If you have angina in your legs it can hurt your legs when you strain them, for example, a shorter distance. This is because the blood is difficult to pass to the muscle cells. Smoking is the most common cause of getting leg cramps. But diabetes, high blood fats, high blood pressure, and obesity also play a role in the development of the disease.

The risk of getting angina in your legs increases the older you are. At the age of 60, about one person of twenty gets the disease. Vascular spasms can sometimes lead to acute blood clots in the legs. 

Vascular spasms in the bones are also commonly called bony artery disease, which is called BAS. In medical language, the disease is called claudicatio intermittent. Another name for the disease is window tinting. The expression comes from some pretending to look in storefronts when forced to rest because of the pain. 

Symptoms of angina in the legs

The main symptom of angina in the legs is a spasmodic pain in the calf muscles after walking a certain distance. This distance can range from tens of meters up to several hundred meters. If you continue to walk, the pain increases and eventually becomes so intense that you are forced to stop and rest for a while. The pain will then disappear within a minute. You may get sore thighs instead if the vasoconstriction is in a blood vessel higher up that goes to the thigh muscle. It is also common for the muscles to feel stiff and weak.

Pain, when you rest, is a sign that the disease has worsened

Blood flow in the legs is worse if you have lower leg or foot pain even when you are resting, especially when lying down. It is a sign that the disease has worsened. It can be alleviated by sitting up and supporting your feet on the floor. Then the blood flow to the lower legs increases.

Wounds on the legs

Most people with angina in the legs have no leg ulcers, but when it does occur the wounds are often painful and difficult to heal. There are other causes of leg and foot ulcers that are much more common.

The most common cause of prolonged leg ulcers is impaired blood circulation in the veins, the blood vessels that bring the blood back to the heart. These so-called venous leg ulcers are superficial and usually sit on the lower legs.

You may get sores on your feet if you have had diabetes for many years. The wounds can be due to poor circulation of the arteries, and to the fact that fine nerve fibers have been destroyed so that the feeling in the feet has deteriorated. This increases the risk of having small ulcers that you do not know.

Blood clots can cause blood flow to stop

In rare cases, it can suddenly stop completely in the blood flow, usually due to a blood clot. You get sore, your legs get pale, cooler and the feeling subsides. It is a serious condition that requires you to go to the hospital directly for examination and treatment.

Other diseases with similar symptoms

Other diseases that are not related to blood flow can cause similar symptoms with leg pain, such as osteoarthritis of the hip or knee, or spinal disorders such as spinal stenosis and sciatica with sciatica. Leg pain in these conditions can also occur or worsen as you walk. The difference is that in these conditions, it takes considerably longer before the pain lets go when you rest. To exclude these causes of the inconvenience, you may have to undergo more investigations.

When and where should I seek care?

Contact a health care center if you suspect that you have angina. You can contact many receptions by logging in.

If it’s in a hurry

If you have one or more of the following problems, please contact a health care center or an on-call reception immediately :

  • Suddenly you get very sore and your leg becomes pale.
  • You get a reduced feeling and the skin feels colder than the healthy bone.

Seek care at an emergency room if it is closed at the health center or on-call reception. The chances of good treatment are degraded by just a few hours of delay to care.

Investigations

You can tell your doctor about how the problems started, if you have any other illnesses and if you are using any medicines. The doctor does a body examination and especially checks the blood circulation by listening to the heart and taking the pulse in several different places. By listening to the blood vessels in some places, the doctor can sometimes detect distresses that give rise to special wheezing. When constricted in the leg arteries, there is often no pulse in the knee or foot, and sometimes not in the groin.

An ECG examination is often done to check the heart. You may also have a blood test to check how the kidneys work and to check the levels of blood fats and blood sugar. It can show if the vascular disease is due to diabetes.

Blood pressure at the ankle usually gives notice

Blood pressure is measured on the upper arm, but also on the lower leg just above the ankle. The doctor then uses a so-called doppler with ultrasound. The blood pressure in the lower leg should be as high as in the arm. If the blood pressure is clearly lower in the ankle than in the arm, there may be vasoconstriction in the leg. At a specialist clinic, you also have the opportunity to get the blood pressure measured in the big toe.

Treatment for angina in the legs

If you smoke, the most important part of the treatment is to stop smoking. If you cannot stop on your own, you can get help from the medical service. Some district nurses have specialized training to help with this and sometimes you can join a quit smoking group.

One option is the Stop-Smoking-Line, which you can reach both over the phone and over the Internet.

Walking on your own is an effective treatment

Training in the form of walking is also part of the basic treatment. When you get hurt, try to walk a bit before you rest. Ideally, you should walk at least half an hour at least three times a week. The more you walk, the better it is. Lifting is also a good way to train the calf muscles. Regular training for half a year increases the distance you can go significantly. It is the heart problems that determine how much effort you can make if you have angina in both the heart and the legs. It is usually easier to train with others. Take the help of a physiotherapist, for example.

