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.
Areas of darker skin color in the lower leg, ankle or foot are called 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 is called Stasis Dermatitis and is usually a symptom of Venous Insufficiency.
Ankle Discoloration / Stasis Dermatitis
Stasis dermatitis is a common inflammatory skin disease that occurs on the lower extremities. It is usually the earliest cutaneous sequela of chronic venous insufficiency with venous hypertension and may be a precursor to more problematic conditions, such as venous leg ulceration and lipodermatosclerosis.
Accurate diagnosis is critical, as many patients admitted for the treatment of cellulitis actually have stasis dermatitis and lipodermatosclerosis.
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 Ankle Discoloration / brown color changes in the skin at the inner aspect of the ankle. These changes 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.
Causes of Stasis Dermatitis
Stasis dermatitis occurs as a direct consequence of venous insufficiency. Disturbed function of the 1-way valvular system in the deep venous plexus of the legs results in a backflow of blood from the deep venous system to the superficial venous system, with accompanying venous hypertension. This loss of valvular function can result from an age-related decrease in valve competency.
Alternatively, specific events, such as deep venous thrombosis, surgery (eg, 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.)
Occurrence in the US
Although not nearly as prevalent as skin cancer, dermatophytosis, or xerosis, stasis dermatitis affects a significant proportion of the elderly population. No conclusive investigations into morbidity and mortality in stasis dermatitis have been undertaken, but 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. Modern Vein Treatments are a great option for people with these problems”, mentioned Dr. Andrew Jones.
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, localizing the problem areas.
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.
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 knee-high stockings.
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.
According to Dr. Edward Boyle, “Stasis dermatitis is a common problem for people that generally responds well to treatment.”
INOVIA® Vein Specialty Center
Dr. Edward Boyle has a career that spans clinical surgery, vascular research, and medical innovation. After starting out his career specializing in cardiothoracic surgery, he now sub-specializes entirely in treating patients with vein and vascular disorders.
Dr. Andrew Jones is a board-certified general surgeon with a special interest in the management of venous disease. Dr. Jones is a diplomat of The American Board of Phlebology and also serves on the International Affairs Committee for the American College of Phlebology.
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For more information about varicose veins and to learn if Treatment might be right for you, fill out our Online Appointment Request Form or Call INOVIA® Vein Specialty Center at (541) 382-8346 today!