Question 1

What is “nonhealing great toe wound” and how can treating PAD help such a wound?

Accepted Answer

That refers to an ulcer or injury at the big toe that isn’t healing despite standard wound care. In the example on AVA’s site, opening tiny blood vessels via angioplasty led to healing of such a wound in ~6 weeks.

Question 2

Does PAD cause rest pain (pain in toes/feet without activity)?

Accepted Answer

Yes, especially when it progresses. Rest pain can occur, particularly in small muscles of the feet and toes, often at night when lying down.

Question 3

Is pain alleviated by stopping activity or resting?

Accepted Answer

In PAD, cramps or pain during activity (walking, climbing) typically improve when you rest. This is a distinguishing feature.

Question 4

What kinds of wounds or skin changes suggest PAD rather than just neuropathy?

Accepted Answer

Non-healing ulcers, especially on toes or feet; wound that recurs; skin thinning; hair loss on legs; nail changes; cold skin.

Question 5

How do I know if my physician is overlooking PAD?

Accepted Answer

If treatments for neuropathy (medications, creams, etc.) don’t relieve cramps or pain; if wounds aren’t healing; if rest pain, cold feet, skin changes happen; if no vascular tests have been done. You may need a second opinion.

Question 6

What is the role of protecting the feet (sores, wounds, moisture)?

Accepted Answer

Very important. Because neuropathy reduces sensation, a person might not notice sores; keeping skin moisturized (but not between toes), wearing well-fitting shoes, checking feet daily, seeking care for any sore that doesn’t improve is essential.

Question 7

When is surgery necessary?

Accepted Answer

Surgery is typically avoided. AVA emphasizes minimally invasive options. Surgery or amputation may be considered only if non-invasive or interventional options are not possible or in very advanced disease, but many cases are treatable without major surgery.

Question 8

What is the role of protecting the feet (sores, wounds, moisture)?

Accepted Answer

Very important. Because neuropathy reduces sensation, a person might not notice sores; keeping skin moisturized (but not between toes), wearing well-fitting shoes, checking feet daily, seeking care for any sore that doesn’t improve is essential.

Question 9

When is surgery necessary?

Accepted Answer

Surgery is typically avoided. AVA emphasizes minimally invasive options. Surgery or amputation may be considered only if non-invasive or interventional options are not possible or in very advanced disease, but many cases are treatable without major surgery.

Question 10

How long does it take to see improvement after vascular treatment?

Accepted Answer

The site cites a case where a wound healed and neuropathy improved within about 6 weeks after angioplasty to restore blood flow to the toe.

Question 11

What about balance, risk of falls, sleep issues due to neuropathy or PAD?

Accepted Answer

Neuropathy and PAD both can lead to balance issues, unsteadiness; night pain can disturb sleep. Solutions include physical therapy, balance training, addressing vascular circulation, proper pain management.

Question 12

Are there lifestyle changes that help PAD and neuropathy together?

Accepted Answer

Yes: good control of blood sugar (for diabetics), managing hypertension/cholesterol, quitting smoking, good foot care, proper footwear, regular movement/walking as tolerated.

Question 13

What are the minimally invasive treatments available?

Accepted Answer

Angioplasty of arteries; opening blocked vessels with catheter-based procedures; opening circulation all the way to small vessels and toes; outpatient interventions avoiding major surgery.

Question 14

If I get a vascular ultrasound and angiogram, what do they do?

Accepted Answer

Ultrasound measures blood flow in arteries to find narrowed/blocked sections. Angiogram involves imaging the arteries (often using dye) to see exact locations needing intervention.

Question 15

What should I ask or tell my doctor if I suspect PAD?

Accepted Answer

Describe where cramps/pain are, when they occur (during walking? rest? night?), any wounds, coldness, skin changes; mention all risk factors (diabetes, smoking, etc). Ask if vascular testing has been done or could be done.

Question 16

Could I have both neuropathy and PAD at the same time?

Accepted Answer

Yes. Many patients do. Overlooking PAD when dealing with neuropathy can leave some symptoms untreated. Treating both may be necessary.

Question 17

Why might symptoms be worse at night or when lying flat?

