The patient's lower legs and feet should be examined with shoes and socks off, with attention to pulses, hair loss, skin color, and trophic skin changes. The pulses at the brachial, radial, ulnar, femoral, popliteal, dorsalis pedis, and posterior tibial sites are palpated.
The carotid artery pulse should be palpated and the carotid upstroke and amplitude should be determined.
Blood pressure is measured in both arm and the arms are examined for any inter arm asymmetry. Hair loss, thickened nails, trophic sin changes hypertrophic nails, smooth and shiny skin, coolness, pallor or cyanosis.
Critical limb ischemia is defined as limb pain that occurs at rest or impending limb loss that is caused by severe compromise of blood flow to the affected extremity. Acute limb ischemia arises when a rapid or sudden decrease in limb perfusion threatens tissue viability.
Peripheral Vascular Disease of the Hand: Advanced disease with gangrene of several digits.
Gangrene is a serious condition and potentially a life threatening ailment which arises due to the loss of blood supply causing the body tissue to die.It can affect any area of the body though it starts in the toes, feet, hands and fingers but can also occur inside the body, damaging muscles and organs.
Primary cause of gangrene is reduced supply of blood to the affected tissues which end up in cell death. Some of the symptoms of this condition include redness and swelling in the affected part of the body, loss of sensation or severe pain, sores or blister in the affected areas which tend to bleed or produce foul smelling pus. Blood is the most essential element for health since it transports oxygen and nutrients to the entire body to feed cells, in delivering disease fighting antibodies which protects the body from various infection and when the blood circulation is not circulated effectively in the body, the cells are unable to survive resulting in infection and the tissue may die from gangrene. Conditions affecting the blood stream flow could increase the risk of gangrene like atherosclerosis, peripheral arterial disease, trauma, Raynaud’s phenomenon, a condition wherein the blood vessels supplying the skin tends to get narrowed down, besides diabetes and smoking. Wet gangrene occurs with the complication of an untreated infected wound, resulting in swelling from the infection of the bacteria due to sudden stoppage of circulation of the blood flow.
Dry gangrene is the result of reduction of blood flow through the arteries and appears gradually and the process is slow.

Gas gangrene is another type of wet gangrene caused by bacteria known as Clostridia which are a type of infection causing bacteria that grow only in the absence of oxygen and as they grow they produce poisonous toxins and gas.
Right Upper Extremity DVT: Diffusely swollen RUE resulting from a PICC line induced thrombosis.
Peripheral Vascular Disease of the Hand: Advanced disease with gangrene of several digits. Calf muscle tension most likely is gastrocnemius or soleus muscle strain, and it is concurrent with acute sensitivity and pain, and swelling. A stiff calf muscle may be perpetuated because of a biomechanical complication during high-stress activity mainly from running, then orthotics is necessary to rearrange asymmetry or malformation in the foot. Microscopic calf muscle tears can cause spasms when it is constricted then there is poor blood circulation. Inactive people who exercise after a prolonged stretch, also are afflicted with calf muscle pain and stiffness after high-exertion exercises. Sport Injury Expert, QiVantage CoFounder , Traditional Martial Arts Practitioner, and Coach. Patients with PAD might have cyanosis, atrophic changes like loss of hair, shiny skin, decreased temperature, decreased pulse or redness when limb is returned to a dependent position. The term “critical limb ischemia” should be used for all patients with chronic ischemic rest pain, ulcers, or gangrene attributable to objectively proven arterial occlusive disease. This form of CLI may be the first manifestation of arterial disease in a previously asymptomatic patient or may occur as an acute event that causes symptomatic deterioration in a patient with antecedent lower extremity PAD and intermittent claudication. Based on work by Maheep Sangha, Michael Maddaleni, Vishnu Vardhan Serla and Raviteja Reddy Guddeti and wikidoc users Kiran Singh and Rim Halaby. Due to termination of the blood flow, the tissues tend to react to the presence of bacteria which multiply and the disease fighting cells - the white blood cells cannot reach the affected areas resulting in becoming moist and wet and breaking down causing death of the tissues.
Regular check-up are essential and quitting smoking followed by adopting a healthy lifestyle with regular exercises and low fat diet should be maintained to reduce the risk of this ailment. Movement, generally running aggravates the severity, conversely for other individuals running can marginally slacken the muscle.

Inevitably, a sports orthopedics professional or a podiatrist needs to be visited for a thorough biomechanical examination. Then calf muscles constrict to release blood when there are blood and nutrient deficiencies, then the muscles tighten to naturally protect themselves and the muscle becomes languid. Wearing incompatible shoes such as high-heels can induce irregular constriction of the calf muscles. Although the progression of PAD from intermittent claudication to CLI may occur gradually, it may also reflect the cumulative effect of multiple acute local thrombotic events that progressively increase the intensity of ischemia.
Also a compartment syndrome may occur from pressure distending a thin envelopment around the muscle that may be painful thus delimiting mobility. Possibly your muscles have steadily toughened probably over months, because of neglecting to stretch properly. At the heart of its occurrence is the sudden vascular spasm in the peripheral parts of the body – most commonly the hands. These disorders have been well described for other peripheral, protruding parts of the body – the feet, nose, ears.
Thus, the syndrome often occurs against a background of connective tissue diseases, especially scleroderma. The role of occupational diseases in its development: vibration disease, intoxication by various chemicals.
With Raynaud's syndrome can occur, some diseases of the spine, as well as diseases of CNS (syringomyelia, stroke).

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