Smoking and peripheral vascular disease. Podiatric medical update

Although there is strong evidence that cigarette smoking is perhaps the major risk factor associated with peripheral occlusive vascular disease, there still appears to be little indication that clinicians in podiatric medicine and patients recognize this. When smoking is combined with other risk factors such as diabetes mellitus, the probability of developing peripheral arterial disease is greatly increased. In addition, smoking appears to accelerate the natural history of the process of atherogenesis and thrombosis. Diabetic neuropathy seems to have a greater prevalence when the patient has a history of an increased number of pack years smoked. By eliminating smoking, patients can often receive considerable relief from intermittent claudication and other sequelae of occlusive vascular disease, including the avoidance of amputation of the lower extremity. Patient care routinely should include efforts to prevent individuals from smoking as well as advice to smokers to stop. Podiatrists need to become a more prominent source of information about the hazards of smoking and should freely share this knowledge with their patients.