Five Vascular Warning Signs You Should Not Ignore

Leg pain when walking, a swollen calf, a foot wound that will not heal and troublesome varicose veins can all warrant a vascular assessment. Sudden severe chest, back or abdominal pain is different: it may be an emergency and must not wait for a clinic appointment.

To close his September vascular awareness series, Dr Andrew Choong describes five patterns worth recognising. These symptoms do not prove a particular diagnosis. Knowing what to do next helps you seek the right care at the right time.

For sudden severe chest, back or abdominal pain, collapse, stroke symptoms or a suddenly cold, painful or weak limb, call 995 in Singapore or your local emergency number elsewhere. Do not wait for a WhatsApp reply or travel to Singapore for a planned consultation.

1. Leg Pain When Walking That Improves With Rest

Repeated aching, cramping or tightness in the calf, thigh or buttock during walking may be claudication. This can occur when peripheral arterial disease (PAD) limits blood flow to working muscles. The discomfort often settles when you stop, then returns when you walk again.

Similar symptoms can come from joints, nerves or muscles. An assessment helps distinguish these causes and considers smoking, diabetes, cholesterol, blood pressure and kidney disease. Stable walking symptoms usually allow a planned review. New pain at rest or a sudden change in the foot’s temperature, colour, sensation or strength needs more urgent attention.

Treatment is not automatically an operation. Risk-factor management, prescribed medicines and structured exercise are important. Angioplasty or stenting may be considered in selected patients after reviewing the symptoms, anatomy, alternatives and risks.

2. A Painful, Swollen Calf, Especially on One Side

A new swollen, painful or tender calf can be a sign of deep vein thrombosis (DVT), a clot in a deep vein. Other conditions can cause swelling too, and DVT cannot be confirmed or excluded from appearance alone.

Seek urgent medical assessment for a suspected DVT, rather than waiting for a routine appointment. Tell the clinician when symptoms began and about recent travel, surgery, reduced mobility, illness or previous clots. Clinical assessment and appropriate testing establish the diagnosis and guide DVT treatment.

New breathlessness, chest pain, coughing blood or fainting may indicate a pulmonary embolism. Seek emergency care immediately; call 995 in Singapore for these potentially life-threatening symptoms.

3. A Foot or Toe Wound That Is Not Healing

A persistent wound may involve more than the skin. Reduced arterial blood flow can limit healing, while pressure, infection and reduced sensation may also contribute. This is particularly important in people with diabetes or kidney disease.

Do not wait for a small wound to become painful or black before seeking help. Diabetic foot and wound assessment considers the circulation alongside infection and pressure on the foot. Fever, spreading redness, blackened tissue, rapidly worsening pain or feeling unwell needs urgent medical attention.

A dressing alone will not resolve every underlying problem. Treatment may combine wound care, pressure relief, infection management and, when needed, restoration of blood flow. The plan depends on the individual findings; no procedure guarantees wound healing.

4. Varicose Veins With Symptoms or Skin Changes

Varicose veins are not always cosmetic. Heaviness, aching, swelling, skin darkening, eczema or an ulcer can indicate clinically important venous disease. Chronic venous insufficiency can affect the skin around the lower leg and ankle.

A vascular review can check for reflux, where faulty vein valves allow blood to flow backwards. Duplex ultrasound helps guide treatment when appropriate. Depending on the findings, options may include measures to manage symptoms or a procedure such as radiofrequency or laser ablation.

Bleeding from a varicose vein needs immediate medical attention. Heavy or uncontrolled bleeding is an emergency: call 995 in Singapore. Do not dismiss an episode simply because it has stopped.

5. Sudden Severe Chest, Back or Abdominal Pain

Sudden severe or unusual pain in these areas can have several serious causes. Occasionally it signals an aortic emergency, such as dissection or a complication of an aneurysm. Pain may be described as tearing, but it does not have to feel that way to be dangerous.

Call emergency services immediately. A routine vascular booking is not the correct first step. If you have a known aneurysm, tell the emergency team. The aortic disease guide explains surveillance and treatment planning for people who are stable; it does not replace emergency assessment.

What to Bring to a Planned Vascular Review

Bring previous scan images and reports, a medication list, details of earlier procedures and a short history of the symptoms. Note what brings them on and how they affect walking or daily activities.

For non-emergency advice or a second opinion, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, Singapore. See how to prepare for your visit and watch the five vascular warning signs video.

World Heart Day: Heart Attack, Brain Attack, Leg Attack

World Heart Day is a reminder to look beyond the heart. The arteries supplying the brain, legs and feet can be affected by the same process of plaque build-up that contributes to heart disease. In this video, Dr Andrew Choong explains why leg symptoms can be an important warning about the wider circulation.

Possible heart attack, stroke or sudden loss of circulation to a limb requires emergency care. Call 995 in Singapore, or your local emergency number elsewhere. Do not wait for a clinic appointment or a WhatsApp reply.

Heart Attack, Brain Attack and Leg Attack: What Is the Connection?

