If your feet, ankles or legs feel sore, heavy or crampy, poor circulation could be part of the problem. The good news is that some of the best fixes are simple things you can start today, and one of them outperformed both medication and stenting in a clinical trial.
In this episode of Talking With Docs, Dr. Brad Weening and Dr. Paul Zalzal count down seven evidence-based ways to improve circulation in your lower legs, explain the difference between artery and vein problems, and look at whether some of the popular gadgets out there actually work.
Circulation in your legs depends on two systems. Your arteries carry blood down from your heart, and when they narrow, your muscles can't get enough oxygen while you walk. Your veins carry blood back up, and they rely on your calf muscles to squeeze it home. When either system struggles, you can end up with aching, cramping, fatigue and heavy legs.
Two doctors discuss evidence-based methods to improve lower extremity circulation, addressing both arterial and venous issues. They emphasize the importance of muscle engagement—specifically the calf muscles—to pump blood back to the heart and the superior effectiveness of walking over medication or surgery for improving walking tolerance.
Looking for ways to improve your leg circulation because you've got sore feet, ankles, legs?
Always.
Welcome to Talking with Docs.
I'm Dr. Braden.
I'm Dr. Paul Zalzal.
This is a common problem.
Yeah.
This is a common problem.
Circulation.
My circulation.
It's my circulation.
I've got poor circulation, which can cause a lot of issues, a lot of symptoms, cramping,
aching, fatigue.
Right.
And we're not talking about people that have wounds that are not healing because that's
a whole separate issue.
You need to see your doctor for that.
We're talking about issues with two different sets of systems.
So, your arteries carry away, blood carry away from your heart.
That's remembered.
Down to your feet.
Yes.
And then your veins.
Yeah.
They carry it back to your heart.
There's no way to remember that one.
They bring it back to your heart.
They should call them veins.
Veins.
Way back to the heart.
Yeah.
So, they cause different problems.
Yeah.
But a lot of this is the pooling in your lower leg.
Yes.
They feel heavy.
Yeah.
And when you don't have enough blood supply, you get some of a claudication.
So, when you walk, your muscles are like, hey, give me more oxygen.
Yeah.
And they get sore.
So, you have to stop.
Rest.
Get better.
Start walking again.
Whereas, most of your veins, the blood is pushed back to your heart, really by the
muscles that surround the veins because they have one-way valves.
So, using and engaging those calf muscles squirts it back up.
So, as the veins fail, that blood can pool if your calf muscles are weak, if you don't
do stuff that makes them heavy, makes them feel heavy and difficult to walk.
Did we ever make some in-depth videos about veins and venous stasis?
And PAD or peripheral artery disease.
We sure did.
Okay.
But now, we're just going to give you seven quick and easy ways that you can improve the
circulation in your lower extremity.
It's kind of evidence-based.
Yeah.
And we looked at whether or not some things that are out there and told you to do actually
work.
Okay.
And first, before we even get into the seven ways, we're assuming that you quit smoking
to help this problem because smoking really does affect the microvasculature.
Yes.
If you quit smoking, you've got your lipids in order, right?
Yeah.
And your diabetes.
Yeah.
And then those kind of things that you need to control, but just on average, generally
people out there are sure quitting smoking has like a zillion benefits and they come
very quickly.
So definitely we recognize it's hard to get help.
There's so many benefits.
I almost feel like starting to smoke just so I can quit to get all those benefits.
All right.
That's ridiculous.
Okay.
You're going to go grab a cigarette after this so I can quit.
So number seven on the list is electrical stimulation type devices and we're not sponsored,
but the one that's most common is, is the Dr. Ho type devices.
And so these are actual electrical stimulation.
So it causes the muscle to contract.
This is different than a TENS machine that does not actually cause the muscle to contract.
It's also different than a vibration plate.
So there's no evidence for the latter two, but for those muscle stimulators, there is
some evidence that this can improve your circulation a little bit.
Okay.
And for those of you that wish to be a little more active than just using a stimulating
device, those little exercise things that fit under the table, I think one's called
a QB or something like that.
Again, not sponsored.
We should have looked into the sponsorship of all these devices.
We need to get sponsors.
Yeah.
So you, uh, we're not supposed to get sponsors.
That's the whole point of our channel.
So you, you have these little exercise devices that fit under the table kind of thing.
You're doing them while you're doing your work or whatever.
Yeah.
And that, and that one specifically gets you to plantar flex or push your foot down and
then dorsiflex, which causes your calf muscles to squeeze against those veins.
And that's what's helping the blood come back to your heart from those veins.
Right.
Number five is ankle range of motion exercise.
So you can imagine if you have really stiff, rigid, sore ankles because of arthritis or
maybe an injury or whatever, if they get stiff, your ability to move your ankle up and down
and engage those muscles is going to be reduced.
So if you can maintain or improve your mobility, that will secondarily improve your ability
to use your calves and that will move that fluid back.
And these are mostly related to the venous side of things.
Getting that blood pump out of your lower body, up to your heart.
And the next one along those lines, I think about number four now is calf strengthening.
Okay.
So strengthen your calf muscles.
Obviously if your calf muscles act like a pump, if you strengthen those, it'll do better.
Now this doesn't include the calf implants that you have, Brad, this has to be a strengthening
exercise.
They look real.
They don't count.
But there is good data to show that if you can strengthen your calf muscles, they will
be effectively be able to move more blood and you don't have to use weights.
You don't have to have any dumbbells.
You can, but even just bodyweight exercise, if you feel like it's getting too easy, you
can even go to one legged calf raises and not have to have any weight.
