Department
of Podiatry - Vascular Assessment
Dermatological
changes
If
a patient has impaired arterial supply to the tissues, there are numerous
dermatological changes that occur which are a good early indicator of
more severe pathological processes. Namely these are hair growth, anhidrotic
skin and general thickening of the nails.
• In order for our hair to grow it requires adequate blood supply
to bring nutrients to the area, allow gaseous exchange, and remove metabolites.
If this blood supply is impaired, and not enough nutrients get to the
tissue, the hair follicles will die and release the hair. The toes are
most vulnerable to this occurring, as they are the furthermost body-part
from the heart. Ensure you ask the patient whether they shave or wax their
toe hairs for cosmetic reasons.
• Again, anhidrotic skin occurs because the metabolic demands of
the epidermis are not being met as a result of decreased arterial perfusion.
The skin becomes flaky and dry, and this may affect the dorsum or plantar
aspects of the foot, and extend proximally up the leg. Differentially
diagnose this from fungal infections, psoriasis, history of inadequate
sweating, or previous sympathectomy (Nelson, 1992).
• General thickening of the nails occurs because of damage to the
nail matrix. Especially in the elderly due to poor peripheral blood supply
(Lorimer et al, 1997). Ask the patient for a history of macrotrauma, and
inspect biomechanical aspects and footwear for evidence of microtrauma.
If uniform thickness is present on all digits, and onychomycosis is ruled
out, impaired arterial supply may be suspected.
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