Preventing Leg Amputation
By Jenny Peterson
For many people, a small sore on a toe or persistent pain in the leg may seem like a minor inconvenience. But in some cases, those seemingly small symptoms can be warning signs of a much more serious problem: peripheral arterial disease (PAD), a condition that reduces blood flow to the legs and feet and can ultimately lead to amputation if left untreated.
The good news? In many cases, amputation is preventable when arterial disease is recognized and treated early.
“Amputation is a very real concern, but we catch these problems every day,” said Dr. Randall Franz, a dual board-certified and fellowship-trained vascular surgeon at Coastal Vascular and Vein Center. “The key is identifying the disease early and improving blood flow before permanent damage occurs.”
Understanding Peripheral Arterial Disease
Peripheral arterial disease develops when arteries become narrowed or blocked, limiting the amount of oxygen-rich blood that reaches the lower extremities. Without adequate circulation, even a small wound can become difficult to heal.
“Because of poor blood flow through the extremity, you can develop a small wound,” Dr. Franz said. “That wound can progress to something larger. The goal is to improve blood supply, which provides nutrition and helps wounds heal before any of that happens.”
Certain people face a significantly higher risk of developing arterial disease. Diabetes is one of the biggest risk factors. Current or former smokers are also at increased risk, as are people who have high blood pressure, high cholesterol, sedentary lifestyles and poor diets.
Unfortunately, South Carolina has long ranked among the states with the highest rates of diabetes-related amputations and vascular disease complications.
“Depending on the year, South Carolina is usually around the fifth worst in the entire country,” Dr. Franz said.
Recognizing the Warning Signs
One challenge is that arterial disease often develops gradually over many years. Symptoms can start subtly and be ignored only to worsen over time.
“The first issue that develops for patients is trouble walking,” Dr. Franz said. “Maybe someone used to be able to walk a mile, then they can only walk a few blocks, then a quarter block. They develop pain in their calves, thighs or feet when they’re walking.”
Patients may eventually develop what vascular specialists call “rest pain” — persistent pain in the foot or leg even when they are not active. Skin wounds or ulcers may also develop and fail to heal.
“Once you have a wound or rest pain, we should treat you as early as possible,” Dr. Franz said.
The danger comes when people dismiss these warning signs.
“If you don’t improve the blood supply, it can spread to other parts of the foot and eventually you can lose your leg,” Dr. Franz said.
Diagnosing and Treating PAD
Fortunately, diagnosing arterial disease is relatively straightforward. During an office visit, providers evaluate circulation and pulse strength before performing noninvasive vascular testing. Ultrasounds and ankle-brachial index (ABI) testing can help determine whether blockages are present.
If more advanced treatment is needed, patients may undergo an angiogram, a minimally invasive procedure used to identify narrowed or blocked arteries.
“At our outpatient facility, patients can park right up front with their family, have their procedure, and go home the same day,” Dr. Franz said. “Their family can stay with them throughout the process, and they don’t have to navigate a hospital stay. We perform the angiogram, identify the blockage and, whenever possible, treat it during the same procedure.”
At CVVC, these procedures are performed through a small puncture rather than large surgical incisions, allowing for faster recovery and quicker restoration of blood flow.
Early intervention can dramatically improve outcomes.
Preventing Leg Amputation
While medical advances can restore circulation, prevention remains the best strategy. Dr. Franz encourages people to stop smoking, manage diabetes carefully, control blood pressure and cholesterol, stay physically active and maintain a healthy diet.
“Any tobacco use can cause damage,” he said. “Smoking, dipping tobacco and vaping all increase risk.”
If walking becomes painful, foot pain develops at rest, or a wound isn’t healing properly, reach out to experts.
“The earlier you intervene, the better the outcome,” Dr. Franz said. “That’s how we prevent amputations.”
