Dr K K Pandey
If the skin colour of one or both your legs is darker than the skin colour of the rest of the body, and you have trouble standing for more than an hour and your legs swell up while walking, feel a strain or excessive fatigue after walking a little, then believe me that the round or spotted black marks on your feet and legs are not due to any skin disease but it is a disease of veins, which is medically known as Chronic Venous Insufficiency or C.V.I.
Why does the colour of the skin of the lower legs change?
Like other parts of the body, legs also need oxygen. This oxygen is delivered through pure blood flowing in the arteries. After providing oxygen to the legs, this oxygen-free impure blood is taken back through veins from the legs to the lungs for purification. This means that these veins form the drainage system of the legs. If the functioning of the veins is impaired for any reason, then the drainage system of the legs and feet collapses, the result of which is that the impure blood starts accumulating in the lower part of the legs instead of rising up and going towards the lungs. Then the swelling in the legs starts and the colour of the skin of the lower part of the legs becomes darker and black marks appear. If these are not treated timely and appropriately by a vascular surgeon, then the black marks on the legs will slowly grow deeper and increase in size and will eventually turn into incurable ulcers.
Accumulation of blood clots in veins is a major reason
There are many reasons for the development of vein disease i.e., C.V.I. The most important among them is Deep Vein Thrombosis (DVT). In this disease, blood clots accumulate in the deep veins of the legs. These clots either do not disappear completely after the disease or even if they dissolve, they destroy the valves located inside the vein. With the result, the process of impure blood going upwards through the veins gets severely disrupted. In some DVT patients, blood clots start residing permanently inside the veins, thus disturbing the drainage system of leg and causing discoloration of leg.
Lack of exercise and regular walking
The second major reason for CVI is the negligible walking and exercise. By not walking or exercising your legs daily, the pump created by the leg muscles that helps to push the impure blood upwards, gets weakened. The valves in the veins of some people do not develop properly or deep vein being not developed since birth, in such patients the symptoms of CVI start at an early age.
What will happen
The initial symptoms of CVI disease are swelling in the legs and feet by evening and the swelling disappears when you wake up in the morning. But as this disease progresses, one starts complaining of mild pain, strain and fatigue in the legs. Later, the skin of the legs and feet starts getting darker and black dotted marks appear on it. Gradually, these black marks start increasing in size. Then later, eczema and wounds develop on these black marks. Due to ignorance, patients start getting treatment from dermatologists/skin specialist without understanding the real cause of eczema. The patient should consult a vascular surgeon.
What to do if the skin colour has become darker.
If the skin of the lower part of your leg has started getting darker and black. Then it is very important to know the cause of these black marks. For this, some special tests like venous doppler study, MRI venogram and sometimes venous angiography are used. Special blood tests have to be done to find out whether the process of blood turning into a clot or a clot is abnormal or faulty. The correct direction of treatment of CVI is determined on the basis of result these special tests.
Treatment methods
Most patients require medication, regular daily walks and special exercises. But some patients require surgery. In today’s era, modern techniques like venous valvuloplasty, axillary vein transfer or venous bypass surgery help in controlling the disease. If there is swelling in the leg and also constriction and narrowing of the veins, then nowadays venous angioplasty and venous stenting are used, so that the flow of venous blood upwards can increase. In this non-surgical procedure, no skin cuts are made
Take following precautions
Never use high-heeled shoes and sandals. Never do jogging, skipping, aerobics or any such jumping exercise in which the knee of the leg gets jolted repeatedly. Exercises that involve lifting and bending the leg without jerking are beneficial for veins. Avoid such occupation or physical posture in which you have to sit or stand for long hours Keep your weight under control. Do not let obesity develop under any circumstances.
Walk at least five to six kilometres every morning regularly. While sleeping at night, put one or two pillows under your feet so that the feet remain ten or twelve inches above the chest. Always wear graduated compression stockingon your legs during the day. Never walk without wearing these special socks. These special socks increase blood flow upwards in the legs and reduce the downward blood flow due to gravity and prevent darkening of the leg skin.
(The author is Senior Vascular & Endovascular Surgeon Indraprastha Apollo Hospitals Sarita Vihar, New Delhi.)
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