Circulatory problems in the legs: what now?

Circulatory disorders occur more frequently with age and often go unnoticed for a long time. Inadequate blood circulation in the legs can result in amputation of the leg and promote the development of other diseases if treatment is delayed.

Now you're probably asking yourself, how do I recognize a circulatory disorder? Which doctor should I see if I suspect circulatory disorders? And what are the treatment options? In our article, we would like to inform you comprehensively about the clinical picture and give you important tips for prevention, so that in the event of an illness you can become suspicious and start treatment in good time.

the essentials in brief

• If the blood can no longer flow unhindered through the vessels, it is a question of circulatory disorders. Persistent circulatory disorders in the limbs (mainly the legs) are usually due to peripheral arterial occlusive disease (PAD) - also known as claudication.
• Hardening of the arteries is mostly responsible for the development of circulatory disorders. Pre-existing diseases such as diabetes mellitus and high blood pressure pose a risk of developing arteriosclerosis.
• In the treatment of circulatory disorders in the legs, timely treatment of the risk factors is essential. In addition to drug and exercise therapy, there are many other forms of therapy that depend on the stage.

Definition: What are circulatory disorders anyway?

If there is a circulatory disorder, the blood can no longer flow unhindered through the vessels. The tissues, organs or extremities (arms, legs) are accordingly no longer sufficiently supplied with oxygen and nutrients. If there is a lack of blood circulation, the undersupplied organs and limbs only work to a limited extent and in the long run they can even die off.

The region of the body where the circulatory disorder occurs is particularly decisive for the further course of the disease. In addition, a distinction is made between acute and chronic circulatory disorders. In the case of acute circulatory disorders, there is talk of a sudden onset, while chronic circulatory disorders are permanent.

If there are persistent (chronic) circulatory disorders in the limbs (usually the legs), this is referred to as peripheral arterial occlusive disease (PAD). In rarer cases, diseases such as Raynaud's syndrome, acrocyanosis and erythromalgia can be associated with circulatory disorders in the limbs.

Background: What you should know about circulatory disorders in the legs

We have put together all the relevant questions about the clinical picture for you and would like to use our answers to provide you with comprehensive information so that you have a better understanding of the cause behind the development of circulatory disorders, the signs by which they can be recognized and the diagnostic methods that unite you can assure correct findings, get.

Why do circulatory disorders in the legs occur and what are the risk factors?

The most common cause of circulatory disorders is hardening of the arteries (arteriosclerosis). This forms when certain substances build up on the walls of the arteries. These are usually deposited at the vascular junctions. Due to the intensive blood flow, the vessel walls are stressed.

For this reason, injuries form there, to which the solid substances from the blood attach themselves. These gradually enlarge and thus reduce the diameter of the blood vessels. The development of arteriosclerosis affects the blood vessels throughout the body and can therefore also cause other diseases such as coronary heart disease or a stroke.

Certain factors represent a risk for the occurrence of arteriosclerosis and thus in a certain respect also increase the risk of the development of circulatory disorders. The main risk factors include the following:

• Diabetes (diabetes mellitus)
• high blood pressure (hypertension)
• Elevated blood lipid levels (particularly increased LDL cholesterol levels)
• lack of exercise
• Smoking
• overweight (obesity)
• Unbalanced diet (excess fat and meat)

In addition, the following factors also play a role:

• Increased age
• Gender (males more common than females)
• genetic predisposition

In rarer cases, injury, embolism, or inflammation of the blood vessels can cause a circulatory disorder.(1,2)

At what age can circulatory disorders in the legs occur?

Circulatory disorders are becoming more and more common. Circulatory problems in the legs are mostly found in older people. More than 15% of the 60-year-olds are among those affected and sometimes without even knowing it. Complaints occur in about 5% of the over 60 year olds. However, younger people are not excluded.

