Poor Circulation in the Extremities

Circulation is blood pumping through the body. The heart is the main pump that pushes the blood. The heart is controlled by the Autonomic Nervous System (ANS), the part of the nervous system that keeps the internal workings of the body going, automatically. You cannot consciously control your heart beating or pumping blood through your arteries and veins.

Blood flow works best in the body areas closest to the heart. The further away from the heart, the less efficient blood flow can be. Toes are the farthest body part from the heart which is why they are at the most risk for poor circulation. Fingers are also more distant from the heart, although not as far as the toes.

Although the heart pumps blood, there is some help along the way. Little shelf like formations are inside the blood vessels which holds blood in place between the lub dub of heart beats. Your muscles also help blood flow by massaging the blood vessels when muscles are activated.

Decreased blood flow in the legs and arms is something that can happen to anyone. Internally, there can be a decrease in blood pressure unable to keep the tiny vessels open. Externally, too much pressure on the skin over boney prominences crushes small blood vessels and blood flow leading to pressure injury.

Detriments to blood flow include some diseases such as diabetes which affects arteries and veins, peripheral vascular disease, coronary artery disease, blood clots and, atherosclerosis or plaque or calcification in the blood vessels. Some medications also play a part in restricting blood flow.

Today, let’s look at decreased blood pressure in the legs from another point of view than pressure injury. Too weak of blood flow from any cause can lead to pain or venous stasis ulcers better known as leg sores. These ulcerations appear anywhere on the legs and even occasionally on the arms. Since the toes and fingers are the farthest points of the body away from the heart, blood flow is slowest in these areas (the least amount of blood pressure).

Just because you have a spinal cord injury does not mean that you will develop venous status ulcers. In fact, most individuals with SCI do not develop this problem. However, having knowledge about a condition is a good step in ensuring you do not develop it. Like many conditions, the earlier treatment begins, the easier the problem is to correct.

A combination of issues can lead to poor circulation. Sedentary lifestyle or not moving your extremities much is one factor. Chronic conditions especially diabetes atherosclerosis, heart disease and obesity are others. Smoking constricts blood vessels. Constriction of blood vessels from a mechanical point of view decreases circulation. This can be from too tight clothing or leg bags, too tight restraints such as seatbelts and spasm fasteners, crossing your legs, ‘hooking’ your arm around the back of your chair and lack of mobility.

Signs and symptoms of poor circulation might include things a person with spinal cord injury may not sense such as cold hands and feet, pain, joint and muscle cramping, and numbness and tingling in the hands and feet. An individual with a spinal cord injury might notice these symptoms: swelling in the feet, ankles, legs, hands and arms, skin color changes, ulcers, varicose veins, digestive issues, tiredness, memory loss and difficulty concentrating. In particular, you might have sensations of spasms or episodes of Autonomic Dysreflexia.

There are ways you can check for poor circulation. First look at your extremities for changes in skin color. Your feet or hands may look mottled or splotchy.

Second, feel your extremities for temperature. An ever so slight coolness to your feet and lower legs, hands and lower arms can be room temperature differences. A noticeable difference to one or both of your extremities could be indicative of poor circulation.

Third, check your pulses. The pedal (foot) pulses can be hard to find. One is on the top of the foot and one behind the inner ankle. The picture below will show you where they are. You will have to feel around to find your pulses as everyone’s are not in the exact same location. Use a light touch when finding the pedal pulse as even a slight pressure can occlude them. Feet pulses can be very hard to find. The wrist pulse is on the inner wrist just below the line of the thumb. You have had this checked by health professionals many times. There is also a faint pulse on the inside of the elbow toward the side of the body. Pulses should be equal on each side and rhythmic.

Arm pulses are assessed by using the index and middle finger together on the areas marked with an X.

Pedal (foot) pulses are assessed using the index and middle finger together on the areas marked with an X. Generally, the top of the feet are assessed at one time with the examiner using both hands, fingers on each foot to compare similarity.

Edema can make feeling your feet or arm pulses difficult. A healthcare professional might want to assess your pulses if they are difficult to locate. Blood flow is assessed with a doppler test which is a device that is placed on the skin over the pulse area. A special transmitting lubricant (not catheterization or bowel program lubricant) is used to enhance the pulse location. If further studies are needed, blood flow studies, CT or MRI tests might be done.