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I had bilateral RFA of both greater saphenous veins in 2007 and am on coumadin for continued LE ulceration. I have significant foot pain, particularly when I first stand. I wear compression hose. Ideas for relief?
I advise you to see a podiatrist. The foot pain may not be vein related.
You may have nerve injury, or you may be wearing support hose that are not strong enough.
The RFA is probably not enough. Most likely, you have other varices that need to be treated by sclerothereapy. A wound clinic will help you treat the ulcerations, but until those varices that likely feed the ulcers are treated, the ulcers (and foot pain and related issues) will not fully heal.
The pain is probably related to the continued ulceration and with treatment of the ulcer, the pain should improve. Additional treatments for the ulceration could potentially be special medicated compression wraps that are typically done through a wound clinic (unna boot or profor wraps) or even a skin graft. The other issue for you is to ensure that you do not have another condition contributing to the pain, such as peripheral artery disease or neuropathy, which are other common causes of leg and foot pain and are often seen in patients who also have venous insufficiency with ulcers. You would need a comprehensive management plan established with the assistance of a vascular specialist to best manage your problem.
You need a re-evaluation by a vein specialist.
You should have a thorough evaluation by an experienced vascular surgeon who specializes in venous disease and venous stasis ulceration including a comprehensive venous ultrasound examination. It would be too difficult to answer your complex questions without all the information. Wearing compression definitely sounds appropriate until then.
My question for you is: Why do you still have an ulcer? Assuming you have never had a DVT in the past with resultant deep vein reflux, your vein treatment doctor should have been able to eliminate your ulcer permanently. Possibilities for why your ulcer is not gone are:
1. You do not have a venous ulcer. You have an arterial insufficiency ulcer.
2. Your vein doctor did not treat all of your vein disease.
Contrary to myth, treating just your saphenous veins and leaving everything else does not fix your vein issues. To properly and effectively eliminate a venous ulcer permanently, the doctor needs to address the entire vein structure in your leg that is abnormal. By addressing all aspects of your disease, your ulcer should heal and never recur.
Be sure you have had a recent high quality venous duplex ultrasound exam for venous insufficiency and to rule out obstruction of veins in the legs AND pelvic/abdominal veins. Re-evaluation of compression is important. Sometimes a different compression stocking or use of the Circaid or Juxtalite device will make a difference.
Significant foot pain upon standing suggests plantar fasciitis as your diagnosis. I would suggest seeking advice from a podiatrist to determine the source of discomfort. In many instances, a silicone heel cup is all that is needed to resolve this condition. As for your ulceration, I would seek additional help from a vein specialist. If you only had RFA, you may have residual varices that, when treated, could help to close your ulcer, and certainly reduce your risk of ulcer recurrence. In summary, the foot pain is likely a foot problem, while the stasis ulcer should seek additional treatment from a full-time vein specialist. I sincerely hope this helps you find relief of both conditions.
It is quite possible the pain comes from insufficient perforator veins. You should have this checked and treated by your vein specialist.
I believe you may need a repeat ultrasound to make sure there are not other veins in the below knee segment which are leaking despite previous RFA. Usually RFA is limited to the mid leg to the groin region and the residual segment may leak significantly later on down the road. Certainly with persistent ulceration I would consider further ultrasound evaluation.
I am not sure that your foot pain is due to your veins. Are you diabetic and could this be a neuropathy? You need a full vascular evaluation of both your veins and arteries. You should see a vascular surgeon.