Warning Sign of Artery Disease: Small Hole or Large Hole in Bottom of Foot


Artery disease is a broad term encompassing various conditions that affect the circulatory system, and is not the same as coronary artery disease. Artery disease often has subtle signs that can rapidly progress into serious medical emergencies, like heart attack and stroke. 

Diabetic foot ulcers are a common complication of diabetes that primarily affects the feet. They are open sores or wounds that can develop on the bottom of the foot or other areas, and they can range in size from small to large.

Diabetes can lead to nerve damage (neuropathy) and poor blood circulation in the feet, making them more susceptible to injuries and infections. Nerve damage can cause a loss of sensation, so a person with diabetes may not notice small injuries or pressure points, which can eventually turn into ulcers. Additionally, reduced blood flow impairs the body's ability to heal properly, leading to slower wound healing and an increased risk of infection.

Small holes can start as blisters, calluses, or minor cuts that break the skin. Without proper care and attention, these small openings can become infected and progress into larger, more serious ulcers.

A common, yet often overlooked symptom is a small hole in bottom of foot. This small hole (or large hole) in the bottom of your foot is often related to a condition called PAD – peripheral arterial disease

It is important to recognize this symptom as a clear indication of more serious health complications. 

Understanding Artery Disease

Artery diseases include a range of conditions affecting the circulatory system, causing the blood vessels to narrow, block, or weaken. The most common cause of these diseases is atherosclerosis, characterized by the buildup of fats, cholesterol, and other substances, known as plaque, inside the artery walls. 

This plaque can harden and narrow the arteries, limiting the flow of oxygen-rich blood to your organs and other body parts.

In extreme cases, a complete blockage of the artery can occur, leading to a critical lack of blood supply to tissues downstream of the blockage, a condition called ischemia. This ischemia can cause tissue death or necrosis, and in the case of the foot, can manifest as small or large holes or ulcers.

One form of artery disease, peripheral artery disease (PAD), primarily affects the arteries supplying blood to the legs. PAD can lead to non-healing wounds on the lower extremities, particularly the feet. A small or large hole in the bottom of the foot that fails to heal could be a significant warning sign of PAD. 

Reduced blood flow to the foot makes it difficult for these wounds to heal, leading to chronic sores or ulcers. These sores could deepen if left untreated, leading to severe complications like infection and even amputation.

Treatment for Artery Disease

The main goals of treating artery diseases are to manage symptoms, slow or stop the progression of the disease, lower the risk of complications such as heart attack and stroke, and improve overall quality of life. The treatment approach usually involves lifestyle modifications, medications, and in certain cases, surgical interventions.

Lifestyle changes are the first line of defense against artery diseases. 

This includes adopting a heart-healthy diet low in saturated fats and cholesterol, engaging in regular physical activity, quitting smoking, and managing underlying conditions contributing to artery disease, such as diabetes, high blood pressure, and high cholesterol.

Medication management is also essential in the treatment of artery diseases. Drugs may be used to control high blood pressure, lower cholesterol levels, prevent clot formation, or relieve symptoms. For instance, in the case of PAD, cilostazol or pentoxifylline might be prescribed to alleviate claudication symptoms (leg pain that occurs with walking).

In severe cases where lifestyle changes and medication management do not provide sufficient relief or when there is a high risk of complications, surgical intervention might be necessary. 

Procedures could include angioplasty, where a small balloon is inflated within the artery to help widen it, often accompanied by stent placement to keep the artery open. Alternatively, bypass surgery might be performed, creating a new route around the blocked or narrowed artery to restore blood flow.

Regardless of the treatment approach, early detection is crucial in managing artery diseases effectively. Therefore, recognizing warning signs like a small or large hole in the bottom of the foot that fails to heal is critical in diagnosis. 

When Should a Patient Visit a Vascular Surgeon?

A patient should consider visiting a vascular surgeon for a hole in the bottom of the foot when the wound is not healing or shows signs of infection, particularly if they have risk factors or symptoms related to poor blood circulation. Vascular surgeons specialize in treating conditions that affect the blood vessels and can play a crucial role in the management of foot wounds, especially when there are concerns about blood flow to the affected area.

Here are some indications that warrant a visit to a vascular surgeon for a hole in the bottom of the foot:

Lack of Healing -  If the hole or wound on the foot has not shown signs of improvement or healing despite proper wound care and treatment, it may indicate underlying circulation issues that require assessment.

Signs of Infection - Redness, warmth, swelling, increased pain, foul-smelling discharge, or fever may indicate that the wound has become infected. Infected wounds can be particularly concerning, especially if there are underlying vascular problems, as they can lead to serious complications.

Presence of Peripheral Artery Disease (PAD) - Patients with a history of peripheral artery disease, characterized by reduced blood flow to the legs and feet, may experience delayed wound healing or have an increased risk of non-healing wounds.

Peripheral Neuropathy -  Individuals with peripheral neuropathy (nerve damage) associated with conditions like diabetes may not have normal sensation in their feet, making them more susceptible to injuries and unaware of developing wounds.

Pain or Discomfort in the Leg or Foot -  Pain or cramping in the calf or foot, especially during walking (intermittent claudication), could indicate compromised blood flow that may affect wound healing.

History of Vascular Disease -  Patients with a history of vascular conditions, such as deep vein thrombosis (DVT) or previous vascular surgeries, should be vigilant about foot wounds and consider evaluation by a vascular surgeon if necessary.

Non-Healing Ulcers in Multiple Locations -  If a patient has experienced multiple non-healing ulcers on different areas of the foot, it could indicate an underlying vascular issue that requires further investigation.

It's crucial to seek medical attention promptly for any foot wounds that are not healing or appear infected, especially if you have diabetes or other risk factors for vascular disease. A vascular surgeon can assess the blood flow to the foot, identify any underlying issues, and develop a comprehensive treatment plan to promote proper wound healing and prevent complications.

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