

Posted on by Angelica Rodezno

Silicon Valley’s South Bay Vascular Center and Vein Institute physicians are recognized as the leading wound care doctors in the greater San Francisco Bay Area. Dr. Kokinos is the current medical director at both the Verity/O’Connor Wound Care Center in San Jose and at St Louise Hospital Wound Care Center in Morgan Hill, CA. She is recognized as one of the regional experts in Northern California and provides cutting edge treatment for the care and treatment of Non Healing Diabetic wounds. Together with her partner Dr. Brad Hill who served as chief of Kaiser Hospital’s entire Northern California Vascular Surgery Department for over 17 years, South Bay Vascular Surgeons provide unmatched cutting edge and compassionate care to patients suffering from non-healing diabetic foot wounds.

Millions of Americans suffer from wounds that don’t heal. It’s a problem most don’t even think about until they or a loved one develops this type of wound. After all, every one of us has fallen or hurt ourselves with a resulting wound. It generally hurts for a little, we put a little Neosporin or a band-aid on it, and forget about it. Pretty soon, it is gone, and there is a little or big scar in its place. However, as we get older, and develop medical issues, this healing may not happen. A wound that has been “open” for more than four weeks, is called a chronic wound, and often needs the special attention of a wound care center. In these centers, team of specially trained nurses and doctors use a variety of diagnostic and therapeutic tools to help promote healing.

Diabetics must pay special attention to their feet and ankles and it is vitally important to NOT ignore a small wound when it develops. Diabetic wounds, when left untreated, are the cause of 85% of the amputations that occur in these patients. Once these ulcers develop, they often DO NOT HEAL just by putting a Band-Aid over them, or even with wound care and ointments prescribed by your primary care doctor.

Several different problems can contribute to wound healing. The most common of these is a circulation issue. Either the arteries are blocked that supply oxygen and nutrients to help heal the wound, or the veins that promote drainage of toxins and fluids are not functioning properly. This can occur either because they have leaky valves, or because they too are blocked. In general, it has been discovered that about 70% of wounds seen in wound care centers have an underlying vascular issue. This problem is most often an issue with leg or foot wounds. For this reason all of these should be consulted on by a vascular surgeon, a specialist in treating circulation problems. Simple tests, most of which are not invasive, can reveal problems in the arteries and veins. It is very important to do this, because treating these issues alone can greatly improve the wound healing rate.

If you suffer from non-healing leg or ankle wounds, especially if you are a diabetic, call the diabetic wound care experts at South Bay Vascular Center to schedule an appointment to have these wounds evaluated. We offer hope when others say there is none. 408-858-3586.