Arteries carry oxygen-rich blood from the heart to the body. Atherosclerosis is the build-up of plaque within their walls. It can narrow an artery, and a clot can sometimes suddenly block blood flow. The effect depends on which part of the body loses its blood supply.

• Heart: a blocked coronary artery can cause a heart attack.

• Brain: a blocked artery can cause an ischaemic stroke, sometimes called a brain attack. Not every stroke is due to blockage; bleeding can also cause a stroke.

• Legs and feet: narrowed or blocked arteries can cause peripheral arterial disease (PAD). Severe loss of blood supply can threaten the foot or leg.

These connections do not mean that everyone with leg pain has heart disease or will have a stroke. They mean that confirmed PAD deserves attention to both the leg and overall cardiovascular risk. Carotid artery disease, affecting the neck arteries supplying the brain, is another part of this wider picture.

What Does “Leg Attack” Mean?

“Leg attack” is an awareness phrase rather than a precise diagnosis. In the video, it draws attention to a foot threatened by severely impaired circulation: pain at rest, a wound that does not heal, blackened toes or infection. The established term for longstanding severe arterial insufficiency of this kind is chronic limb-threatening ischaemia (CLTI).

This differs from acute limb ischaemia, where blood flow falls suddenly. A suddenly painful, cold or pale foot, particularly with new numbness or weakness, is an emergency. A longstanding problem can also deteriorate abruptly. Neither situation should be managed by waiting to see whether an exercise programme helps.

Persistent foot pain at rest, an ulcer or blackened tissue needs urgent assessment. Fever, spreading infection or rapidly worsening symptoms make immediate medical attention particularly important. Read about diabetic foot and wound care for the relationship between circulation, infection and healing.

Why the Same Risk Factors Matter

Dr Choong highlights smoking, diabetes, high blood pressure, high cholesterol, kidney disease, excess weight, inactivity and an unhealthy diet. These can affect more than one area of the arterial circulation.

Smoking and diabetes are particularly important in PAD. A person with diabetes may also have reduced sensation, so a serious foot problem may cause less pain than expected. High blood pressure is an important stroke risk factor. Managing these risks is relevant even when the symptom that first brings someone to the clinic is in the leg.

Care may include help to stop smoking, appropriate activity, foot care and prescribed treatment for blood pressure, cholesterol and diabetes. Medicines and exercise plans should be individualised; do not start or stop blood-thinning medicine on the basis of a video.

When Should Leg Symptoms Be Assessed?

Recurring calf, thigh or buttock discomfort during walking that improves after stopping can be claudication. It is worth assessing rather than assuming it is simply age or poor fitness. Joint, nerve and muscle conditions can cause similar symptoms, so the pattern alone does not establish PAD.

An assessment reviews the symptoms, risk factors, pulses and feet. Depending on the findings, ankle or toe pressure measurements and vascular ultrasound may help assess circulation. Further imaging is selected when it will guide care; not everyone needs every test.

Many patients with stable walking symptoms begin with medicines, risk-factor management and structured exercise. For selected patients with a threatened foot or continuing major limitations, leg angioplasty and stenting or bypass surgery may be discussed. The decision depends on the circulation, overall health, likely benefit and risks.

Act on Warning Signs; Plan Non-Emergency Care

Chest discomfort with breathlessness, sweating or collapse, or sudden facial weakness, arm weakness or speech difficulty, needs emergency assessment. Stroke symptoms that disappear still need urgent emergency evaluation.

For stable leg symptoms or a planned second opinion, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, Singapore. Bring previous scan images, reports and a medication list; the visit preparation guide can help. You can also watch the World Heart Day video or explore the short explanation of walking-related leg pain.

A Wound That Won’t Heal? Check Blood Flow First

A foot or leg wound that is slow to heal may need a blood-flow assessment, particularly if you have diabetes or known poor circulation. Dressings help protect a wound, but they cannot correct an arterial blockage. The important question is whether enough blood is reaching the tissue to support healing.

In this video, Dr Andrew Choong, vascular and endovascular surgeon in Singapore, explains why circulation should be considered alongside wound care, especially before major decisions such as amputation.

Why might a wound fail to heal?

Peripheral arterial disease (PAD) narrows or blocks the arteries supplying the legs. When blood supply is inadequate, a wound may remain open despite repeated dressings. Infection can add to the problem, and antibiotics may be needed when infection is present.

Not every slow-healing wound is caused by an arterial blockage. Assessment needs to establish the cause and address the wound itself as well as circulation. Recurrent wounds, increasing pain, black tissue or a wound in someone with diabetes deserve early attention.

What does a blood-flow assessment involve?

A vascular assessment starts with the history, examination of the wound and checking pulses. Depending on the findings, tests may include:

• A handheld Doppler to assess blood-flow signals.

• Ankle or toe pressure measurements to help assess circulation.

• Duplex ultrasound to map arterial narrowing and flow.

• CT angiography or other imaging when more anatomical detail is needed.

