Lower leg disorders
Updated July 2006
Inflamed, thickened soft tissue and bony overgrowth at the base of the big toe.
A bunion is a thickened lump at the base of the big toe. They are more common in young adults and older people, particularly females since wearing tight, pointed shoes, especially with high heels is a risk factor. A bunion may become inflamed and painful, making walking difficult. The underlying cause is usually a minor bone deformity in which the joint at the base of the big toe develops an abnormal projection, which forces the tip of the toe to turn towards the other toes. People with diabetes mellitus are particular susceptible to infected bunions because the sensation in their feet may be reduced.
Without attention, a bunion may gradually worsen. Pain may be alleviated by wearing comfortable shoes and a special toe pad or corrective sock that straightens the big toe. If a bunion causes severe discomfort, surgery may be offered to correct the underlying deformity by realigning the bone. A bunion also increases the chance of developing osteoarthritis of the toe joint in later life.
Further information:
- Feet for Life - the website for the Society of Chiropodists and Podiatrists
- Feet for Life – Bunion, bunions and toe deformities
- MedlinePlus Medical Encyclopaedia - Bunion removal
- NHS Direct Online - Bunion
- The Institute of Chiropodists and Podiatrists
Chilblains
Itchy, painful, reddish-purple swellings on the fingers or toes.
Chilblains are more common in children and older people. They result from excessive narrowing of blood vessels under the skin in cold weather. The reddish-purple swellings, which most commonly affect the fingers and toes, are painful when they are exposed to cold and are intensely itchy once the skin has become warm again. Chilblains usually disappear without treatment but may recur. To prevent chilblains from developing it is important to wear appropriate clothing, including gloves, socks, and a hat, to keep warm. In susceptible people exercise may also help prevention by encouraging blood flow to the hands and feet.
Further information:
- British Association of Dermatologists
- Feet for Life – the website for the UK Society of Chiropodists and Podiatrists
- Feet for Life - Chilblains
- The Institute of Chiropodists and Podiatrists
Peripheral Vascular Disease
Hardening of the arteries
All the tissues of the body require a continuous supply of blood to provide oxygen and nutrition. With increasing age, there is a tendency for arteries to become narrower, limiting the flow of blood. When there is a shortage of blood supply to the tissues of the body, they are unable to do the same amount of work as before. If the blood supply to the legs, for example, is affected the muscles become short of blood on walking thus giving rise to a cramping pain (usually in the calf). As the condition progresses, and less blood reaches the tissues, the pain can occur after walking only short distances and may eventually occur when at rest.
All forms of circulation or vascular disease, such as heart disease, stroke and peripheral vascular disease, are more common in the Western world. Once into late middle age, most people will have some evidence of vascular disease. It begins with a few small plaques of fat being deposited in the lining of the arteries. As this becomes more widespread the artery becomes more rough and narrowed. This roughness means that a blood clot can form more easily, further narrowing the artery. It is this narrowing which reduces the flow of blood.
Most people with mild peripheral vascular disease will never need surgical treatment. This condition can be treated simply by avoiding cigarettes, regular exercise and reducing weight where necessary.
Further information:
- BBC Health - Heart Disease
- BBC Health - Peripheral vascular disease
- British Cardiac Patients Association
- British Cardiovascular Society
- British Heart Foundation
- Department of Health - Coronary heart disease, includes the National Service Framework
- European Society of Cardiology
- Heart Online, peer reviewed journal for health professionals and researchers in all areas of cardiology
- Heart Research UK
- HEART UK, national charity supporting all those at risk of inherited high cholesterol and cardiovascular disease
- Hearts for Life, information website for people concerned about their hearts
- High Blood Pressure Foundation
- MedlinePlus Medical Encyclopaedia - Coronary artery disease
- MedlinePlus Medical Encyclopaedia - Arteriosclerosis of the extremities
- National Heart Forum
- NHS National Library for Health - Cardiovascular diseases specialist library
- Women’s Heart Foundation
- World Health Organisation - Cardiovascular diseases
- World Heart Federation
Varicose Veins
Visibly swollen and distorted veins that lie just beneath the skin.
Varicose veins mainly affect the legs and are more common with increasing age. Although the condition may cause discomfort and appear unsightly, it is not usually harmful to health. Contraction of the leg muscles helps to pump the blood in the veins upwards to the heart, with one-way valves to stop blood from flowing backwards. If these valves do not close adequately, the blood flows back into the legs superficial veins causing a build up of pressure. The pressure of returning blood causes the veins to become swollen and distorted – known as varicose veins.
If varicose veins develop in the legs symptoms such as easily visible, blue, swollen, distorted veins that bulge beneath the skin and are more prominent when standing may develop. Aching, or pain in the affected leg, especially after prolonged standing, is also possible. In severe cases, the skin over a varicose vein, usually in the ankle area, becomes thin, dry, and itchy – eventually leading to ulceration.
In the majority of cases, varicose veins do not require medical treatment, discomfort may be relieved by using self-help measures such as avoiding prolonged standing, taking regular exercise and avoiding clothing that may restrict the flow of blood. Treatment is usually only carried out if the veins become painful, especially unsightly, or if the skin becomes ulcerated.
Further information:
- MedlinePlus Medical Encyclopaedia - Varicose veins
- NHS Direct On-line Health Encyclopaedia - Varicose veins