The signs of vascular pathology are non-specific, as pain, trophic abnormalities and oedema can also be due to metabolic or neurological reason, among others.
The specific examination of arterial, venous and capillary abnormalities.
Acrosyndrome or capillary podalgia
This occurs after a period of exposure to heat or cold, and is accompanied by local cutaneous temperature and pain modifications.
Some medications such as beta blockers can increase the likelihood of its appearance.
- It is a good idea to avoid driving until the feet recover their temperature and the pain disappears.
Varicose veins in the lower limbs cause pain and develop along with trophic abnormalities, which get better when walking and worse with bipedestation and heat.
Pre-ulcer pain is intense and when it progresses is accompanied by trophic abnormalities. Sural phlebitis is associated with plantar pain.
- Drivers suffering from symptomatic varicose veins should increase the number of stops they make on long journeys, stretching their legs and elevating them if possible.
- Drivers with varicose veins should be more careful inside the vehicle not to knock themselves on the controls or pedals.
- The heating air jets should not be pointed at the feet.
- Light clothing should be worn for driving, that does not put pressure on the groin or thighs, which might interfere with blood circulation.
- Try to drive in the morning, when the legs are not tired from daily activity.
- If the heaviness and swelling of the legs is pronounced, this will make it difficult to move and the patient must not drive.
- In cases of phlebitis, while the erythema, pain and oedema persist throughout the affected vein, the patient must not drive.
- Ulcers, that because of their location or symptoms, interfere with the vehicle’s pedals mean that the patient must not drive.
- Drivers with infected ulcers, located in places where the body rests or for which rest with the foot elevated have been recommended, mean the patient must not drive until they are healed or the doctor has expressly permitted driving.
The difference between venous and lymphatic oedema can only be diagnosed at the beginning of the disease, as later on they become associated. Oedema can be of cardiac, renal, carential or hepatic origin, and is bilateral.
Oedema related to essential varicose disease is white, soft, quite painful and vespertine, and usually presents in the retromaleolar and submalleolar regions.
Cyclical idiopathic oedema appears periodically, improves on elevating the foot and gets worse when the car heating is switched on, when the patient sits in the car seat without moving his legs, and when he suffers from anxiety.
Postphlebitic oedema gets worse throughout the day, with increased sensitivity and harness, making the foot go blue because of perimalleolar venous dilatation, and worsening when driving for long periods, preventing the correct flexo-extension of the ankle in advanced cases.
Post phlebitis trophic disorders can lead to the appearance of ulcers.
Essential lymphoedema is white, firm and vespertine like the venous variety, but doesn’t hurt or cause cyanosis, and gets a little better at night. It is more common at the front of the foot, first in the toes and then the dorsal face.It usually begins insidiously in the foot, and later goes hard and sclerotic and quickly becomes permanent, not altering with postural changes.
There are some very serious cases that mean driving is impossible because the feet cannot be moved, and at the same time, the position of driving makes them worse.
- The heaviness produced by oedema makes driving uncomfortable.
- In advanced cases, oedema can limit movement of the legs and feet, interfering with driving as the driver cannot operate the pedals or does it slowly and with little precision.
- At the same time, the driving position makes oedema much worse, and this is why patients are warned not to drive for long periods in any case.
This is not often recognised as a foot problem, as it is not exposed as the hand.
The idiopathic version of Raynaud can produce acrosclerosis with digital, puntiform, pulpar gangrene of scant importance.
Protecting the feet from the cold with thermal footwear and micro fibre socks, as well as using vasodilating drugs such as nifepidine and prazosin are the most effective treatments for this illness.
- A driver with symptoms of Raynaud and decreased sensitivity shouldn’t drive with the air conditioning pointing at his feet.
- He should drive with both hands and feet protected from the cold.
- Patients on nifepidine therapy should be advised that their ability to react quickly may be affected, so they should take extra case when driving. The risk increases significantly if alcohol is taken simultaneously. This can also produce headaches, nausea, vertigo, a feeling of warmth, palpitations and leg oedemas.
- Patients on prazosin therapy should be made aware of the temporal risk of hypotension until the dose is adjusted definitively, which can interfere with driving. The most frequently reported side effect is slight dizziness.
This is a symmetrical bilateral functional vascular disorder that is observed in middle-aged men up to the age of 40, which produces urent pain and causes total incapacitation.
Cooling and elevating the feet causes the symptoms to improve, and acetylsalicylic acid can lead to spectacular improvements, which have diagnostic value.
- Driving is not to be undertaken while the symptoms persist.