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Stepensky_Interview_October2019_eng.doc

Help for Painful Legs

A Talk with Dr. Leon Stepensky, Podiatrist and Foot Specialist

Are your legs sore? Do you experience pain when you walk or stand?

You may think it’s just a part of aging, but according to Dr. Leon Stepensky, an experienced podiatrist and foot specialist working in Brooklyn for over 20 years, there may be treatments that can help you walk comfortably once again.

What is the main cause of leg pain?

The legs, like the rest of the body, require a consistent supply of blood to operate correctly. Blood brings in oxygen and nutrients to the cells, which the tissues need to function properly. Two parts of the circulatory system—the arteries and veins—manage this blood delivery system. Arteries get oxygen from the heart and take it towards the legs, and the veins then return the oxygen-depleted blood back to the heart, where it becomes oxygen-rich once again.

The two most common issues I see in my podiatric practice caused by poor blood circulation include:

Swollen legs, including varicose veins

Cold, tired, painful legs with dry or thin skin

The veins work against gravity to take blood up towards the heart. They have a thin lining of muscles that help them achieve this. Due to age, inactivity, diabetes or other underling medical condition, this lining can become stretched, which creates varicose veins. This may also makes it harder for veins to get blood back to the heart.

Swollen legs and other vein disease can also be caused by a malfunctioning/weak heart, kidney disease and a malfunctioning lymph system, but we’ll concentrate on issues with the veins for this article. Heart issues and kidney disease may be diagnosed by your primary care provider.

What are the diagnostic tools you use in your office?

We can conduct a simple, painless test to check the veins and the arteries in your feet. This test helps us determine what's causing painful or swollen legs, and then we can help prevent other complications like difficulty walking or having to walk with a cane.

This same test can check the arteries as well. Age, genetic predisposition, diabetes, heart disease, and other conditions can damage the arteries, narrowing them so that it takes longer for the oxygen to reach the legs. This is why people will feel that their legs are cold. It can also cause the skin on the legs to be very dry or pale, clumping, or wet. Our tests can help determine what’s causing this and give us clues as to the best way to address it.

We can also test diabetic patients to determine the potential risk of them suffering from diabetic neuropathy (nerve damage in the feet and legs). This is another painless test that checks the integrity of the nerves in the feet. It’s best to undergo the test once a year to make sure there are no changes, and to help prevent future problems.

All three of these tests can be performed in our office. We use them to educate patients on their conditions, and to determine the best methods for treatment, prevention and progression of diseases.

Who performs the tests you described?

A licensed technician performs this test in our office, with the help of computer technology. We can actually see on the computer monitor what is happening to the patient’s veins and arteries. According to the results of these studies, we can determine a more accurate diagnosis and a more appropriate treatment plan. In the past, we had to rely solely on physical examination.

How do you treat circulatory problems in the legs?

We provide many treatments right in our office, including oral or topical medications along with compression stockings and pumps, medicated bandages and certain types of physical therapy. Other times, more invasive treatments may be required.

When is surgery needed?

In certain situations and severe cases, surgery may be necessary. I do not perform such operations, but refer the patient to a specialist surgeon. But I have to say that sometimes surgery is not the best option. I prefer conservative treatments—medications, ointments, medicated strappings, pumps etc.—depending on our evaluation and studies.

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