There's some that can be done easily on your own.
Make sure that your balance is okay.
Sometimes holding a handrail or something to that, but calf raises can make a big difference
and you can get relatively quick improvement in a short period of time.
I do these when I'm standing in a line or something, I just start doing, Oh, you're
that guy.
Yeah.
I make it look like I'm trying to look over everyone's head.
Yeah.
I look up again.
Nice.
The third one is on the same vein.
No pun intended.
Um, ankle pump.
So even when you're sitting in a chair, you're like, listen, I'm sore.
I can't really do some of these things, but if you're sitting in a chair and your feet
are flat on the ground and you go up onto your toes, you can feel your calf muscles,
both your gastrocnemius and your soleus muscles engaged and that will help pump fluid back
to your heart.
Okay.
Uh, and the next one for me, number two would be, don't sit too long.
Okay.
Like our society.
Yeah.
I mean, like for example, making a YouTube video and just sitting there and not doing
anything.
Right.
Like, uh, yeah, don't do that for too long.
You want to get up and move around because sitting for too long makes the blood pool.
Yeah.
Even if you're on a plane, right.
You got to get up, walk around a few times, as long as there's not turbulence and you
don't fall.
But yeah, it's common sense.
Get up, walk around.
Don't sit too long.
We've actually talked to you about how these little exercise snacks, even one or two minutes
every hour while you're at work can really alter your metabolism.
Yes.
So just engaging those muscles and kind of waking it up rather than going into that super
rest slash hibernation kind of mode.
Yeah.
Especially if you work from home.
Right.
And lots of people do or work in the office and they're sitting at a desk a long time.
And you think, well, I'm really locked in.
Yeah.
I'm not going to do it.
I'm just going to eat while I'm sitting here doing my work.
A lot of people do that.
But if you can really incorporate a bit of a break in there to get up and move around,
that's going to help your circulation.
Those people would have been good for the non-exercise pre-teen group in that study
that we're doing.
Your lean muscle mass would go up, but your circulation would not.
Okay.
The last one.
This is the reason that you're here.
And this is the thing that every single person that has circulation problems should be doing
if they're watching right now.
And this is why.
So there is very good, robust, diverse evidence that shows walking drastically improves your
circulation.
So on the venous side, yes, walking, you engage your calf muscles.
This works to lift back your heart.
But on the arterial side, this is where it's really interesting.
So say you smoke for a long time, unfortunately, your vessels fill with plaque, the combination
of inflammation and cholesterol and the smoking toxins lead to plaques.
So your vessels get smaller, it gets harder for your heart to pump blood down to your
legs.
What happens then when you walk, you get something called claudication.
So your muscles are working at a fixed rate, but they cannot get enough oxygen out of the
reduced blood supply.
And this is what causes the pain.
This is called claudication.
They did a study.
It was called the Clever Study.
I love studies that have clever names.
Yeah, that's a clever name.
So the Clever Study, where they actually had three treatment groups, 111 patients, where
they had supervised exercise.
They had stenting, where literally you had, you know, you had a stent on the back of your
where they went into where your vessels were a little bit blocked, put a little cage in
there to prop it open to increase the blood supply to your feet.
So that was group two was the stent group, and then the third group was medical therapy
alone.
So a combination of medications to increase the blood supply to your feet.
What they did is they tested them all before.
They all had a walking tolerance of about five minutes.
What this means is that you walk for five minutes, then your legs get sore enough that
you have to stop.
This is kind of a classic symptom of an arterial claudication type problem.
You stop and all of your pain goes away.
Totally.
Shortly within like seconds to minutes.
Right.
And then you walk again.
And then that same fixed distance, because your body cannot get enough oxygen.
So what they did is they trained these people in these three groups.
So exercise, stenting, medication, and then retest them to see if they could walk.
So average walking tolerance is about five minutes.
So after medical therapy alone, it went up 1.2 minutes, right?
So it increased by about 25%.
Not bad.
25%, not bad.
I'll take it.
This is over a period of 12 weeks.
Then you have the stenting group.
So this is a little more invasive, carries some associated risks of stenting, but it
makes sense, right?
You got a blocked pipe, you know, all plumber, open up the pipe, things just start moving
better.
These increased by 3.7 minutes or 70%.
I'll take that.
Better than the medical group.
Right.
Has some risks, but better benefit.
And then the exercise alone group, they increased their walking tolerance for five minutes to
10.8 minutes.
So by 5.8 minutes or 125%.
So I'm telling you that instead of taking pills, which everybody's like, or, oh, you're
surgeons, you want to do surgery, you want to make money out of your procedures, blah,
blah, blah.
Got a hammer.
Everything's a nail.
Exercise alone, outperform both of them, like significantly, 125% improvement, winner, winner,
chicken dinner.
So if you have sore feet, just get out there and walk.
And at first it might be difficult.
So do a little bit and then do a little bit more or do multiple times of shorter distances.
Aerosmith and then Run DMC said it best.
Walk this way.
Do you know that that collaboration is probably, I would say in my humble opinion, almost solely
responsible for the popularity and the mainstream effect of, of hip hop.
I would agree with that.
They sort of just merged the two.
Right.
Brilliant.
And I remember back in the day when people watch videos, there was a wall or like Aerosmith
is on one side of the wall and Run DMC was on the other side of the wall and then eventually
kicked the wall down.
They did it together then.
Yeah.
Great sound.
And who knew they were visionaries because that's going to help your circulation.
Walk this way.
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way to deal with your sore legs or whether or not you're more of an Aerosmith fan or
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Or both.
Remember, you are in charge of your own health.
We'll see you next time.