Friday, August 4, 2017

Never ignore black spots on your legs and feet

K . K . Pandey

If the lower portion of your leg has black spots or discoloration , or if the colours of the skin of your ankle and leg are darker than the rest of your body skin, or if you develop swelling in the leg after walking or if after a short walk you feel your legs are stretched - out and profoundly fatigued , then all these point not towards skin disease , as usually believed , but surprisingly towards disease of the veins , which in medical terminology is called Chronic Venous Insufficiency or C . V. I.

A majority of the women above 30 years of age of suffer from Chronic Venous insufficiency . This venous disease in most of the ladies starts developing just after either pregnancy or delivery of the child . Physical exercises and regular daily walk have become non- existent in our modern day- to- day living . Young males and females working in call centres, at reception counters, stock exchange and offices of government and multinational companies are falling victim to this debilitating venous disease , as they are required to sit every day with legs hanging down in front of computers or stand continuously for a long period during their working hours .

The supply of oxygen to legs and feet is made possible by pure blood that flows through arteries. After giving away oxygen to the legs , the remaining deoxygenated impure blood has to go back to lungs through heart for purification or replenishment with oxygen. The channels that carry back impure oxygen -deficient blood from legs to lung are called veins . This itself explains that veins of legs form the drainage system of the leg . If the functioning of veins is deranged by any reason, the drainage system of leg and foot becomes faulty.
Because of this malfunctioning in drainage systems of legs , the impure blood instead of going upward towards the lung starts accumulating in the lower portion of the legs. This ultimately heralds the beginning of swelling and discoloration of leg skin. If timely intervention is not initiated under the guidance of a cardiovascular or a vascular surgeon , the black patches which are small in size in the initial state, will enlarge and deepen and eventually will convert into a non - healing ulcer of leg .

The one of the main reasons of development of the CVI is deep vein thrombosis in which blood flowing in the leg veins gets clotted and thereby blocks the return flow of impure blood. These blood clots may or may not dissolve completely even after treatment . Even if blood clots dissolve completely but not before they have already destroyed valves, which are situated inside the veins . These venous valves control and maintain the unidirectional flow of blood. The destruction of valves of vein deranges the process of upward return of impure blood through veins . The muscular pump of the leg which help in pushing the impure blood upwards also becomes weal , due to lack of regular daily walk and leg exercises . In some patients , venous valves are either congenitally absent or under developed since birth . In such patients , the symptoms of the CVI appear from the very early age.

The early complaints in a patient of the CVI are the appearance of swelling in the leg and feet by the evening, and disappearance of swelling in the morning when the patient gets up . As the disease progresses , patients of the CVI start complaining of mild pain, stretching and early fatigue in the legs. Later on , appear black spots on the skin of legs and feet, which slowly keep on increasing in size and depth . As the days advance, the same very black spots give rise to eczema and ulcer .

Go to a hospital where a full time availability of a vascular or a cardiovascular surgeon is there. It is utmost essential to know the cause of these black spots on the leg. For this , we need the help of investigations like Venous Doppler study . M . R. Venogram and sometimes angiography . Some special blood tests too are required to know whether mechanism of blood clotting is defective or not . Always make sure before entering a hospital where these modern investigatory facilities are available or not . A few years back , in a majority of the cases , medicines and special exercises were required to control the diseases. But in the modern era, specialised latest operations like Venous Valvuloplasty, Axillary Vein Transfer or Venous Bypasses are done to control the disease .

What then can one do if one has black spots on the leg?

1 . Avoid tight belt and clothing around your waist . Avoid tight panties .
2 . Avoid high- heeled sandals . Low -heeled sandals keep muscular pump of your leg active and dynamic .
3 . Avoid jogging, skipping and exercises which give constant jerks to your knees . Do normal stretching exercises .
4 . Avoid postures , which require prolonged standing or prolonged sitting with legs handing . Have a break after one hour of continuous sitting or standing.
5 . Avoid oily and cholesterol - rich food . Prefer foods having plenty of fibers with low calorie content , which will be helpful for veins .
6 . Females should avoid contraceptives or other estrogen preparations because these medicines dilate the veins that will result into more accumulation of blood into the legs.
7 . Do regular and daily morning walk for at least 5 - 6 km .
8 . Always wear on your legs , the specialised graduated compression stockings . These specialised stockings increase the blood flow and decease the swelling . They decrease the backpressure of blood in the leg caused by gravity . This halts the progression of the CVI.
9 . Any yogic exercise , which gets your legs elevated for a few minutes , will be helpful in controlling this disease .
10 . While in bed during sleep, keep your legs elevated 10 - 12 inches above the chest level . This accelerates the returns of impure blood towards the heart .

Dr . Pandey, Senior Vascular and Cardio Thoracic Surgeon ,
Indraprastha Apollo Hospitals , New Delhi , India wrote in via drpandeykk@gmail . com

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