3 Key Takeaways from the article:

One diagnosis doesn’t always explain everything.

• Persistent foot pain, cramps, or slow-healing wounds in diabetics may be caused by more than just neuropathy.
• Ending the search for answers too soon can leave patients untreated and still suffering.

Peripheral Artery Disease (PAD) is often missed but treatable.

• PAD and neuropathy share overlapping symptoms (pain, numbness, tingling), but PAD is caused by poor blood circulation.
• Unlike nerve damage, PAD can be diagnosed through vascular testing and treated with minimally invasive procedures to restore blood flow.

You don’t have to settle for ongoing pain—there are solutions.

• If current treatments aren’t helping, patients should advocate for themselves, seek further testing, and get a second opinion.
• Identifying PAD can open the door to effective treatments that relieve pain, improve wound healing, and restore quality of life.

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When a patient experiences a symptom such as pain or cramps in the feet and legs, the number of potential causes for them can send their medical providers on an extended hunt to find the underlying issue. However, sometimes there isn’t one single cause, but a combination of medical conditions that contribute, and if they are not all correctly identified and treated, the symptoms persist. When the search to find the possible cause ends prematurely, patients may continue to suffer because they are not receiving treatment that could be effective in relieving their symptoms.

What Happens When the First Answer Isn’t the Only Answer?

Consider the case of an older man who was diagnosed with Type 2 diabetes some years ago. Despite the cautions of his doctor and the concerns of his wife, he did not watch his diet or exercise regularly, and his blood sugar was often higher than it should have been. It wasn’t until he started experiencing numbness in his toes and realized that minor scrapes on his feet took forever to heal that he started taking his condition more seriously. His medical provider diagnosed him with peripheral neuropathy in addition to his diabetes.

He’s been much more diligent with his health since then, but lately he has been complaining of cramps in his feet and toes at night, severe enough that they sometimes wake him up. Worse, he developed a sore after scraping his bare foot against a chair leg. Despite his regular wound care appointments, it isn’t getting better, and the specialist is starting to suggest that surgery may be indicated if nothing changes.

The man’s children, who recently started taking him to his medical appointments, have asked many times if there could be a reason beyond his peripheral neuropathy for him to be experiencing persistent pain, because it doesn’t seem to be responding to the medications he’s been given. But his doctors just point out that nerve damage is a reasonable explanation for what he’s feeling. Their advice is to continue treatment and keep his blood sugar under control.

Misdiagnosis or Missed Diagnosis?

In this situation, the man’s doctors aren’t necessarily wrong, but they may not be wholly right either. Pain in the feet can be a symptom of peripheral neuropathy, but it can also be a result of peripheral artery disease (PAD), a condition in which arteries in the limbs are narrowed by atherosclerosis (the buildup of fatty plaques) that restricts blood flow to the legs and, less often, the arms. Diabetes is a key risk factor for PAD as well as for peripheral neuropathy, and the two conditions share symptoms such as pain, numbness, and tingling in the legs. In diabetic patients, though, persistent foot pain, especially when they are also experiencing poorly healing wounds, should be a warning sign to look for vascular disease.

One symptom that is often considered a classic indicator of PAD is leg cramps that come on during activity, when reduced circulation is unable to keep up with the muscles’ demand, a phenomenon known as intermittent claudication. Pain tends to fade again with rest. However, when PAD is caused by diabetes, it is more likely to present with ischemic rest pain that affects the small muscles of the feet and toes when the patient is sleeping, rather than cramps that affect the larger muscles of the calves, thighs, or buttocks during activity. Both types of symptoms are indicative of poor circulation, though, which contributes to poor healing of diabetic wounds despite treatment.

In the scenario above, it may not be that the man’s doctors are incorrect, but that they have missed an additional cause for their patient’s symptoms. Specific testing, such as a vascular ultrasound should be done to measure blood flow to the limbs and identify narrowed areas and blockages to confirm a suspected diagnosis of peripheral artery disease (PAD). While the symptoms of PAD and peripheral neuropathy can overlap, the underlying cause requires different treatment. For example, it is possible to restore blood flow through narrowed or blocked arteries with minimally invasive techniques, which can help reduce pain and promote healing of diabetic foot ulcers. However, treatment aimed at reducing nerve pain will not solve a problem caused by poor circulation.

Effectively Treating Peripheral Artery Disease and Its Complications

If pain in your feet hasn’t improved despite the care you’re getting for peripheral neuropathy, you may not have a complete answer for what’s behind your symptoms. At AVA Vascular, we can help determine if peripheral artery disease (PAD) is a contributing factor and improve your health and quality of life with nonsurgical procedures to restore circulation through arteries affected by PAD. Before you give up on feeling better, get a second opinion. To schedule your consultation, contact us here today.

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