The tests answer different questions. Not everyone needs every scan; the investigation should help guide a useful treatment decision.

Can improving circulation help the wound?

For selected patients with threatened tissue from poor arterial supply, restoring blood flow can support healing and help preserve a functional limb. Options may include angioplasty and stenting or leg bypass surgery, depending on the anatomy, previous treatment and overall health.

A procedure does not guarantee healing or avoidance of amputation. Diabetic foot and wound care remains essential, and some people need a different treatment plan. Circulation assessment helps make that discussion better informed.

When should I seek urgent help?

Do not wait for a routine appointment if a foot suddenly becomes severely painful, cold, pale or numb, or develops new weakness. Seek emergency care; call 995 in Singapore. Worsening wound redness, discharge, fever or new pain at rest needs prompt clinical assessment.

Arrange an assessment in Singapore

For a planned review, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre. Bring previous scan reports, wound-treatment records and your medication list. You can also watch the blood-flow and wound-healing video or explore the leg circulation video collection.

Poor Leg Circulation?

If you have been told that you may have poor circulation in your legs, the first step is to understand the blood-flow problem. The important questions are how much circulation is affected, where the disease is, and whether the foot or leg is at risk.

In this video, I explain what I look for during a vascular assessment for suspected peripheral arterial disease, or PAD. A treatment decision follows that assessment; it is not determined by the phrase “poor circulation” alone.

What is peripheral arterial disease?

Peripheral arterial disease occurs when arteries supplying the legs become narrowed or blocked, commonly because plaque has built up in their walls. Reduced blood flow may limit the oxygen available to the muscles during walking or, in more severe disease, affect the tissues even at rest.

PAD is an arterial problem. Other conditions, including venous disease, nerve problems and joint disorders, can also cause leg symptoms. Establishing the cause matters because their treatments are different.

Which symptoms can suggest poor arterial circulation?

A familiar pattern is discomfort or cramping in the calf, thigh or buttock that starts with walking and eases when you stop. This is called intermittent claudication. Some people also notice coldness, numbness or wounds that are slow to heal.

Symptoms that deserve particular attention include:

• Walking pain that repeatedly limits the same everyday activities.

• Foot or toe pain at rest, especially when persistent or occurring at night.

• A wound or ulcer that is not healing.

• Dark or black tissue, or a new change in foot colour or temperature.

These features need clinical assessment; none should be diagnosed from an online description alone. Diabetes can alter sensation, so a threatened foot may not always be as painful as expected.

What will I ask during the consultation?

The history helps connect the symptoms to what the leg is doing. How far can you walk? Where does the pain occur? Does it settle with rest, and does it return when you start again? Has the walking distance changed? Are there wounds, night pain or symptoms in the other leg?

I also ask about diabetes, kidney disease, smoking, heart disease and previous arterial treatment. Earlier angioplasty, stents or bypass operations can affect both the investigation and the options available. Bring your medication list and previous scan or operation information if you have it.

How are the legs and blood flow examined?

I examine the legs and feet, checking pulses, skin colour, temperature, wounds and signs of infection. The aim is to establish the likely circulation problem and identify whether the foot needs urgent attention.

Tests may include an ankle–brachial pressure measurement, which compares blood pressure at the ankle and arm, and duplex ultrasound to assess blood flow. Diabetes or kidney disease can make ankle-pressure results misleadingly high, so a normal result may not exclude PAD; toe-pressure testing or further assessment may be needed. Other tests or CT angiography may be appropriate when more detailed information is needed, particularly when planning a procedure. The choice depends on the clinical question rather than ordering every available scan.

Does PAD always need angioplasty or surgery?

No. Many patients need a plan built around prescribed medication, management of cardiovascular risk factors and an appropriate structured exercise programme. Stopping smoking and controlling diabetes, blood pressure and cholesterol are important parts of care.

For selected patients, angioplasty, stenting or bypass surgery may improve circulation. A procedure may be considered for symptoms that remain substantially limiting despite suitable treatment, or when blood supply threatens wound healing or limb survival. I weigh the artery pattern, wound risk, expected benefit and overall health together.

The goal is more than opening a narrowed artery on a scan. It is to improve function, support healing when needed and reduce the risk of complications.

When is poor circulation an emergency?

A suddenly painful, cold, pale, numb or weak limb needs immediate emergency assessment. Seek urgent care rather than waiting for a routine appointment. A non-healing wound, black toe or persistent rest pain also needs prompt assessment; do not try to exercise through a threatened or infected foot.

Where can I arrange a circulation assessment in Singapore?

For non-emergency symptoms or review of known PAD, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. I will assess your symptoms, examination and blood-flow findings together to discuss a treatment plan suited to you.

What Is Linked to 11 Million Deaths a Year? Sepsis, Foot Wounds and Poor Circulation

Sepsis happens when the body's response to an infection begins to damage its own tissues and organs. It can become life-threatening quickly. In this World Sepsis Day video, I explain why a worsening foot wound deserves particular attention when someone has diabetes or poor circulation.

