Varicose veins of the feet
Treatment of varicose veins of the feet has long been overlooked by angio-phlebologists and vascular surgeons.
Varicose veins frequently cause genuine cosmetic discomfort and can even be painful. Treatment of foot varicose veins is simple thanks to mini-invasive surgery using local tumescent anesthesia.
Foot varicose veins : causes and risks
For a long time, feet were a kind of “no-man’s land” for venous surgeons and remain so for most phlebologists.
The problems associated with foot varicose veins are in most cases cosmetic, but they can also be the source of superficial phlebitis or paraphlebitis, bleeding and marks on the skin.
The major complication is bleeding, as varicose veins of the feet are located where the pressure is greatest. A “venous rupture” of a varicose vein in the foot can lead to massive hemorrhaging that can not only involve serious quantities of blood but also appear upsetting. (“Puddles” of blood on the floor)
However, the hemorrhage can easily be temporarily stopped by performing a simple movement: the victim should lie on the floor and raise the leg at a right angle. The blood in the vein empties into the other veins in the leg and the hemorrhage stops.
A tourniquet should never be applied, as this will only aggravate the bleeding. It is better to apply a pressure dressing to the source of the bleeding, apply a bandage from the top of the leg to the start of the toes, and not to get up until medical help arrives.
This is a “genuine medical emergency”, where surgery on foot varicose veins must be performed without delay.
Apart from this special case, the indication is essentially cosmetic as feet are increasingly exposed to view, well-groomed and form a part of a person’s charm: nobody wants horrible varicose veins disfiguring the back of a well-groomed and pedicured foot. Foot varicose veins have long been overlooked because sclerosis can be dangerous due to the many perforating veins intersecting with deep veins, which are a possible source of phlebitis.
Foot varicose veins : operating techniques
Operating techniques for varicose veins of the legs have long overlooked the cosmetic aspect of the results.
Thanks to today’s “mini-invasive surgery” techniques using local tumescent anesthesia, it has become commonplace to remove varicose veins from the foot without running the risk of injuring any of the many nerve-endings on the top of the foot.
It is always important to perform a color Doppler ultrasound scan on the veins of the leg and foot in order to locate the sources feeding the veins of the foot.
For full mini-invasive surgery, it is essential that an angiologist draws up a pre-operative location map in advance.
Foot varicose veins : surgery
The operation for varicose veins of the feet is carried out under “surgical conditions” by a vascular surgeon specializing in varicose vein surgery.
Tumescent local anesthetic is put in place the length of the “location”.
1mm-long “micro-incisions” are performed using the point of the scalpel, and a small Muller hook (like a lace-makers’ hook) is used to pull out the varicose vein.
Surgery on varicose veins of the feet is performed with no bleeding; “Steristrips” are used on the “micro-incisions” and a special compression dressing is applied.
Furthermore, this surgery can be carried out at the same time as that for traditional varicose vein surgery on the legs providing two conditions are met:
- The varicose vein surgery on the legs must be performed under local tumescent anesthesia (indeed, with general anesthetic or epidural there is a significant risk of damaging the nerve endings in the feet).
- the varicose veins are not too numerous
If these conditions are not met, foot varicose veins surgery will be performed secondarily under a purely local anesthetic. Lastly, there are some cases of isolated varicose veins of the foot where there are none in the leg:
- Either because these have been treated beforehand (without treating the veins in the foot).
- Or because they are fed from an isolated “perforating” vein in the foot or in the instep.
This surgery is best performed by a vascular surgeon specializing in varicose vein surgery:
- The better able to treat the combined problem of varicose veins in the legs and feet at the same time.
- Following a Doppler ultrasound scan for location
- Using local tumescent anesthesia
- Using mini-invasive surgery
- Without hospitalization
Read on: Medical treatment of varicose veins
Traitement et operation des varices