“A journey of a thousand miles begins with a single step”. Discomfort in the legs and feet can cause great inconvenience to life. The performance varies from person to person, some legs and feet numbness, walking inconvenience; some lower limbs swelling unbearable; some cold, numb; some pain, can not walk; some local redness, infection; some joint swelling, soreness; some skin color darkening, itching; some ulcers; serious tissue blackening, necrosis. In addition to brain lesions, lumbar spine diseases, and bone and joint lesions that require consultation in neurology and orthopedics, a large proportion of these symptoms are due to peripheral vascular lesions and require consultation in vascular surgery. The proverbial “old rotten feet” and “vasculitis” refer to peripheral vascular disease. The term “old rotten feet” in Western medicine is lower limb venous insufficiency, due to venous obstruction or reflux resulting in superficial varicose veins in the lower limbs, which in turn leads to skin nutrient disorders, ulcers, and does not heal over time. “Vasculitis” refers to the lower limb arterial occlusive disease, can be caused by atherosclerosis, diabetes, arterial inflammation, early manifestations of the lower limb cold, numbness, walking for a period of calf soreness, severe limb pain, sleepless nights, and even tissue blackening, necrosis, the need for amputation. If these diseases are diagnosed early and treated early, it is possible to obtain satisfactory treatment results through surgery. Therefore, don’t ignore the small gross diseases on your legs and feet. Lower limb swelling and deep vein thrombosis Auntie Yang underwent myomectomy in the hospital for uterine fibroids. After her stitches were removed and she returned home, she was afraid to move for fear of wound pain and spent all day resting in bed. A week after her discharge from the hospital, she felt pain in her right calf after getting out of bed, which was obvious when she stood up. The next day found that the calf swelling, skin heat, and a press a pit. With hot water bags, rubbing with the hands are not effective, she rushed to the hospital. The doctor’s diagnosis was “deep vein thrombosis of the lower limbs” and criticized her for not doing hot compresses and massage treatment at home without permission, because those treatments are very dangerous. What is deep vein thrombosis? The human venous system is responsible for recycling blood from all parts of the body to the heart, and there are superficial and deep veins. The superficial veins are located on the superficial surface of the skin, where we usually draw blood with a needle, while the deep veins are deeper, located deep in the muscles, which cannot be seen, but are responsible for the main task of blood return, so if the blood in the deep veins clots and forms a thrombus, then the blood’s pathway back to the heart will be blocked and the legs will swell up at once. It mostly occurs in one lower limb (Figure 1). The main symptom is local pain and swelling, which is aggravated when walking or standing, unfortunately, many patients are misdiagnosed as muscle strain, fasciitis, cold, etc., which makes treatment late. Who is prone to it? If the venous blood flow is slow, the blood is easily clotted or the walls of the veins are not smooth, it is easy to form thrombosis, leading to deep vein thrombosis. Auntie Yang’s blood was hypercoagulable after surgery, and she was afraid to move because of fear, which slowed down the venous blood flow and caused deep vein thrombosis. In addition to post-surgical patients, post-fracture, post-birth, chronic disease, long-term bed rest, obesity, diabetes, hyperlipidemia, malignant tumor, connective tissue disease such as lupus erythematosus, etc. are all risk factors for deep vein thrombosis. Why did the doctor say that Zhou’s practice of applying heat and massage on her own is wrong? Because the fresh deep vein thrombus is still fresh and only mildly adheres to the vessel wall in the blood vessel, so if hot compress or massage is applied, the clot is likely to fall off. The dislodged thrombus returns to the heart with the venous blood flow and reaches the pulmonary artery through the right heart, which will lead to sudden death due to pulmonary embolism. Therefore, people who are bedridden or lack of exercise should not take it lightly when one or both calves are swollen and painful, and should not treat themselves. Besides pulmonary embolism, what other harm can deep vein thrombosis bring? Because the main veins of the lower limbs are blocked, blood can only flow back through the superficial veins, which leads to varicose veins and skin nutrition disorders, pigmentation and ulcers that do not heal for a long time, bringing great inconvenience to life, which is called deep vein thrombosis syndrome (Figure 2). Is there a cure? Prevention is more important than treatment. If you are sedentary or bedridden for a long time, it is recommended to do some ankle flexion and extension activities to make the calf muscles contract and squeeze the blood back to the heart to speed up the blood flow so that it does not clot. And if deep vein thrombosis occurs, the earlier the treatment, the better the effect, because the clot is fresh and easy to dissolve just after the onset, preferably within 3 days. The latest method is to place a protective device, called inferior vena cava filter, in the path where the clot must be dislodged to intercept the dislodged clot and prevent the occurrence of pulmonary embolism, and at the same time, a needle is given at the root of the thigh to insert a thrombolytic catheter into the clot, through which the clot-dissolving drug is injected to open the vein. Usually the swelling will subside significantly in 1~2 days with the medication. Of course, some oral anticoagulant medication will be taken later to maintain it, and medical compression stockings will be worn to protect the function of the vein. Interventional treatment of lower extremity atherosclerosis The names of coronary heart disease and cerebral infarction are already familiar to everyone, but you may not know that they are actually caused by the same disease, which is atherosclerosis. Atherosclerosis occurs in the coronary arteries that supply blood to the heart, leading to heart ischemia, which is what we call coronary heart disease, and in serious cases, myocardial infarction; and cerebral atherosclerosis, which causes cerebral infarction. Similarly, atherosclerosis occurs in the lower extremities, causing “foot infarction”, which is still not well understood. Older people, hypertension, hyperlipidemia and diabetes will increase the occurrence of atherosclerosis, just like the scale in the