What are the symptoms of circulatory disorders in the legs?

stage	symptoms
stage 1	Mostly without complaints
stage 2	Inadequate oxygen supply to the muscles behind the narrowing. Pain occurs in the affected leg, which makes it necessary to stand still (Claudio intermittents). After a moment's recovery, those affected are able to continue walking again.
Stage 2a	A distance of more than 200 meters can be covered on foot without pain.
Stage 2b	A distance of less than 200 meters can be covered on foot without pain.
stage 3	Complaints at rest
stage 4	Tissue destruction due to insufficient supply of oxygen (necrosis)

In addition to pain, there are other typical signs of circulatory disorders in the legs:

• Cold and paleness behind the narrowing (stenosis)
• Missing pulse
• Tingling and numbness felt
• lack of control and mobility of the leg
• No healing of ulcers and wounds due to reduced blood flow
• Muscle weakness on exertion
• tachycardia and impaired consciousness

When deep vein thrombosis occurs in the leg, other symptoms appear with the circulatory disorders. The affected body region (foot, calf or the entire leg) swells and an increased temperature can be felt. There are also bluish discolorations.(3,4)

Which doctor diagnosed circulatory disorders in the legs?

If you have already observed some of the listed symptoms of circulatory disorders or you would like to undergo a check-up to be on the safe side, you are in particularly good hands with specialists in angiology.

If you experience symptoms of a circulatory disorder, you should make an appointment with a specialist as soon as possible. (Image source: Online Marketing / Unsplash)

These give you precise information about the diagnosis and precautionary measures that are recommended to prevent circulatory disorders and for better blood circulation. Otherwise, you should at least consult your family doctor in advance.

If an acute vascular occlusion occurs, an emergency doctor must be contacted immediately or a trip to the hospital is required - the risk of life-threatening consequences is particularly high here.

When should a doctor be consulted for circulatory disorders in the legs?

In particular, if you can only walk less than 200 meters continuously, if you experience discomfort or open wounds even when you are resting, you should urgently undergo an examination by your specialist.

Which diagnostic methods are used for circulatory disorders in the legs?

In the diagnosis of circulatory disorders, in addition to the basic examinations such as measuring blood pressure and feeling the pulse, many other methods such as ultrasound examinations and so-called angiography are used.

anamnese

First of all, the doctor will ask you about your medical history (anamnesis). Here, typical complaints such as pain in the legs during exertion are particularly important. He will also ask you about possible risk factors for arteriosclerosis, which can promote circulatory disorders.

If coronary artery disease (CHD) is suspected, circulatory disorders in the legs often appear. In addition, erectile dysfunction in men can also draw attention to a vascular disease.

Basic Investigations

1. During the examination, the doctor pays particular attention to the color and temperature of the skin and, if necessary, to skin injuries and wounds.
2. Then it's time to feel the pulse on the arms, groins, back of the knees and feet. A vasoconstriction can be recognized by the fact that the pulse cannot be felt in the affected area.
3. In addition, the blood pressure is measured and the heart sounds and blood vessels are listened to with the stethoscope. With the help of the flow noise, bottlenecks may be uncovered.
4. The so-called storage test according to Ratschow is also used. This involves elevating your legs for a few minutes while your feet perform circular motions. Afterwards, the feet are left hanging again. If there is arterial occlusive disease, the raised foot will turn pale - due to the lack of blood circulation. In addition, blood circulation returns much later than in a healthy foot.(5,6)

Other investigative procedures

1. With the help of a blood test, existing risk factors for arteriosclerosis can be revealed more precisely. The blood sugar value in particular provides more detailed information on diabetes and blood lipid levels.
2. The Doppler pressure measurement is able to prove a circulatory disorder in the legs. An ultrasound device is used to determine the blood pressure in the legs. The ankle-brachial index is formed from the pressure values. Usually the pressure value should be above one. Values ​​below 0.9 indicate a circulatory disorder in the legs.
3. Oscillography is a method that uses pressure cuffs to measure volume fluctuations on the thighs, lower legs and feet. These normally occur with every heartbeat. Decreased fluctuations are associated with circulatory disorders.
4. Ultrasound examinations serve to determine and locate circulatory disorders more precisely and are usually only carried out by experts in the field. With the help of the ultrasound device, the blood vessels can be made clearly recognizable. Color Doppler sonography makes it possible to show blood flow in color. In this way it is possible to identify constrictions, which are quite easy to reach with the ultrasound device.
5. During angiography, an X-ray examination takes place. A contrast agent is injected into the patient's bloodstream. It is thus possible to make the arteries and their constrictions recognizable. In particular, MR (Magnetic Resonance) angiography is being used more and more. This is based on an MRI (magnetic resonance imaging) and therefore does not use X-rays.(7,8)

Better blood flow: approaches to treatment and tips to prevent it

We have put together an overview of the most important approaches to treating a circulatory disorder in the legs as well as all tips for prevention. We have also selected a few efficient exercises for you that can boost your blood circulation in everyday life. Keep in mind that the stage of the disease is important when choosing treatment options.

