Do you or someone you know have foot or ankle discoloration? Have you noticed swelling or indents from socks that worsen later in the day? These may be signs of Vein Disease.
Ankle Discoloration / Areas of darker skin color in the lower leg, ankle or foot may be from hemosiderin deposits. Hemosiderin is a brownish pigment caused by the breakdown of blood hemoglobin, the iron content in red blood cells. Foot and Ankle discoloration, when caused by hemosiderin, is called Stasis Dermatitis and is a sign of Venous Insufficiency, also called venous reflux disease and venous hypertension among other names. Although the easiest association is with dark pigment, venous insufficiency may also as persistent redness of the lower legs and feet.
Stasis dermatitis is a common inflammatory skin disease that occurs on the lower extremities (see the image above). It is a skin sign of chronic venous insufficiency with venous hypertension and may be a precursor to more problematic conditions, such as venous leg ulceration.
Accurate diagnosis is critical, as many patients treated for cellulitis may actually have stasis dermatitis. Dr. Banda says, “When redness is evenly distributed between the two legs and seemingly unresponsive to common treatment for cellulitis, the cause may well be stasis dermatitis and not a bacterial infection. Indeed, recurrent cellulitis of several times a year may also be facilitated by venous insufficiency”.
Stasis dermatitis typically affects middle-aged and elderly patients, rarely occurring before the fifth decade of life. An exception would be patients with acquired venous insufficiency due to surgery, trauma, or thrombosis.
The most common manifestation of stasis dermatitis is the development of brown color changes in the skin at the inner aspect of the ankle. This Ankle Discoloration will worsen over time and will eventually result in the development of open poorly-healing wounds called venous stasis ulcers. These changes usually take many years to develop and patients may be treated for years with creams and salves which do not solve the problem.
Stasis dermatitis occurs as a direct consequence of venous insufficiency. Disturbed function of the 1-way valvular system in the venous network of the legs results in a backflow of blood down the leg instead of the normal persistent upward flow towards the heart. Dr. Banda further says “Remember that the heart does not pump vein blood back to itself. Something else has to help this blood get back to the heart. Hence the need for valves in veins but not arteries”. This loss of valvular function can result from an age-related decrease in valve competency.
Alternatively, specific events, such as deep venous thrombosis, surgery (e.g., vein stripping, total knee arthroplasty, harvesting of saphenous veins for coronary bypass), or traumatic injury, can severely damage the function of the lower-extremity venous system. (See the image below.)
Although not nearly as prevalent as skin cancer, fungal skin infection, or eczema, stasis dermatitis affects a significant proportion of the elderly population. Studies have estimated an approximately 6-7% prevalence of the condition in patients older than 50 years.
This would translate into approximately 15-20 million patients older than 50 years with stasis dermatitis in the United States. This finding makes stasis dermatitis twice as prevalent as psoriasis and only slightly less prevalent than seborrheic dermatitis.
The key to treatment of stasis dermatitis is to treat the underlying vein disease.
Evaluation is important to determine the cause and severity of Venous Insufficiency. Diagnostic Ultrasound is used to identify where and how badly your veins are damaged. The ultrasound examination is designed to evaluate the blood flow through your veins in your legs.
Following evaluation, a treatment plan is discussed, including risks and benefits.
Endovenous Ablation is the technique of harnessing technological advancements to get rid of damaged veins by performing minor surgery from within inside the vein. The results are cosmetically much better than vein stripping (surgically cutting the vein out). These minor surgeries allow people to carry on with normal daily activities sparing just a couple of hours for the procedure. Laser endovenous treatment of veins is the procedure offered by Dr. Banda’s practice. Other technologies are available on the market.
Compression Therapy is an integral part of managing venous insufficiency, deep vein thrombosis, superficial vein thrombosis, and venous obstruction. The most commonly used form of compression treatment is prescription strength graduated medical grade stockings. These come in knee high and thigh high denominations. Pantyhose are also available, but the effective part is equivalent to thigh high stockings. Dr. Banda notes, “these have to be properly fitted for every patient individually. Occasionally the fitting for the two legs will be different. We take measurements and hence fit all patients who get graduated compression stockings from our office. When we do send out a prescription we specifically send patients to those medical supply facilities that we know do this correctly. It is not good enough to just buy these online or at a regular pharmacy without the proper fitting. Additionally, the prescription grade stockings have a notation of how much pressure they will deliver. When you do get them on your own, make sure they are as prescribed.”
Lifestyle Changes are often advised. Elevating the legs when at rest, avoidance of prolonged sitting and standing are all helpful measures. When one must sit or stand, repetitive ankle exercises are beneficial. For the same reason, exercise such as walking or running is helpful.
MD Vein & Skin Specialists is a medical practice which offers comprehensive Vein Care and Dermatology. All treatments are offered as non- invasive medical therapies and minimally-invasive vein restoration procedures such as endovenous ablation, sclerotherapy, ambulatory phlebectomy and surface lasers.
Dr. Clement Banda, M.D. (Founder and Medical Director of MD Vein & Skin Specialists) has more than 25 years of medical experience and is certified by the American Board of Venous and Lymphatic Medicine. He additionally received postgraduate training in Clinical Dermatology from Queen Mary, the University of London.
As a further demonstration of his commitment to quality care, Dr. Banda is also a Registered Phlebology Sonographer (RPhS) with certification through Cardiovascular Credentialing International (CCI).
If you have Ankle Discoloration you should be observed by an experienced Vein Specialist with the aid of a properly performed ultrasound examination. Schedule your Consultation with Dr. Banda now.
Call (443) 681-6367 or Fill out Online Contact Form to start your way to healthier legs.