As a vascular surgeon in Singapore, I look at two linked questions: is the wound infected, and is enough blood reaching the foot for it to heal? Both matter when deciding how urgently someone needs care.

What does the figure of 11 million deaths mean?

The figure in my video reflects a major global estimate: approximately 48.9 million sepsis cases and 11 million sepsis-related deaths worldwide in 2017, reported in research published in 2020. These figures describe the scale of the problem; they are not a new count for 2026 or a prediction of what will happen to an individual patient.

Sepsis can arise from many infections. A foot wound is one possible source, particularly when infection spreads or a person's ability to fight infection and heal is impaired.

Why can a small foot wound become serious?

A small break in the skin can allow infection to develop. Diabetes, kidney disease and poor arterial circulation can complicate the situation. A history of smoking also matters because it increases the risk of vascular disease. The appearance of the wound alone does not tell the whole story.

When peripheral arterial disease reduces blood flow, the tissues may not receive enough oxygen and nutrients to support healing. Antibiotics and appropriate dressings may be necessary, but they do not automatically correct a circulation problem. Infection control and assessment of blood supply need to be considered together.

Can a diabetic foot infection be serious without much pain?

Yes. Diabetes can damage the nerves that normally warn us about an injury. A wound or infection may therefore hurt less than expected. Little pain is not reliable reassurance, especially if the foot looks different, the wound is worsening or the person feels unwell.

This is why I encourage patients and families to notice changes rather than wait for severe pain. A new wound, spreading redness, increasing swelling, discharge or a change in skin colour needs attention, even when walking remains possible.

Which warning signs need urgent help?

A foot wound needs prompt medical assessment if it develops pus, worsening redness or swelling, severe pain, black tissue or a rapid change in appearance. In someone with diabetes or known poor circulation, do not wait for a wound to become large before seeking help.

Possible sepsis is an emergency. Warning signs may include:

• New confusion, unusual drowsiness or sudden deterioration.

• Severe shivering, fever, or feeling markedly unwell.

• Breathlessness or unusually rapid breathing.

• Passing very little urine.

• Mottled, pale, blue or otherwise discoloured skin.

Not everyone has every sign. If someone with an infection becomes seriously unwell, seek emergency care immediately; in Singapore, call 995 when emergency ambulance help is needed. Do not wait for a routine clinic appointment.

How does a vascular assessment help?

I assess the wound alongside the person's symptoms, medical history, foot temperature, skin changes and pulses. When indicated, blood-flow tests or vascular ultrasound help establish whether narrowed or blocked arteries are contributing to poor healing. Further imaging depends on the findings and the treatment being considered.

The plan may involve infection treatment, wound care, pressure relief and management of diabetes and other risk factors. Some patients also need a procedure to improve circulation. The right sequence depends on the severity of infection, the blood supply and the person's overall health.

For more on ongoing care, read our diabetic foot and wound care guide. Suspected sepsis still needs immediate emergency assessment, as explained above.

Where can I discuss a foot wound or circulation concern in Singapore?

For a non-emergency vascular assessment, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. I can assess whether poor circulation is affecting healing and discuss an appropriate treatment plan.

This article accompanies my video for general patient education. A worsening wound needs an individual assessment, and suspected sepsis requires immediate emergency care.

Can Walking Improve Your Circulation???

Walking can support both arterial and venous circulation, but it helps them in different ways. For people with assessed, stable claudication, structured walking can improve walking ability. For venous symptoms, each step activates the calf muscles and helps move blood back towards the heart.

In this video, I explain these two benefits and the warning signs that should never simply be “walked off”. The right exercise plan depends on the cause of your symptoms, your overall health and whether it is safe for you to walk.

How can walking help arterial disease?

Claudication is cramping, aching or tightness in the calf, thigh or buttock that develops with activity and improves with rest. When it is caused by peripheral arterial disease (PAD), narrowed arteries cannot meet the muscles’ increased demand for oxygen during walking.

Regular training can improve fitness and how effectively the leg muscles use oxygen, helping some people walk further before symptoms limit them. This does not mean that a blocked artery has simply opened or that everyone will improve at the same rate.

Exercise is one part of PAD care. Smoking cessation, management of cholesterol, blood pressure and diabetes, and prescribed medicines also matter because PAD is linked to wider cardiovascular risk.

What is the walk–rest–repeat approach?

For suitable people with stable claudication, a structured programme often uses intervals of walking and rest. In the video, I describe this pattern:

1. Walk until the familiar discomfort becomes moderate. Use the level of effort agreed with your clinician.

2. Stop and rest until it settles. Allow the discomfort to ease before starting again.

3. Resume walking and repeat. Build consistency within an individual programme rather than force a particular distance.

A supervised or clinician-supported programme can help set a suitable pace and monitor progress. This approach is for an assessed condition; unexplained new pain should first be investigated. Severe pain, a sudden change or symptoms at rest should not be treated as a training target.

How does walking help the veins?

