It takes a while for blood to travel from the heart down to the toes. Chronic ischemia is the process where the gradual onset of ischemic changes has allowed the body to change to compensate for decreased blood supply. The vascular bed survives with less blood. This leads to slow growth of skin, nails, hair follicles, and sebaceous glands. Visually this results in dry, thin skin with loss of hair, especially seen on the dorsal aspect of the foot.
Determine if the patient has:
(+) positive digital hair present – hair is seen on top of the toes, looks healthy, so the digits receive good blood flow. No current concern for ischemic changes.
(-) negative digital hair present – no hair present, skin is cold, so poor blood flow to the toes is seen. We are worried that any small trauma or cut will NOT allow the injury at the toe/ foot level to heal. This can lead to non-healing, later infection, and ultimately an amputation.