Combating risk factors

The treatment of circulatory disorders in the legs is primarily aimed at treating the risk factors. Eliminating these aims to prevent further narrowing of the arteries. In particular, the risk of resulting amputations and possible complications such as strokes and heart attacks should be reduced.

Smoking just a few cigarettes a day already promotes the development of arteriosclerosis. The narrowing of the blood vessels impairs blood flow and the supply of oxygen to the heart. (Image source: Gerd Altmann / Pixabay)

It is essential to give up smoking. In addition, if you are overweight, lose weight, exercise more, eat a balanced diet and treat high blood pressure, diabetes mellitus and high cholesterol levels properly. If you are overweight and drink more alcohol, a fatty liver could lead to increased cholesterol levels.

Medical therapy

Drugs can significantly delay the progression of the disease by inhibiting the clumping of blood platelets. This is how acetylsalicylic acid and clopidogrel are used. In rarer cases, blood-thinning drugs such as phenprocoumon are used.

Alternatively, medications are used to stimulate blood circulation. The following active ingredients are available:

1. Prostanoids can dilate blood vessels and ensure better blood flow. They also slow down the clumping of blood platelets. Under their influence, the red blood cells can be prevented from sticking to the bottlenecks. These are mainly used for severe circulatory disorders with wounds and ulcers.
2. Cilostazol dilates the blood vessels and reduces the ability of the blood platelets to clump. In tablet form, these are used to relieve pain when walking (intermittent claudication).

Homeopathy for circulatory disorders

Homeopathic remedies can be taken to support circulatory disorders in the early stages. The intake of these should be discussed with your doctor in advance. In particular, Arnica, Slicea or Barium carbonicum are used most frequently.

movement therapy

Especially in the second stage, walking training and foot roll exercises should be carried out so that so-called bypass circuits are promoted. As a rough guide, you should train three times a day for 30 minutes each. Training should be stopped as soon as slight discomfort occurs in the affected part of the body.

restore blood flow

Restoring blood flow to areas affected by narrowing of the artery is particularly important. This treatment is used in the second stage to relieve pain when walking, and in the third and fourth stages to keep the leg from dying.

During PTA (percutaneous transluminal angioplasty), a small balloon expands the narrowed blood vessel. Simultaneous thrombolysis is also possible. A drug is inserted through the catheter into the narrowing, causing the blood clots to disappear.

operative therapy

Sometimes an operation is also a conceivable option for treating circulatory disorders in the legs.

• A so-called thrombendarterectomy occurs with shorter occlusions of the leg arteries. The inside of the blood vessel is peeled out so that the vasoconstricting substances are removed.
• Longer vascular occlusions can be bypassed with the help of bypass operations. A vein from another part of the body or a plastic prosthesis can be used to bridge the gap.

Golden tips for better blood circulation

We have put together a brief, yet informative summary of our most important tips for better circulation and would like to share them with you so that you can get any circulatory problems under control or even prevent them as best you can.

1. Do not smoke. If you are struggling to quit smoking, you should definitely seek help. Participation in smoking cessation programs can be particularly helpful. Your doctor can advise you on sensible measures.
2. A healthy and balanced diet is essential. We advise you to keep the consumption of alcohol, fat and meat as low as possible or even to avoid it altogether. You should also avoid sugar as much as possible. If you're having a hard time, the cause could be a sugar addiction . In particular, vegetables, fruit and whole grain products are recommended.
3. Regular exercise is essential for the body and the blood vessels - they remain elastic and the heart is adequately supplied with oxygen. Try to walk at least 30 minutes a day. In addition, gentle endurance sports such as swimming, running or cycling are particularly efficient.
4. If you are overweight, you should definitely try to reduce your weight. If you are trying to lose weight without success, you should seek professional help. A change in diet usually works wonders when it comes to losing weight - especially when it comes to stimulating the metabolism.
5. Rely on regular check-ups and any preventive check-ups with your doctor. Possible risk factors - such as diabetes mellitus, high blood pressure and dyslipidemia - can thus be identified at an early stage and treated in good time.
6. If you are prescribed medication, you must ensure that you take it regularly and correctly.
7. If you are dependent on bed rest for a longer period of time, e.g. B. after an operation, your doctor can prescribe you so-called antithrombosis injections. With the help of a certain active ingredient, blood clotting is inhibited and thus also the formation of blood clots.