Leg veins return blood towards the heart. When your calf muscles contract, they squeeze the veins and help propel blood upwards. One-way valves support this flow and limit backward movement.

Walking therefore activates the calf muscle pump, unlike remaining still for long periods. It can help some people with venous heaviness, aching or swelling. If there is venous reflux or varicose veins, movement may be part of symptom management, but it does not repair faulty valves.

Compression may also be appropriate for selected patients. The type and pressure should be advised according to the venous problem, arterial circulation and other health conditions.

How can you make walking a sustainable habit?

Choose a route and pace that suit your mobility and balance. Comfortable, well-fitting footwear matters, particularly if you have diabetes or reduced sensation. Check your feet for rubbing, blisters or wounds rather than relying only on pain to alert you.

In Singapore’s heat, a cooler time of day or a sheltered route may make activity more comfortable. Build the routine around your circumstances and any medical advice, including fluid restrictions if you have them.

A simple note of your walking time, symptoms and recovery can help you and your clinician see whether the pattern is improving or changing. Walking can also support glucose control, heart health and general conditioning, although it does not replace prescribed treatment.

When should you stop and seek medical help?

Seek urgent assessment for new pain at rest, a non-healing wound, blackened toes or one-sided painful swelling. Swelling with warmth or tenderness may need investigation for DVT, not a longer walk.

Sudden severe leg pain with coldness, numbness or weakness requires emergency assessment. Chest pain, sudden breathlessness or collapse also need emergency care. In Singapore, call 995 for a life-threatening emergency rather than waiting for a routine appointment.

Assessment and Treatment Guides

For more on the next steps, see vascular duplex ultrasound assessment and leg angioplasty and stenting for selected patients. The appropriate next step depends on clinical assessment.

Planning safe walking with a vascular condition

If leg symptoms are limiting your daily activity, contact Andrew Choong Vascular Surgery to discuss assessment at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Understanding the cause helps us decide how walking fits into your care.

This article provides general education and does not replace an individual medical assessment.

What Is a Duplex Ultrasound? Vascular Surgeon Explains

Duplex ultrasound combines an image of a blood vessel with information about the blood flowing through it. Ultrasound provides the picture; Doppler assesses movement and flow. Together, they help us investigate problems affecting arteries and veins.

In this video, I explain why a duplex scan is frequently used for varicose veins, leg swelling, blocked arteries and possible blood clots. Understanding what the test measures can make a scan appointment less unfamiliar and help you understand the next steps in your care.

What does the ultrasound part show?

Ultrasound uses high-frequency sound waves. A probe sends these waves into the body and receives the echoes that return from tissues. The machine converts those echoes into an image.

For a vascular scan, this helps show the vessel and the structures around it. The person performing the scan can examine a particular area and take measurements relevant to the clinical question.

What does Doppler add?

Doppler uses changes in reflected sound waves to assess moving blood. It provides information about the direction and speed of flow, which can be displayed as colours or waveforms and sometimes heard as a sound.

This matters because a vessel’s appearance is only part of the story. I also need to understand whether blood is passing through effectively, whether flow is altered by narrowing, or whether it is moving backwards through a vein. Duplex brings the image and flow assessment together.

Which circulation problems can a duplex scan investigate?

• Varicose veins and venous reflux: identifying backward flow and mapping affected veins when assessing venous symptoms.

• Possible blood clots: examining the deep veins when deep vein thrombosis (DVT) is suspected.

• Narrowed or blocked arteries: assessing blood flow in people with symptoms that may relate to peripheral arterial disease.

• Treatment planning or follow-up: providing information that may guide a procedure or help assess circulation afterwards.

The scan is tailored to the reason for referral. An examination for venous reflux is not identical to an arterial scan or a scan for suspected DVT. Explaining your symptoms clearly helps ensure the assessment answers the relevant question.

What happens during the scan?

Usually, gel is applied to the skin and a handheld probe is moved over the area being examined. You may be asked to change position so the vessels can be assessed properly. The area needs to be accessible, so comfortable clothing can be helpful.

A standard external duplex scan is non-invasive and does not use ionising radiation. You may hear the machine’s blood-flow sounds during the examination. Let the sonographer know if an area is painful or if you have difficulty standing or changing position.

Preparation and appointment length depend on the vessels being examined. Follow the instructions supplied by the clinic rather than assuming every ultrasound appointment has the same requirements.

Does a scan result tell the whole story?

No single investigation replaces a clinical assessment. I interpret the findings alongside your symptoms, examination and medical history. Sometimes duplex provides the information needed; sometimes further tests or another form of imaging are appropriate.

Useful questions to ask include: What was the scan looking for? What did it show? Does the finding explain my symptoms? What should happen next? The aim is to connect the result to a clear care plan, rather than leave you with an unfamiliar technical term.

The vascular ultrasound guide explains different scan types, preparation, limitations and how results guide care.