It is unclear why training helps. The blood flow does not appear to improve immediately, but in the long term, new blood vessels may be formed that lead the blood past the narrowed blood vessel. There are also theories that the muscle cells are trained to utilize the blood flow that still exists in a better way. Perhaps the improvement is due to an improvement in the heart’s pumping function. Training of the arms also seems to have a similar effect.

Vascular spasms mainly cause older people who already have a disease that can make training difficult. It can be, for example, a joint disease, balance problems, heart attack, heart failure or stroke. Some still manage to exercise on, for example, an exercise bike and a little exercise are better than none at all.

Medicines unless smoking cessation and walking help

Medicines containing cilostazol may allow you to go a little further without getting hurt. This causes the blood vessels to widen and so that the platelets do not clump together as much. 

You may benefit from the drug if smoking cessation and walking training do not help and if you experience leg pain after a short distance. However, the drug is not appropriate if you are in pain when you are resting.

Important to care for diabetes

It is important to get help in managing the disease in the best way if you have diabetes. It is likely that you can prevent impaired blood circulation if you are properly treated for high blood pressure. You should also get cholesterol-lowering drugs and medicines that prevent blood clots if needed.

Prevent sores on the feet

You should avoid getting sores on your feet if you have poor circulation in the arteries. This is especially true if you have diabetes. Wounds can be more easily infected and lead to colds and amputation. Good foot care, on the other hand, can reduce the risk of amputation. Keep in mind the following:

  • Inspect your feet daily to detect wounds, cracks, redness, and hardening. With the help of a small mirror, you can see the whole foot.
  • Wash your feet regularly in lukewarm water. Dry thoroughly between the toes. Use a soft towel.
  • Lubricate with a moisturizing cream for dry and cracked skin.
  • Change socks every day. It is good to turn the seams outwards and use socks that are not so tight.
  • Never cut or cut hardens. Use a sandpaper foot file.
  • Cut your nails straight over and not too short. File down the edges with a nail file if they feel sharp.
  • If you have problems, you can consult the district nurse or a professional pediatrician. Sometimes special shoes from an orthopedic department are needed.

Which food is suitable?

There is no reliable scientific evidence as to which diet is best for bone fat. Therefore, dietary advice may be different depending on who you ask. But the following advice many experts agree:

  • Use water as the main drink.
  • Eat fish that may be fat at least twice a week ..
  • Eat more fruits, root vegetables, vegetables, and nuts.
  • Eat less sugar, fatty dairy products, and hard food fats.

Prevention drugs are mostly given for the sake of the heart

The vasculature itself in the bones cannot be treated with drugs. However, you usually get certain drugs to reduce the effects of the same vascular disease in other parts of the body. If you have vasoconstriction in the leg arteries you often have vascular disease in other parts of the body such as the heart and brain. You can have it without feeling it. Here are some common medicines you can get:

  • Acetylsalicylic acid reduces the risk of blood clots in the vessels and is recommended for anyone with bone disease. Examples of such drugs are Thrombyl. It also reduces the risk of heart attack and stroke by not staining the platelets. Sometimes acetylsalicylic acid is combined with another drug that reduces the risk of blood clots.
  • Statins are drugs that lower cholesterol in the blood, reduce the deterioration of vein fat and thus the risk of heart attack and stroke. Examples of such drugs are atorvastatin and simvastatin.
  • Antihypertensive drugs slow down the process of arteriosclerosis in the blood vessels. Many people with impaired blood circulation in the legs also have high blood pressure and the drug reduces the risk of heart attack and stroke, although in the short term it can sometimes reduce the blood flow in the legs.

When do I need to be treated by a specialist?

Most people with poor blood circulation in the legs can get help from a general practitioner at a health center. The doctor may write a referral to a vascular surgical specialist who assesses whether it is appropriate to plan for an operation if you have severe pain at rest and ulcers that do not heal.

Even in the case of vasoconstriction in the legs which severely limits the way of life and is invalid, the doctor can refer a vascular specialist for an examination.

Various operations

Some surgical intervention is often needed if you have debilitating problems such as pain at rest, difficulty to heal wounds or so-called critical oxygen deficiency with the risk of a burn.

In a bypass operation, the surgeon sews a new vessel that passes the blood past the obstruction in the constricted vessel. Artificial material or blood vessels from another part of the body are used for the new vessel. Sometimes it is enough to clear out the entangled constrictions, so-called endarterectomy.

The surgeon may also choose to do a balloon dilation of a constriction similar to that in the coronary heart. The technique is called PTA, percutaneous transluminal angioplasty. A thin plastic tube called a catheter is inserted via the groin to the narrowed area. There, a balloon is inflated on the tip of the catheter and the constriction is widened. To counteract a new constriction, the surgeon often inserts a so-called stent. The stent is a fine tube of metal mesh that is pressed into place with the balloon.

