Confusion abounds among disorders of nerves, arteries, and veins because terminology is cumbersome and complex.  To follow is a simplified introduction to the common peripheral disorders that afflict these lengthy structures that branch and ramify throughout our bodies.

A. Neuropathy is a nonspecific term that means disease of nerves.  Nerve diseases lead to disturbances of sensations and/or to weakness of muscles and are not usually caused by problems with blood supply or circulation.  Certain common examples are featured below: 

a) Mono-Neuropathy is the disease of one nerve.  A common example is the Carpal Tunnel Syndrome where the Median Nerve is trapped at the wrist leading to numbness and weakness of the hand on the side of the thumb, index and ring fingers.  It often wakes up one from sleep and is relieved by shaking the hand.  When it becomes severe and chronic, it may require injections or surgery to free the trapped Median Nerve.

b) Peripheral Neuropathy is disease of the ends of the long nerves that supply the edges of the body, or periphery.  A common example is Diabetic Neuropathy where, due to chronic high sugar, the nerve endings are progressively damaged.  Patients begin to feel numb in the feet and this numbness climbs up the legs and may also involve the hands and arms.  With the numbness come foot ulcers and joint deformities due to diminished position sensations.  The best treatment is preventive, which is to keep diabetes in good control at all times.  A deficiency of Vitamin B12 may cause a similar neuropathy and may worsen the diabetic neuropathy when it coexists with it.  Blood supply to the extremities is usually good.

c) Neurogenic Claudication means that the longer one walks, the more numb, more painful, and more weak one’s leg muscles become until one is forced to stop walking.  This condition is caused by entrapment of the nerves in the bony canals of the vertebral column after they emerge from the spinal cord.  These spinal bony canals can narrow down with time until they start to choke the emerging nerves.  Because this choking is made worse by walking, it causes the syndrome of neurogenic claudication, which reverses after one sits down and rests his legs a while.  Again, blood supply to the legs is usually good.

d) Neuralgia means nerve pain.  The causes are numerous but the common causes are few.  Trigeminal Neuralgia, for example, is face pain generated by the Trigeminal Nerve, which comes out of the brain and supplies the face with sensation.  The pain is sharp, electric, and comes in flashes if the face is touched or moved.  Post Zoster Neuralgia is the regional nerve pain that follows a shingles attack and may last for weeks, months, or years.

B. Arterial Insufficiency or poor blood supply is caused by clogged arteries.  The feet may become ischemic (lacking in oxygen), pale, cold, and pulseless.  Walking is limited by the diminished blood supply, which causes a syndrome known as Intermittent Claudication. 

a) Intermittent Claudication is similar to Neurogenic Claudication because the feet and leg muscles become painfully sore and weak the longer one walks until one is forced to stop and rest.  Here, unlike neuropathy, the nerves are intact but the blood supply and arterial pulses to the feet are impaired.

b) Angina Pectoris, or chest pain with exertion, is similar to Intermittent Claudication but here, the chest pain is central instead of peripheral and is caused by diminished blood supply to the heart muscle, which causes oxygen debt or ischemia.

c) Ischemic Ulceration of the feet is caused by poor blood supply, which causes the skin over pressure points to develop necrosis and gangrene.  The toes and feet may turn black and become mummified.  Amputations may be the only option unless the blood supply can be reestablished with surgical bypass or stenting.  Arterial pulses cannot be detected on examination of the feet.

C. Venous Insufficiency is caused by damaged veins.  The function of veins is to return blood from the body to the heart.  Blood is propelled by muscle movements and the blood flow is directed centrally by valves strategically placed inside the veins.  These valves always point toward the heart and direct the blood to flow only in that direction.  Blood is not allowed to regress or fall back as long as the venous valves are intact.  However, when the valves become damaged or when the veins become so dilated that they prevent the valves from locking, blood tends to flow backward toward the body and away form the heart.  This increased venous backflow pressure is called Venous Insufficiency.

a) Varicose Veins are the commonest cause of Venous Insufficiency to the legs.  The venous dilatation with its consequent valve dysfunction causes the feet and lower legs to swell by day when the legs are down.  This swelling tends to recede during sleep, when the legs are level with the body, and to re-accumulate by day when one is up and about.  When the Venous Insufficiency becomes severe, venous ulcers may develop on the calves, shins, or feet.  Below-knee support hose that limit venous dilatation can help stabilize the condition.  Arterial pulses are usually intact.

b) Post Phlebitis Venous Insufficiency occurs, as the name implies, after the leg veins are attacked by blood clots.  Blood clots destroy the vein valves, which protect the central blood flow.  The absence of valves promotes back flow of the blood, which leads to swelling and ulceration of legs and feet.  Below-knee support hose and blood thinners are the main treatments.  Arterial circulation and pulses are usually intact.

D. Foot Ulcers:  The distinction among foot ulcers requires clinical judgment.  Ischemic Ulcers caused by lack of arterial blood supply are associated with cold, pulseless feet.  Venous Insufficiency Ulcers are associated with bad veins, which cause the legs to swell in spite of good arterial pulses.  Neuropathic Ulcers are associated with severely diminished or totally absent feet sensations.  Pressure Ulcers or bedsores are caused by prolonged bed stays that apply sustained pressure to certain bed contact zones, causing necrosis in spite of good arteries, veins, and nerves.  The treatment is to reverse the process with frequent position changes.

E. Leg Edema:  Leg and foot swelling has many causes, the most important being bad veins.  Other common causes are high blood pressure, certain medications, heart failure, obesity, excessive salt intake, liver and kidney diseases, and prolonged car and airplane rides.