Small exercises to promote blood circulation

We would like to give you a few small exercises that you can easily integrate into your everyday life. With this you can boost your blood circulation and prevent potential disorders.

Toe rocker exercise: Here you stand on tiptoe in an upright position. Then slowly roll onto your heels. Please do this training about 10 times. Then you switch feet and repeat the same game.

Seated foot tapping exercise: Sit in an upright position with your legs together. The thighs and lower legs are at a right angle. Now lift your heels up so that only your toes touch the ground. Then lower your heels and stretch your toes up. You repeat this exercise another 10x.(9,10)

Conclusion

Circulatory disorders should be detected early so that they can be treated in good time and serious consequences of arteriosclerosis can be prevented as far as possible. Caution is advised, especially if there are already risk factors for the development of arteriosclerosis.

Quitting smoking, a balanced diet, regular exercise and reducing excess weight can protect against arteriosclerosis or significantly slow down the progression of the disease. In addition, both medicinal and surgical forms of therapy are common and even procedures that restore blood circulation. It is also worth doing exercises to strengthen your own blood vessels in everyday life.

References

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2. netdoktor.de: Circulatory disorders. 03/19/2019. dr Andrea Bannert. Sabine Schroer. Source
3. Sanada H, Higashi Y, Goto C, Chayama K, Yoshizumi M, Sueda T. Vascular function in patients with lower extremity peripheral arterial disease: a comparison of functions in upper and lower extremities. atherosclerosis. 2005 Jan;178(1):179-85. doi: 10.1016/j.atherosclerosis.2004.08.013. PMID: 15585216. Source
4. Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. [Updated 2021 Mar 17]. In: StatPearls [web]. Treasure Island (FL): StatPearls Publishing; 2021 Jan- Source
5. praxisvita.de: Circulatory disorders: How they arise and what helps. Source
6. Meneses AL, Nam MCY, Bailey TG, Magee R, Golledge J, Hellsten Y, Keske MA, Greaves K, Askew CD. Leg blood flow and skeletal muscle microvascular perfusion responses to submaximal exercise in peripheral arterial disease. Am J Physiol Heart Circ Physiol. 2018 Nov 1;315(5):H1425-H1433. doi: 10.1152/ajpheart.00232.2018. Epub 2018 Aug 10. Erratum in: Am J Physiol Heart Circ Physiol. 2019 Feb 1;316(2):H433. PMID: 30095999. Source
7. Suzuki K, Sekiguchi M, Midorikawa H, Sato K, Akase K, Sawada R, Konno S. Correlation between Changes in Leg Blood Flow and Ankle-Brachial Pressure Index: A Study Using Laser Doppler Flowmeter -The 1st Report-. Ann Vasc Dis. 2011;4(2):79-86. doi: 10.3400/avd.oa.10.01031. Epub 2011 Jun 2. PMID: 23555434; PMCID: PMC3595823. Source
8. apotheken-umschau.de: Circulatory disorders of the extremities (PAD). Source
9. Bopp J. Therapy for arterial circulatory disorders in the lower extremities. Muscle ergometric investigations under the influence of butalamine hydrochloride in a double-blind study [Therapy of arterial-circulation disorders in the legs. Muscle-ergometric studies under the effects of butalamine hydrochloride in a double-blind trial]. Fortschr Med. 1976 Apr 22;94(12):725-7. German. PMID: 823084. Source
10. Limberg JK, Johansson RE, McBride PE, Schrage WG. Increased leg blood flow and improved femoral artery shear patterns in metabolic syndrome after a diet and exercise programme. Clin Physiol Funct Imaging. 2014 Jul;34(4):282-9. doi: 10.1111/cpf.12095. Epub 2013 Nov 18. PMID: 24237709; PMCID: PMC4025981. Source