The pain is usually noticed at night, when the patient rests in bed. Here, the cardiac output is low, and the skin vessels are dilated, in response to the warmth. Relief is usually obtained by making the leg dependent, by hanging the leg over the side of the bed, or by sleeping in a chair. The patient may need to walk around. Elevating the leg makes the pain worse.
Buerger's test is positive; it may take several minutes for the colour to return to the foot.
Other features of chronic lower limb arterial insufficiency are usually present e.g. ulceration, gangrene.
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