Accepted Answer

At night, lying flat reduces the effect of gravity which helps blood flow; also circulation problems tend to become more noticeable when muscles are at rest or when feet elevated. This can lead to cold feet, numbness, tingling, or cramps that wake people.

Question 18

What is intermittent claudication?

Accepted Answer

Pain/cramping in legs during walking/exertion which is relieved by rest. It’s a hallmark symptom of PAD.

Question 19

Can treating PAD improve neuropathy symptoms?

Accepted Answer

Yes. In some cases, restoring blood flow helps heal wounds, reduce pain, and improvement of neuropathy symptoms has been reported after vascular intervention.

Question 20

How is PAD treated if found to be the cause?

Accepted Answer

Minimally invasive interventional radiology procedures like angioplasty to open narrowed arteries, restore blood flow—even down to the toes. These can often be done outpatient, without general anesthesia.

Question 21

What tests should be done to detect PAD?

Accepted Answer

Vascular testing such as vascular ultrasound; screening for arterial blockages; possibly angiogram to pinpoint where circulation is impaired.

Question 22

What symptoms distinguish PAD‑related problems from neuropathy?

Accepted Answer

With PAD: cramps during exertion (claudication), pain relieved with rest; rest pain in toes, especially at night; cold feet; skin/nail changes; sores or wounds that don’t heal. Neuropathy more so tingling, burning, numbness, often affected by sugar control.

Question 23

Why are leg cramps, pain, or wounds not healing despite neuropathy treatment?

Accepted Answer

Because neuropathy may not be the only—or primary—cause. Poor circulation from PAD could be limiting blood supply, impairing healing, causing cramps. Treatment aimed at nerves won’t work if arteries are blocked.

Question 24

What are common risk factors that make PAD more likely?

Accepted Answer

Diabetes, hypertension, high cholesterol, smoking, older age (especially >65), renal failure. These conditions contribute to plaque buildup and narrowing of arteries.

Question 25

What is “critical limb ischemia” (CLI)?

Accepted Answer

A severe form of PAD where blood flow is so limited that even rest causes pain; open sores/wounds may appear; urgent treatment needed.

Question 26

Could peripheral artery disease (PAD) be contributing to my neuropathy symptoms and leg cramps?

Accepted Answer

Yes. PAD can have overlapping symptoms with neuropathy (pain, numbness, tingling, leg cramps) but is caused by poor blood flow (arterial narrowing/blockage). If treatment for neuropathy is not helping, PAD should be tested.

Question 27

Why do my feet feel burning, tingling, or “pins and needles” all the time?

Accepted Answer

These symptoms are common in neuropathy because damaged nerves misfire. To manage: gentle daily foot care, protective footwear, medication or therapy as needed.

Question 28

HMO Referrals for Diabetic Wound Care

Accepted Answer

If you are on a HMO insurance, your primary care physician will have to refer you over to AVA Vascular in Murrieta for chronic wound care treatment. Dr Nik Patel is able to assess wounds and provide treatment that has proven to heal many patients. If you are on Medicare or PPO Insurance, we are able to see you without a referral and can begin initial consults via telehealth.

Question 29

Do you have Telehealth appointments?

Accepted Answer

We can most definitely provide patients with telehealth appointments however, the actual procedure and part of the process will involve the doctor meeting the patient in person. Initial consults with patients and their families can be done via telehealth. We accept all Medicare and PPO insurances at this time.

Question 30

What happens if my knee surgery has been scheduled?

Accepted Answer

If you have a scheduled date for knee surgery do not cancel it. However if you wish to get a second opinion, please call in and make an appointment with our doctor to see if you qualify for GAE. Information on GAE can be found HERE

Question 31

Do you take Medical or HMO Insurances?

Accepted Answer

At this time we do not accept Medical and HMO Insurance policies. However we can take all PPO insurances and Medicare.

Question 32

Can I travel to Murrieta for this treatment?

Accepted Answer

Yes this is a same day procedure and you can most definitely travel from anywhere to Murrieta for this treatment. We have some great hotels near our facility.

We are not far from the famous Murrieta Hot Springs and Temecula Wine Country. You can most definitely make this a family trip.

Closest airports to us are Ontario International Airport, John Wayne Airport in Orange County and for some LAX may be the best option.

FAQ

FAQ

Can I travel to Murrieta for this treatment?

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