Welcome to PVD
The whole problem is that I feel that
every patient with PVD should have the
opportunity to be referred to a vascular
doctor especially in the hospital setting
where such specialists should be
In treating ulcerations, I believe every patient should have their shoegear evaluated
to ensure that no biomechanical forces are impairing wound care healing.
I believe that if a foot is
swollen and PVD is
present, think twice
before elevating that foot
too high.

Foot elevation can
possibly help
swelling but this could
possibly impair blood flow
to the feet in an ischemic
foot ( a foot lacking blood
flow needed to survive.
I feel it is possible for one day to see a toe
ulcer and the next day not to see an ulcer on
the toe.

Sometimes one can have good pedal pulses and an ischemic foot due to
small vascular disease of diabetes. Signs of this might be decreased hair growth,
decreased thin skin texture, thickened toenails, color changes in the toes,
temperature changes in the toes ( toes feel cold ), etc....

I believe the sub specialty of podiatric orthopedics and primary podiatric
medicine is important. There are many patients who have poor circulation in the
feet that would benefit from a podiatrist, vascular doctor and internist working
as a team.