Which Medical Specialty Should I Consult for My Leg Symptoms?

Which specialty should I see?

Hello doctor, I noticed two swollen veins on the inner sides of both my feet yesterday, and they are painful when pressed.
A few days ago, a prominent vein appeared on the top of my left foot (extending to my left big toe), which sometimes feels numb and painful, and occasionally feels swollen.
Today, the area where the vein on my right foot is located has been painful all day; although the swelling has decreased, the vein is still visible.
My feet have been frequently numb lately.
The appearance of swollen veins and pain occurs after exercise.
I also have other symptoms, such as low blood pressure (the highest is around 80-98, with a pulse pressure often less than 30-50), and my muscles throughout my body frequently twitch, including in my arms, soles, thighs, calves, palms, and the outer or inner sides of my feet.
Recently, both of my big toes often feel numb, a specific area on my back feels numb, and sometimes the left side of my head feels like cold liquid is flowing through it.
My fingers occasionally tremble as if they lack strength.
Last night, I elevated my legs to promote blood flow, but it made sleeping uncomfortable, and I felt a sensation of difficulty breathing.
The left side of my chin and head felt numb for a moment, and I felt something pulsating inside my body, matching my heartbeat.
Both my toes and the soles of my feet also have a slight numbness, and the left side of my chest and sternum feels very uncomfortable.
Additionally, half of the nail on my left big toe has turned a light black color.
Last week, I mentioned my headaches to a neurologist, who suggested it might be due to poor peripheral circulation.
In April, I underwent several tests, including blood tests, EEG, CT, and MRI of the brain, all of which were normal.
The only issue found was in my cervical spine X-ray, where the curvature of my cervical spine has straightened (C1-C3).
I visited a cardiologist who noted a heart murmur and mild arrhythmia caused by mitral valve prolapse.
I have been scheduled for a portable ECG and echocardiogram, and the neurologist has scheduled a neck ultrasound, which I have not yet completed.
I would like to ask which specialty I should consult for the symptoms mentioned above (primarily the swollen veins, foot numbness, and nail discoloration)? Should I see a family physician, dermatologist, or another specialist? Thank you.

Miss Wang, 20~29 year old female. Ask Date: 2018/05/29

Dr. Chen Bozhang reply Family Medicine

Dear Ms.
Wang,
In your letter, you mentioned that the veins on the dorsum of your foot often hurt and feel numb, and that your left big toe experiences numbness and even has a blackened nail.
Additionally, you have some systemic symptoms such as low blood pressure, unusual sensations in your head, and a pulsating feeling within your body.
The symptoms you described in your feet are more indicative of vascular issues, which could involve both arteries and veins.
The blackening of the toenail suggests possible arterial circulation impairment, while the pain and numbness in the veins may be related to venous inflammation.
However, we cannot rule out systemic diseases, such as autoimmune vasculitis or issues related to the endocrine system or electrolyte imbalances.

I recommend that you first consult a vascular surgeon to assess whether there are any diseases affecting the arteries and veins in your lower limbs.
If the vascular surgeon finds everything to be normal, you may then seek a referral to other relevant specialists for further evaluation.
Sincerely,
Dr.
Chen Po-Chang
Department of Family Medicine
Keelung Hospital, Ministry of Health and Welfare

Reply Date: 2018/05/29

More Info

Based on your symptoms and medical history, it seems you are experiencing a complex set of issues that may involve multiple medical specialties. Given the presence of prominent veins (varicosities), pain, numbness, and changes in your nails, I would recommend consulting with a few specific specialists to get a comprehensive evaluation.

1. Vascular Specialist (Phlebologist): Since you mentioned the appearance of bulging veins and pain in your legs, a vascular specialist would be the most appropriate first point of contact. They can assess for conditions such as chronic venous insufficiency or varicose veins, which could explain the symptoms you are experiencing. They may perform an ultrasound to evaluate blood flow and check for any underlying venous abnormalities.

2. Neurologist: Given your symptoms of numbness, tingling, and the sensation of coldness in your extremities, it would be prudent to follow up with a neurologist. They can evaluate for peripheral neuropathy or other neurological conditions that may be contributing to your symptoms. Since you have already had some neurological evaluations, it may be beneficial to discuss your ongoing symptoms and any new developments with them.

3. Cardiologist: Since you have a history of heart murmurs and mitral valve prolapse, it would be wise to continue monitoring your cardiovascular health. The symptoms of feeling faint or having low blood pressure could be related to your heart condition. A cardiologist can provide further insight into whether your heart condition is contributing to your symptoms.

4. Primary Care Physician (Family Medicine): Your primary care physician can help coordinate care among these specialists. They can also evaluate your overall health, manage any medications you may be taking, and address any other health concerns you might have. They can also help interpret the results of your previous tests and guide you on the next steps.

5. Physical Therapist: If your symptoms are related to muscle spasms and discomfort, a physical therapist may help with exercises to improve circulation and reduce muscle tension. They can also provide guidance on safe exercises that can help alleviate some of the discomfort you are experiencing.

Additional Considerations:
- Blood Circulation: The symptoms of numbness and tingling, especially in the context of your neck issues, could suggest that there may be some vascular or neurological compromise. The straightening of your cervical spine could potentially affect blood flow to your brain and upper extremities, leading to symptoms like those you described.

- Lifestyle Factors: Consider discussing lifestyle factors that may contribute to your symptoms, such as hydration, nutrition, and physical activity. Sometimes, changes in these areas can significantly impact symptoms related to circulation and nerve function.

- Monitoring Symptoms: Keep a detailed log of your symptoms, including when they occur, their severity, and any potential triggers. This information can be invaluable for your healthcare providers in diagnosing and treating your condition.

In conclusion, I recommend starting with a vascular specialist to address your immediate concerns regarding the bulging veins and pain in your legs. From there, you can follow up with a neurologist and a cardiologist as needed. Your primary care physician can help coordinate this care and ensure that all aspects of your health are being addressed.

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