water pipe, which will accumulate thicker and thicker and finally block the lumen of the artery and cause distal ischemia. In the heart, it manifests as chest tightness, shortness of breath, and severe inability to lie down. In the lower extremities, the early stage may only have the feeling of cold and numbness in the feet, and gradually after walking for a while, the calves become sore and need to stop and rest for a moment. In fact, at this time the arteries in the lower extremities have been occluded, but often because the elderly do not walk too far, at most near home, and walk more slowly, even if some discomfort, will be considered older people, leg inconvenience and ignore the arterial occlusion of the lesion. When the disease develops further, it is painful even without walking, medically known as resting pain, unable to sleep at night due to pain, and even some toes appear blackened and necrotic, the occluded arterial lesions are already extensive. Coronary heart disease, can be treated by heart bypass or put a stent, in the lower extremity artery occlusion lesions, can also bypass the blocked artery with their own blood vessels or artificial blood vessels to build a bridge to make the artery open. With the current development of medical technology, interventional treatment can be used to open the blocked artery. The common interventional treatment methods are percutaneous transluminal balloon angioplasty and vascular stent implantation, in which a puncture needle is inserted into the artery at the root of the thigh or arm, and then a catheter with a dilating balloon is inserted into the blocked artery to dilate the balloon, causing the occluded artery to expand and form a channel, and then the balloon is contracted and the catheter is removed. permanent support to restore blood flow and relieve symptoms. The entire procedure can take as little as half an hour, with minimal trauma and a quick recovery for the patient. After treatment, the patient’s painful symptoms can be relieved, and even if there is already necrosis of the tissue, only the necrotic tissue needs to be removed, avoiding the previous need to amputate to the thigh to grow the wound. With the development of technology, the emergence of long balloons and ultra-fine guidewires has made this treatment method more and more mature and the scope of treatment more and more extensive, making it the preferred treatment method for this disease. Angiopathy of diabetic foot Definition of diabetic foot: a foot disorder caused by loss of sensation due to neuropathy or loss of mobility due to ischemia, combined with infection in diabetic patients. The most common consequence is chronic ulceration, and the most serious outcome is amputation. It is one of the four most serious chronic complications of diabetes. According to statistics, 15% of diabetic patients will develop diabetic foot, and 10%-14.5% of them will have their limbs amputated as a result, and the mortality rate within 30 days after amputation is as high as 10%. The quality of life and the lives of patients with diabetes are seriously threatened. Diabetic foot usually has three conditions: ① Neurological lesions. Increased blood glucose can cause microangiopathy, which affects nerve function and causes numbness in the patient’s limbs. So clinically some patients are unaware of hot and cold sensations or painful sensations, such as walking sand falling into shoes without knowing, and repeated wear and tear will easily cause infection. ②Ischemia. The main factor causing necrosis of diabetic foot tissue is atherosclerotic occlusion of limb arteries causing insufficient arterial blood supply, which manifests as numbness and coldness of the limb, the need to rest for a while when walking for a while, pain at night rest in severe cases, and inability to sleep, which develops later, most patients have terminal gangrene. ③Infection. High blood sugar causes bacterial multiplication leading to infection, and once a diabetic patient is infected, it is a variety of mixed bacterial infections that smell very bad and even unbearable for the family. If you have foot symptoms, you should immediately go to the hospital vascular surgery examination. The doctor assesses the arteries by feeling the pulse; measuring the blood pressure of the upper and lower limbs; doing color ultrasound, or further arteriography, CT, magnetic resonance artery imaging to clarify the arterial lesions. If there are vascular lesions, the corresponding treatment can be carried out according to the degree of lesions, such as vasodilating Chinese and Western medicine, surgical bypass, interventional treatment and so on. Even if the tissue is necrotic, the arterial blood flow can be reconstructed through surgery to remove the necrotic tissue and heal the wound. The attached picture shows a 75-year-old diabetic woman who suffered from arterial occlusion and secondary infection, resulting in lateral foot necrosis. Although it is now possible to treat the diabetic foot by surgical means, which has greatly reduced the rate of amputation, there are still a considerable number of patients whose condition has become quite serious and who have to preserve their lives through amputation, so it is important for diabetic patients to take care of their feet. Diabetic foot is often induced by minor trauma to the foot, such as extrusion of ill-fitting shoes, abrasions, chafing, improper treatment of corns, etc. Usually control blood sugar; exercise properly; ban smoking; low-fat and low-cholesterol diet; lose weight in obese people; regularly check the foot in the vascular surgery department of the hospital; frequently check the foot condition by yourself, maintain foot hygiene, check your feet every day, use a mirror to check the bottom of your feet, whether there is a break, soak your feet in warm water, avoid using hot water to soak your feet, gently dry your feet, including between the toes, use skin care products to prevent cracking of the skin on the feet, but forbid between the toes. carefully trim toenails, to cut straight, do not cut too short, do not apply corns cream, do not repair their own calluses, wear clean and dry socks, change them every day, socks should not be too thick, do not have very tight elastic ring, feet cold can wear socks to sleep, do not use electric blankets or hot water bags, do not sit with legs crossed for a long time, buy new shoes in the afternoon, wear new shoes for no more than 2 hours at a time, change a pair of shoes to wear every day, check with your hands before wearing whether there are foreign objects in the shoes, keep your feet warm and dry, don’t get wet with rain or snow, and don’t walk barefoot at any time or anywhere.