In moderate disorders of angina in the legs, usually, no vascular surgery is done, but it is to stop smoking if you do and walking is the most important part of the treatment.  

How long does the improvement last after an intervention? 

Congestion of the leg arteries may be in the pelvic arteries, in the thigh or below the knee. The further up the body the stop is, the better the results will be. Nine out of ten operating in the pelvis are still better after five years. Of those who operated below the knee, four out of ten are better after just as long. The reason for this fact is likely that the higher blood flow in the vessels above the groin causes the measures there to have a better effect.

Stops in the blood flow must be addressed quickly

You must be treated quickly in the hospital if there has been a sudden stop in the blood flow to one of the legs. The bone can be saved if the blood flow is restored within about six hours. If it is a plug that is stuck in a vessel branch, it can often be removed by inserting a balloon catheter via the groin to the blood vessel. The tip of the collapsed little balloon is passed past the obstacle, the balloon is filled and when the catheter is retracted, the surgeon can clear the clot from the blood vessel. If an old constriction has stopped, a more extensive vast surgical procedure is required.

If the stop has occurred slightly less urgently, blood clot-dissolving medication that is administered with a catheter is sometimes used directly in the current artery. This is called thrombolysis, a technique that is sometimes also used in myocardial infarction.

Amputation can be a solution when the disease has progressed 

Many who are told that they have vein fat in their legs are wondering if it can lead to vomiting and amputation. Most people don’t have to worry about it. The risk is small, especially if you stop smoking. 

Sometimes the disease has gone so far that it is not possible to perform a bypass operation or balloon enlargement. For example, if you have severe pain, prolonged foot ulcers that do not heal or the onset of a cold, the situation may be much better after an amputation.

An amputation can include a toe, multiple toes or half of the foot. Most often the amputation on the lower leg is done a bit below the knee so that the operating wound should be able to heal well. Thus, the leg can more easily fit in a lower leg prosthesis.

After the amputation of the lower leg, the physiotherapist and orthopedic technician assist in fitting the prosthesis and walking training. It is usually possible to learn to wear a prosthesis if you could walk yourself before the amputation.

Right to information

The healthcare staff should tell you what treatment options are available. They should make sure you understand what the different options mean, what side effects are available and where you can get treatment. That way you can help decide which treatment is right for you.

In order for you to be active in your care and make decisions, it is important that you understand the information you receive. The healthcare staff is obliged to make sure that you do so. Ask questions. 

What is the cause of angina in the legs?

Vascular spasms are due to constriction of the arteries. The constrictions are usually caused by atherosclerosis, which means that fat, blood cells and connective tissue have been stored on the inside of the blood vessels for a long time. This makes the blood more difficult to pass.

When the constrictions in the arteries called arteries become so large that they can no longer carry enough oxygen to the cells, lactic acid is formed, mainly in the calf muscles. It causes you to have spasmodic pain when exerted, that is, angina in the legs. Other symptoms of angina in the legs may be sudden weakness or fatigue in the leg muscles.

Congestions may also be due to inflammation

There is a type of constriction in the leg arteries that is not due to vein fat. It is due to inflammation of the vascular wall in defined areas of the arms and legs and is most common in men who smoke for more than 45 years. Doctors do not know exactly how it occurs, but it is clear that the disease is linked to tobacco smoking. The only treatment available is to stop smoking. Then the inflammation in the vessels usually goes over quite quickly. If you do not quit smoking, there may be a complete stop in the blood vessels so that you get cold and be amputated.

What happens in the body?

Atherosclerosis in the body’s arteries is also called atherosclerosis or atherosclerosis and is one of the most common and most serious folk diseases. Atherosclerosis causes the blood vessels to become narrower, making the blood difficult to pass through. It becomes a constriction that can lead to angina, that is, a decrease in blood flow which causes oxygen deficiency in the muscles.

If the constriction is in the coronary heart it can cause angina and myocardial infarction. If the constriction is in the vessels of the brain, you can get a stroke. 

The blood provides nourishment and oxygen to the muscles of the bones

A large body pulmonary artery begins at the heart and goes down through the body just in front of the spine. When it reaches the navel height, it divides into two arteries that continue down each leg. Branches of these blood vessels go to the muscles of the thighs. The main vessels in the legs continue down into the kneecaps, further behind the inner tubes and then into the foot. On the upper side of the foot is a superficial pulmonary vein where those who have good blood circulation in the legs can feel the pulse with their fingers. The blood supplies the cells in the bones with oxygen and nutrition and transports slag products.

More information

Smoking cessation line

Stop Smoking Line is a national free service run as a collaboration between the Stockholm region and the Karolinska Institutet.

Professional smokers are on site all weekdays and some evenings. The phone number is 08-840000 and the call is free.

Ehtisham Nadeem

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