Duplex ultrasound assessment in Singapore

As I explain in the video, our practice has its own vascular laboratory and a dedicated vascular sonographer who focuses on vascular scans. For advice about an assessment, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563.

New one-sided painful leg swelling needs urgent assessment; do not wait for a routine scan appointment. Sudden breathlessness, chest pain or collapse requires emergency care. Call 995 in Singapore for a life-threatening emergency.

This article provides general education and does not replace an individual medical assessment.

Why Do Some Foot and Leg Wounds Not Heal?

A foot or leg wound that is not healing may need more than a change of dressing. Wound healing depends on several things working together, including an adequate blood supply, controlled swelling, protection from pressure and appropriate management of infection and underlying health conditions.

In this video, I focus on two questions from a vascular perspective: is enough blood reaching the wound through the arteries, and are the veins draining effectively? These questions can help explain why a wound remains open despite regular care.

When is a wound considered chronic?

In the video, I describe a wound that persists beyond about four weeks as chronic. Definitions vary, and the important point is that a wound which is not progressing needs its underlying cause reviewed.

Four weeks is not a waiting period before seeking help. A new foot wound in someone with diabetes, a worsening wound or signs of infection deserves earlier assessment. Reduced sensation can make a significant wound surprisingly painless.

How can blocked arteries delay healing?

Arteries bring blood carrying oxygen and nutrients to the tissues. If they are narrowed or blocked, the wound may not receive enough blood to repair itself effectively. This is one reason peripheral arterial disease (PAD) matters in foot and leg wound care.

Some people also notice pain when walking, pain at rest or a foot that feels unusually cold. Others have fewer obvious symptoms, particularly if diabetes has affected their nerves. The wound’s appearance alone cannot establish whether the blood supply is adequate.

How can vein problems affect a wound?

Veins return blood from the legs towards the heart. When their one-way valves do not work properly, blood can flow backwards, a problem called venous reflux. Raised venous pressure and swelling can damage the surrounding skin and interfere with healing.

This is a different mechanism from arterial blockage. Someone with venous disease or varicose veins may also have ankle swelling, aching, brownish skin changes or a recurrent ulcer. Arterial and venous problems can occur together, so treatment should follow an assessment rather than an assumption.

What else can prevent a wound from healing?

Circulation is only part of the picture. Factors that may need attention include:

• Diabetes: including glucose control, nerve damage and infection risk.

• Pressure or repeated injury: for example, footwear rubbing the same area.

• Smoking and nutrition: both can affect the body’s ability to repair tissue.

• Medicines and other illnesses: these may influence healing and should be reviewed.

• Infection: which can worsen a wound and become more serious when blood supply is poor.

What does a vascular wound assessment involve?

I would ask how the wound started, how long it has been present and what care it has received. Examination includes the wound, surrounding skin, swelling and foot pulses. Your medical history and medicines help guide further investigation.

Tests may include ankle or toe pressure measurements and duplex ultrasound to assess arterial flow or venous reflux. Further imaging is selected according to the findings. Not every wound requires every test or a procedure.

A treatment plan may combine dressings, pressure relief, management of infection and diabetes, and treatment of a circulation problem where appropriate. Compression can help selected venous ulcers, but its suitability depends on the arterial blood supply. Avoid starting tight bandaging yourself.

The diabetic foot and vascular wound-care guide explains how circulation, infection treatment and pressure relief fit together.

Which changes need urgent attention?

Seek urgent medical help for spreading redness, increasing warmth or swelling, pus, worsening pain, fever or black tissue. A suddenly cold, painful, numb or weak foot needs emergency assessment. Do not wait for a routine clinic appointment if the problem is rapidly worsening; call 995 in Singapore for a life-threatening emergency.

Assessment for a non-healing wound in Singapore

For a wound that is slow to heal, contact Andrew Choong Vascular Surgery to discuss assessment at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Understanding the cause helps guide care beyond the dressing itself.

This article provides general education and does not replace an individual medical assessment.

Arteries vs Veins: What’s the Difference?

Arteries carry blood away from the heart, while veins return blood towards it. That simple distinction helps explain why different circulation problems can produce different patterns of leg pain, heaviness and swelling. Both types of vessel matter, but an arterial problem and a venous problem do not necessarily need the same investigation or treatment.

What do arteries and veins actually do?

Think of arteries as the outward route from the heart and veins as the return route. In the body’s main circulation, arteries deliver oxygen-rich blood to tissues and veins bring blood back after oxygen has been used. The circulation through the lungs is the important exception: pulmonary arteries carry oxygen-poor blood to the lungs, and pulmonary veins return oxygen-rich blood to the heart.

The most reliable definition is therefore the direction of travel, rather than how much oxygen the blood contains. Tiny vessels called capillaries connect the two sides and allow exchange between the blood and surrounding tissues.

Why are the vessel walls different?

Arteries have relatively thick, muscular walls suited to carrying blood under pressure from the heart. Veins operate at lower pressures and have more flexible walls. Many veins in the limbs contain valves that help direct blood towards the heart.

