Critical limb ischaemia awareness

Overview

Critical limb ischaemia (pronounced 'iss-KEE-mee-uh') is a serious condition where blood flow to the leg or foot is severely reduced, usually because of blocked arteries. This lack of blood supply can cause pain, slow-healing wounds, and may lead to tissue damage or amputation if not treated quickly.

It is not common, but it occurs more often in people over 60, especially those with diabetes, high blood pressure, or who smoke. About 1 in 100 people with peripheral artery disease may develop it.

Critical limb ischaemia mostly affects older adults, particularly those with diabetes, high cholesterol, a history of smoking, or kidney disease. It can also affect younger people with severe diabetes or autoimmune conditions, but this is less common.

Symptoms

Common symptoms

• Severe pain in the leg or foot, even while resting or at night
• Numbness or a feeling of coldness in the foot or toes
• Skin that looks pale, shiny, or bluish
• Sores or wounds on the foot or toes that do not heal
• Gangrene (black, dead tissue) on the toes or foot

Symptoms in children

• Critical limb ischaemia is very rare in children, but if it occurs, symptoms may include limping, poor growth of the affected leg, or pain when walking.
• Children with underlying conditions like diabetes or vasculitis may be at risk.

Symptoms in older adults

• In older adults, symptoms may be less obvious because they may have other health problems that mask the pain, such as nerve damage from diabetes.
• Look for non-healing sores, leg pain that wakes them at night, or a leg that feels colder than the other.

Causes

Main causes

• Atherosclerosis – buildup of fatty deposits in the arteries, narrowing them and reducing blood flow
• Blood clots that block an already narrowed artery
• Severe inflammation of blood vessels (vasculitis) – less common

Risk factors

• Smoking or tobacco use
• Diabetes
• High blood pressure
• High cholesterol
• Being overweight or obese
• Having peripheral artery disease
• Kidney disease
• Being older than 60

When to see a doctor

See a doctor urgently if:

• If you have a leg or foot wound that does not heal after a few days
• If you have ongoing pain in your leg or foot, especially at night
• If your foot or leg feels cold or looks pale or blue

Book a routine appointment if:

• If you have risk factors (like diabetes, smoking, high blood pressure) and you notice changes in your legs or feet
• If you have leg pain when walking that goes away when you rest (intermittent claudication)

Diagnosis

Doctors will ask about your symptoms and medical history, and examine your legs. They will check the pulse in your feet and look for skin changes. Special tests can measure blood flow and find blockages.

Tests that may be done

• Ankle-brachial index (ABI) – compares blood pressure in your ankle and arm to see if the leg has reduced flow
• Ultrasound or Doppler study – uses sound waves to see the blood vessels
• Angiography – a dye is injected and X-rays are taken to show blockages

What to expect at your appointment

If you go to the emergency room or your doctor suspects critical limb ischaemia, you will be seen quickly. The tests are mostly painless. You may be asked not to eat or drink before some tests. Results can help decide if you need treatment right away.

Treatment

The goal of treatment is to restore blood flow to the limb as soon as possible to save it and relieve pain. Treatment depends on how severe the blockage is and your overall health. It often involves a combination of medicines and procedures.

Self-care at home

• Keep the wound clean and dry if you have a sore – do not apply any creams or ointments unless told by a doctor
• Avoid smoking completely – it makes the condition worse
• Elevate your leg only if advised – sometimes hanging the leg down helps blood flow
• Follow your diabetes and blood pressure management plan carefully

Medical treatments

Medicines to help widen the arteries or prevent blood clots may be prescribed. Other treatments include angioplasty (inflating a small balloon inside the artery) or inserting a small tube called a stent to keep the artery open. These procedures are done by a specialist and aim to restore blood flow without major surgery.

When is surgery considered?

If less invasive treatments are not possible or fail, bypass surgery may be recommended. This involves using a healthy blood vessel from another part of your body to create a detour around the blocked artery. In severe cases where the tissue has died, amputation of the toe, foot, or part of the leg may be needed to prevent infection from spreading.

Living with this condition

Living with critical limb ischaemia means taking good care of your feet and legs every day. Check your feet daily for any new sores, blisters, or colour changes. Wear comfortable shoes and avoid going barefoot. Follow your healthcare team’s advice on wound care and activity levels.

Lifestyle tips

• Stop smoking – it is the single most important step you can take
• Keep diabetes under tight control if you have it
• Manage blood pressure and cholesterol with guidance from your doctor
• Stay as active as your pain allows – gentle walking may help, but rest when needed

Diet and exercise

Eat a balanced diet low in saturated fats and salt, and high in fibre, fruits, and vegetables. If you have diabetes, follow your meal plan. Gentle exercises like stretching or walking short distances can improve circulation, but stop if you feel severe pain. Talk to a physiotherapist or your doctor before starting an exercise plan.

Mental health and emotional wellbeing

Dealing with chronic pain, the fear of amputation, and changes in your ability to move can be very stressful. It is normal to feel anxious or depressed. Talking to a counsellor, joining a support group, or sharing your concerns with loved ones can help. Your doctor may also offer resources for mental wellbeing.

Prevention

You can reduce your risk of critical limb ischaemia by controlling the factors that lead to artery disease. The most important steps are not smoking, keeping diabetes and blood pressure well managed, eating healthily, and staying active. If you have peripheral artery disease, early treatment and regular check-ups can help prevent it from becoming critical.

Vaccines

There is no vaccine for critical limb ischaemia, but staying up to date with other recommended vaccines (like flu and pneumonia) can help prevent infections that might worsen leg wounds.

Screening programmes

There is no routine screening test for everyone. However, if you have risk factors like diabetes or a strong family history of artery disease, your doctor may recommend an ankle-brachial index test to check for peripheral artery disease early.

Complications

If left untreated

• Non-healing wounds that become infected
• Gangrene – death of tissue, which may require amputation
• Sepsis – a life-threatening infection that spreads through the blood

Long-term outlook

With quick treatment, many people with critical limb ischaemia can save their limb and return to daily activities. The key is to see a doctor as soon as symptoms appear. Even if amputation is needed, you can still live a full life with support from your healthcare team and rehabilitation. The condition is serious, but there is hope and help available.

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