Neurovascular Assessment and Why It’s Important
Our feet, ever dependable, taken for granted, often neglected, so little thought is given to our extreme appendages. But why? We are ever reliant on our feet, our entire day to day life functions rely entirely on our mobility, the quality of that mobility is irrevocably linked to the condition and health of our feet.
If we allow our thoughts to dwell on potential problems with our feet, for the untrained minds, most of us will think of similar complaints, corns, bunions, hard skin patches, athletes foot. These are most likely the things that will spring to mind first, and indeed they are common. For such complaints, a quick visit to our local podiatric clinic, and very soon all is well.
However, few people realize the intricacies and complexities of their feet, the foot is, in fact, a very complicated part of the human body. To start with, there are 26 bones and 33 joints in each foot, from the talus to the metatarsal to the sesamoid, each one playing a vital role in the mechanical functioning of the foot. There are also more than 100 muscles, tendons and ligaments all working in perfect unison to give us support, balance and mobility.
Then there is the incalculable length of blood vessels traversing to and from each foot bringing them a constant flow of life giving blood from the body’s pumping station, the heart. All of this is then wrapped in the body’s protective armor, our skin. The skin is the vital component that helps to contain all of these vital mechanisms and defends them from the innumerable threats that the feet are exposed to from our everyday existence.
No matter what we are doing, our work, going to the shops, playing with the children in the garden, playing sports or doing our daily fitness routine, our feet are playing a key role. And yet, in doing so, we fling these valuable appendages around in the air with almost total care free abandon, and with little or no thought to the risks we are exposing them to.
Seldom do we give thought to how our daily lives can be impaired if our feet fail to function at the peak of their ability, and it’s not until a negative condition befalls us that we realize our life’s total level of dependency on these two neglected parts of our anatomy. Only then do we come to appreciate the importance of maintaining our foot health in tip top condition.
The overall health of our feet can be dependent on many things. Obviously there is the general wear and tear of daily life, the risk of physical trauma, poor lifestyle choices and even the pursuit of personal vanity, in the mode of fashionable footwear, can all play a part in inadequate foot health. But there are far more, less obvious, risks to our feet which can come from other, seemingly, non-associated medical issues.
Assessing the Health of Your Feet
Self-awareness is a great tool in staying on top of health issues, and that includes the feet. Regularly inspecting your feet will often identify potential problems. Recognizing unusual colour, deformities, swelling, and of course aches and pains, can help in early diagnosis of a problem. An early diagnosis will usually mean less treatment, quicker recovery and will reduce the disruption to your quality of life.
However, some issues require assessment from a trained practitioner. One the most valuable appraisals a skilled professional can undertake is a ‘Neurovascular Assessment’, or NVA. If it is found that NVA issues exist, it will be equated as being either acute or chronic. So what exactly is meant by neurovascular issues?
Neurovascular, neuro means ‘Of the Brain’ vascular ‘Of the Circulatory System’. Healthy feet require a full and proper flow of rich oxygenated blood, this function is achieved jointly by the heart and the brain working in unison. Unfortunately, things can go wrong with either, or both, of these functional systems. An early sign that this may be the case is often seen in the bodies peripheral parts, the feet being the furthest part of the body from the heart and brain, are often the first parts of the body to suffer.
Acute Neurovascular Diagnosis
When a diagnosis is classified as ‘Acute’ it means that the sufferer is I danger of developing ‘Limb Compartment Syndrome’. Acute limb compartment syndrome, or LCS, can be at least limb threatening, at its very worst it can endanger a person’s life. LCS is denoted as being bleeding or edema within the closed muscle compartment which is encased by fascia tissue and bone, leading to nerve ischemia.
Causes of this acute condition include having had treatment to clear arterial obstructions, reperfusion or acute trauma. If left untreated the patient is at risk of muscle necrosis or amputation. If the condition is found to be in larger muscle compartments, it can result in renal failure.
Chronic Neurovascular Diagnosis
When neurovascular issues are diagnosed as ‘Chronic’, the term used to differentiate it from its acute form is ‘Chronic Exertional Compartment Syndrome, or CECS. Generally, this is less serious than LCS, but nonetheless, still requires treatment to contain, and recover from it.
CECS, as the term suggests, is usually caused as a result of repetitive or excessive levels of exercise, although medically speaking, it is not fully understood. During exercise the muscles tend to expand, they literally get bigger, in individuals with CECS the fascia tissue that surrounds the muscles fails to expand at the same rate. This creates pressure within the compartment which leads to pain.
Spotting the Signs
Early diagnosis of Compartment Syndrome, acute or chronic, is essential for successful treatment, and a neurovascular assessment is the first step. Early signals that a problem may exist include aches, cramping pains or a burning sensation in specific areas along with a tight feeling of the limb. Tingling sensations and numbness in the limb are also common.
Muscle hernias can occur, seen by a bulging or swelling of the muscles. In more severe cases ‘Foot Drop’ is not uncommon, and often similar symptoms will be experienced in similar limbs. The pain associated with exertional compartment syndrome tends to follow a typical pattern. During exercise, after a particular length of time or level of exertion, or perhaps at the same distance covered when jogging, the pain and discomfort tends to kick in.
When a sufferer experiences these pains and sensations they also find that they tend to increase along with the continuation of the exercise. On ceasing the exercise, the pains are almost immediately less intense and have faded completely after around 10-15 minutes of rest.
Who is at Risk?
The simple fact is that anyone can be at risk from LCS and CECS, but of course there are those that are at greater risk than others. Although age is no barrier to sufferance, there are higher numbers in both male and female athletes over the age of 30 and those individuals that regularly partake in a physical fitness routine.
The types of exercise that a person undertakes can also have a bearing on the condition. And physical exercise that is classed as an impact activity, running and jogging in particular, vastly increases the chances of developing the condition. Of course physical exercise should always be encouraged, but there are some that enter into an exercise routine, and rather than build up their levels of endurance, they overdo it too early, this will expose them to a higher level of risk in developing a problem.
Showing Symptoms, what to do Next?
If you are experiencing any of the common symptoms of LCS or CECS a neurovascular assessment is essential, and should not be delayed. The risk then is delay, this may make a sufferer somewhat anxious, given that the health services are over stretched to such unprecedented levels. Realizing that you may require an neurovascular assessment is one thing, actually having one could mean weeks, if not months of waiting.
It is then that your local podiatric clinic comes to the fore. The country is blessed with private podiatric clinics over its length and breadth, in or out of the larger conurbations, you are never far from a trained professional that can carry out your neurovascular assessment, administer treatment, and if necessary recommend referral.
It should be noted that, although the UK has the highest standards in podiatric care that anyone could expect to find anywhere in the world, it is wise to choose a practitioner that is a member of the British Association of Foot Health Professionals. The BAFHP set very high and exacting standards, in ethics, diagnostics, treatment and hygiene, as such, with these member professionals, you are, quite literally, in good hands.
The Midlands are well serviced with Feet@theclinic, Loughborough, Leicestershire. This friendly local clinic has a homely welcoming feel and is administered over by the highly skilled, Rebekah Henning. Rebekah believes in the most exacting of standards of patient care, is highly qualified and well versed in conducting your neurovascular assessment. If you have any symptoms at all, give Rebekah a call.