In the legs, returning blood upwards also depends on movement. Contracting muscles help squeeze the veins, while functioning valves limit backward flow. This is why the way symptoms change with walking, standing and rest can provide useful clues during an assessment.

What does an arterial circulation problem feel like?

When leg arteries become narrowed or blocked, the muscles may not receive enough blood for activity. One possible symptom is claudication: an aching or cramping discomfort brought on by walking, often in the calves, thighs or buttocks. It typically eases after stopping to rest.

A recurring pattern matters more than a single episode of cramp. Tell your doctor whether symptoms start after a similar walking distance and whether that distance is becoming shorter. These details can help guide an assessment for peripheral arterial disease.

Leg pain is not always vascular. Joint, muscle and nerve conditions can also affect walking. A description of symptoms helps, but examination and appropriate testing are needed before deciding what is responsible.

How can vein problems cause a different pattern?

In venous reflux, valves do not close effectively and some blood flows backwards. Varicose veins can develop, and the legs may feel heavy, achy or swollen. Symptoms often build after prolonged standing or towards the end of the day. Resting with the legs elevated may help.

These are useful patterns rather than rules that prove a diagnosis. Cramps can occur with both arterial and venous conditions, and a person can have more than one problem at the same time. Learn more about varicose veins and venous disease.

Why does the distinction change treatment?

An arterial assessment asks whether enough blood is reaching the tissues. A venous assessment asks how effectively blood is returning and whether reflux or obstruction is present. A treatment intended for one problem may not address the other.

A vascular consultation may include checking pulses, examining the skin and assessing swelling. Depending on the findings, pressure measurements or an ultrasound may be appropriate. You can read about the broader role of vascular surgery and vascular assessment before your visit.

Which symptoms need urgent assessment?

Seek immediate emergency assessment for a suddenly painful, cold, pale, numb or weak foot. New unexplained swelling in one leg, particularly with pain, warmth or redness, also needs prompt assessment because a blood clot is one possible cause. Chest pain, sudden breathlessness or collapse requires emergency help; call 995 in Singapore.

Where can I have circulation symptoms assessed in Singapore?

For persistent walking pain, leg heaviness or recurring swelling, arrange a consultation with Dr Andrew Choong at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Note what brings symptoms on, how long they last and what relieves them. This information helps the consultation focus on the right next steps.

Leg Pain When Walking? It Could Be Claudication | Dr Andrew Choong

Leg pain when walking is not always caused by arthritis or simply getting older. A cramping, aching or tight feeling in the calf, thigh or buttock that repeatedly appears during walking and improves with rest can be a sign of intermittent claudication, a symptom of reduced blood flow to the leg muscles.

In the video above, I explain three simple questions that can help you describe this pattern. They cannot diagnose the cause of your pain, but they can help you recognise when a vascular assessment may be useful.

Three questions to ask about leg pain when walking

1. Does it begin after a fairly predictable walking distance? You may notice discomfort after a similar stretch of pavement or on the same hill.

2. Does it ease when you stop walking? Claudication commonly improves after a few minutes of rest.

3. Does it return when you start walking again? The same discomfort may recur as your leg muscles work harder.

If this sounds familiar, arrange a medical assessment. The pattern can suggest claudication, but joint, muscle and nerve problems can also cause leg pain. An examination helps distinguish between them.

Why can poor circulation cause this pain?

Walking increases the amount of oxygen your leg muscles need. If arteries supplying the legs are narrowed, blood flow may not increase enough to meet that demand. Stopping reduces the muscles’ oxygen needs, allowing the discomfort to settle.

This narrowing is often caused by atherosclerosis, a build-up of fatty plaque inside artery walls. When it affects the arteries supplying the limbs, it is called peripheral arterial disease (PAD). Not everyone with PAD has the classic walking-and-rest pattern.

Why does claudication matter for heart health?

When claudication is caused by PAD, the assessment also considers your wider cardiovascular health. PAD and coronary artery disease often share the same underlying process, and people with PAD have a higher risk of heart attack and stroke.

Smoking, diabetes, high blood pressure and high cholesterol are relevant risk factors. Reviewing them is part of caring for your circulation, even if your main concern is walking discomfort.

How is claudication assessed?

I would start by asking where the pain occurs, what brings it on, how quickly it settles and whether your walking distance has changed. Your medical history, medicines and risk factors also help guide the assessment.

An examination includes checking your feet, skin and leg pulses. An ankle–brachial pressure index (ABPI), also called ABI, compares blood pressure at the ankles and arms. A duplex ultrasound may be appropriate to assess blood flow and locate narrowing. Further tests depend on the findings; not everyone needs a scan.

Does claudication always need an operation?

No. Treatment often begins with managing cardiovascular risk, stopping smoking where relevant, prescribed medicines and a structured exercise programme suitable for the individual. Medicines may address cholesterol, blood pressure or blood-clotting risk.

For stable claudication, supervised or clinician-supported walking programmes can improve walking ability. The programme should follow assessment and account for other health conditions. New severe pain, pain at rest or a cold, numb foot should not be treated by simply pushing through a walk.

