White in September? If It's a Sock, It's About Peripheral Artery Disease

Normally, when the calendar turns to September it would be time to pack away the white clothing for the season. But if you see doctors on social media wearing a single white sock this month, there’s a good reason: they are raising awareness about peripheral artery disease (PAD).

PAD is caused by atherosclerosis, or cholesterol buildup in the arteries. Clogged arteries limit blood flow to the legs, and can increase the risk of heart attack, stroke, or amputation. PAD affects 8 to 12 million Americans, including 1 in 20 people over age 50, according to the National Institutes of Health.

Yet Desmond Bell, DPM, CWS, a Jacksonville, Florida, wound care specialist and founder and president of the Save a Leg, Save a Life Foundation, said there’s not enough awareness for a condition that has such severe consequences, especially if amputations occur.

Bell is among the physicians who will spend September raising awareness about PAD through the White Sock Campaign, which asks physicians and others to post photos on social media as they wear a single white sock.

The idea behind Save a Leg, Save a Life’s White Sock Campaign is simple: “A white sock on one leg sticks out. You notice it,” Bell said. If clinicians—or others concerned about PAD—share photos with a white sock and the hashtags #WhiteSockCampaign or #DocsInSocks on social media, awareness of PAD will spread.

Bell said not only can PAD result in amputation, but few people realize that the long-term mortality rates after non-traumatic lower-limb amputation are extremely high. A 2016 study published in Prosthetics and Orthotics International found the 3-year rate was 33%, and higher among those who had diabetes. The complications of PAD can be so costly that Medicare now pays for supervised exercise therapy for patients with the condition, to keep the disease from progressing.

At first, the nation’s aging population might seem to be the looming problem with PAD, but Bell said that’s not the whole story.

“The patients I’m seeing are getting younger,” he said, and wound specialists Bell speaks with are seeing the same thing. This suggests rising rates of diabetes and obesity are playing themselves out in clinics like his. He doesn’t see the problems with amputation and mortality aren’t limited to one socioeconomic group, something observed in the 2016 study as well.

All patients at risk need to make changes in their diet, get more exercise, and follow medication regimens to prevent blood clots. If they smoke, they need to quit—smoking increases the risk of PAD 4-fold, according to NIH.

It’s essential that patients with risk factors learn the signs of PAD, so they can be treated right away and avoid amputation. Lower-leg pain shouldn’t be dismissed, or put off to the next appointment. First, clinicians should warn patients about the risk factors for PAD:

• Having diabetes
• Being over age 50
• Smoking or being a former smoker
• Having high cholesterol
• Having a personal history of vascular disease
• Being African American

Second, knowing the symptoms of PAD is essential so patients can see their physician at the first sign of trouble:

• Claudication: fatigue, heaviness, cramping in the legs, thighs, buttocks, or calves; pain goes away once activity stops, but activity is essential to prevent long-term problems.
• Pain the legs that disturbs sleep
• Sores or wounds on legs, toes, or feet that will not heal
• Color changes in the skin on the feet, including blueness
• Lower temperature in one leg than the other
• Poor nail growth or decreased hair growth on the toes and legs

For Save a Leg, Save a Life, visit thesalsal.org.