Why circulation matters for healing
Blood carries the oxygen, nutrients and infection-fighting cells that skin needs to repair itself. It also carries waste and extra fluid away. When flow in either direction is impaired, the skin of the lower legs and feet suffers first, because it is farthest from the heart.
That is why circulation problems and leg wounds so often appear together. A leg or foot wound that is slow to heal should prompt a question about blood flow.
Two kinds of circulation problems
Arteries bring blood down to the legs. Veins carry it back up. Trouble in each causes a different kind of wound.
Artery problems. Narrowed arteries, often called peripheral artery disease, reduce the supply reaching the feet. Wounds tend to appear on the toes, heels or outer ankle, may look pale or dry, and are often painful.
Vein problems. When valves in the leg veins weaken, blood pools in the lower legs. Pressure builds, the legs swell, and the skin near the inner ankle darkens, hardens and can break down into a shallow, wet ulcer.
Many people have some of both, and that combination changes treatment. Our guide to venous and arterial ulcers compares the two, and the page on arterial and mixed wounds describes how care differs.
Signs to mention to your clinician
Bring these up at a primary care or wound visit:
- Cramping or aching in the calves when walking that eases with rest
- Feet that are cold, pale, bluish or shiny
- Pain in the feet or toes at night that improves when the legs hang down
- Swelling in the lower legs that is worse by evening
- Any sore on the leg or foot that has not improved in two weeks
Tests a clinician may order
The clinician begins with an exam: feeling pulses, checking skin temperature and color, and looking at swelling. If more information is needed, common tests include:
- Ankle-brachial index. Blood pressure at the ankle is compared with blood pressure in the arm to estimate how well blood reaches the feet.
- Arterial duplex ultrasound. Sound waves show blood moving through the arteries and where it narrows.
- Venous ultrasound. This looks for vein valves that leak and for blood clots.
These tests are not invasive. The guide on circulation tests before compression explains why they often come before compression wraps are ordered.
How primary care fits in
The conditions that damage blood vessels are primary care conditions: diabetes, high blood pressure, high cholesterol, kidney disease and smoking. Managing them does not unblock an artery. It protects the vessels you have and lowers the risk of heart attack and stroke, which runs higher in people with artery disease in the legs.
A primary care clinician also reviews medications, decides when a vascular specialist should be involved, and supports quitting tobacco. Our guide on smoking and wound healing explains that connection.
What Gateway coordinates
Your treating clinician decides which tests are needed and reviews the results. Gateway coordinates the steps around the order:
- Scheduling the test, at home or in a facility when a portable study is available, or at an outpatient site
- Making transportation arrangements when the test requires travel
- Getting results back to the ordering clinician and the rest of the care team
- Handling vascular and specialist referral coordination when the clinician refers you on
- Keeping your primary care physician informed, or helping you connect with a practice if you have none
Our page on lab and imaging coordination covers other tests, and limb preservation covers wounds that put a foot or leg at risk.
When to seek urgent help
Some circulation changes cannot wait for a scheduled visit. Call your clinician right away about a wound with spreading redness, a toe or patch of skin turning dark or black, or pain at rest that is getting worse.
Call 911 or go to an emergency room for:
- A leg or foot that suddenly becomes cold, pale, numb or very painful
- Sudden swelling, pain and warmth in one leg, especially with chest pain or shortness of breath
- Bleeding that does not stop with firm pressure
- Fever with confusion, or a rapidly spreading area of red, hot skin
Gateway is not an emergency service.
How to start
Call 314-325-0126 or send the request care form with a name and phone number only. Patients and families in Greater St. Louis and the Metro East can call without a referral.
Tell us about the wound, where you live and which clinicians you already see.
Common questions
How do I know whether my leg wound is from poor circulation?
You cannot tell for certain by looking. Location, appearance, pain pattern and swelling give clues, but an exam and often a blood flow test are needed. If a wound has not improved in a couple of weeks, ask your clinician whether circulation has been checked.
Why would a clinician check blood flow before ordering compression?
Compression squeezes the leg to move fluid out, which helps wounds caused by vein problems. If the arteries are also narrowed, that squeeze can reduce an already limited blood supply. Checking pulses, and often measuring an ankle-brachial index, tells the clinician whether compression is safe and how firm it can be.
Can circulation tests be done at home?
Some can. Portable equipment allows certain blood flow measurements and ultrasound studies to be done in a home or facility, depending on what the clinician orders and which services are available at your location. Other tests require an outpatient site. Gateway checks the options once the order is written.
Does poor circulation mean I will lose my leg?
Most people with circulation problems do not lose a limb. The risk rises when a wound, an infection and poor blood flow occur together and go untreated, which is why early assessment matters. Vascular specialists have ways to improve blood flow for many patients. Ask your clinician what your test results mean for you.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.