Angioplasty or surgery may be considered when symptoms remain significantly limiting despite treatment, or when circulation is severely compromised.

When should you seek urgent help?

Seek prompt medical assessment for new pain at rest, a foot or leg wound that is not healing, or symptoms that are worsening, particularly if you have diabetes.

A suddenly painful, cold, pale, numb or weak leg or foot needs emergency assessment. Seek emergency care immediately rather than waiting for a clinic appointment.

Assessment and Treatment Guides

Read more about vascular duplex ultrasound and leg angioplasty and stenting, including when a procedure may be considered. Not everyone with walking pain needs a scan or an operation.

Vascular assessment in Singapore

If recurring walking pain is limiting your daily activities, contact Andrew Choong Vascular Surgery to discuss an assessment at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563.

This video follows my introduction to September’s vascular disease awareness series. Recognising a symptom pattern is a useful first step; a clinical assessment establishes what it means for you.

This article provides general education and does not replace an individual medical consultation.

September is Vascular Disease Awareness Month | Signs & Symptoms

Leg pain when walking, persistent leg swelling and wounds that heal poorly can be warning signs of vascular disease. Some blood vessel conditions cause few or no symptoms until they become serious. Recognising a change in your circulation - and knowing when to seek help - is the message behind this video.

September’s vascular disease and peripheral arterial disease awareness campaigns are an opportunity to talk about arteries, veins, blood clots and the aorta. In the video above, I introduce a series of short explanations about vascular health, the symptoms people sometimes overlook, and when a proper assessment may be needed.

What is vascular disease?

Vascular disease affects the blood vessels that carry blood around the body. Arteries carry blood away from the heart; veins return it. The aorta is the body’s main artery.

Vascular conditions include peripheral arterial disease (PAD), varicose veins, deep vein thrombosis (DVT), aortic aneurysms and aortic dissection. These are different conditions, so their symptoms, risks and treatments are not interchangeable.

Heart health and arterial health are closely connected. PAD and coronary artery disease share risk factors such as smoking, diabetes, high blood pressure and high cholesterol. Looking after these risk factors matters beyond the heart itself.

Which symptoms should you look out for?

The topics introduced in this Short cover several changes worth paying attention to:

• Leg pain when walking. Aching or cramping brought on by walking and relieved by rest can be a sign of peripheral arterial disease, where narrowed or blocked arteries reduce blood flow to the legs. Repeated symptoms should not automatically be put down to age or fitness.

• Swelling, aching or heavy legs. These may occur with varicose veins or other venous problems. Persistent swelling, skin changes or ulcers deserve assessment; visible veins alone do not establish how serious a problem is.

• Foot or leg wounds that are slow to heal. Poor healing can have several causes, including impaired circulation. A foot wound in someone with diabetes needs prompt medical attention.

• New swelling in one leg. Especially when accompanied by pain, tenderness or warmth, this needs urgent medical assessment for a possible deep vein thrombosis. DVT is a clot in a deep vein, and not everyone develops all the typical symptoms.

These signs are reasons to seek advice, rather than a way to diagnose yourself. Muscle, joint and other medical problems can also cause leg symptoms.

Can vascular disease be silent?

Yes. Some vascular conditions develop without obvious warning signs. For example, an abdominal aortic aneurysm often causes no symptoms. An aneurysm is an abnormal widening of an artery; an aortic dissection involves a tear in the inner lining of the aorta.

This does not mean everyone needs a scan. Whether an examination, circulation test or imaging is appropriate depends on your symptoms, medical history and individual risk.

When should you seek urgent help?

Seek emergency care now for sudden severe abdominal or back pain, sudden breathlessness or chest pain, fainting, or a limb that suddenly becomes cold, painful or numb. These symptoms can signal serious problems and should not wait for a routine clinic appointment.

In Singapore, call 995 for a life-threatening emergency.

When is a vascular assessment appropriate?

Arrange a medical assessment for persistent or recurring leg pain when walking, unexplained swelling, skin changes or a wound that is not healing. Mention any diabetes, smoking history, high blood pressure or high cholesterol.

An assessment helps determine whether your symptoms relate to the arteries, veins or another cause, and whether further tests are needed. New one-sided swelling or rapidly worsening symptoms require more urgent attention.

Follow the September vascular health series

In this introductory video, I set out the topics for the month: walking-related leg pain, poor circulation, diabetic foot wounds, varicose veins, blood clots, aortic aneurysms and aortic dissections.

September also includes Aortic Dissection Awareness Day on 19 September and World Heart Day on 29 September. The next Short starts with a commonly missed warning sign of PAD: leg pain when walking.

Vascular care in Singapore

For non-emergency concerns about your circulation, contact Andrew Choong Vascular Surgery to enquire about an assessment with Dr Andrew Choong, Consultant Vascular and Endovascular Surgeon.

The clinic is at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563.

This article expands on the accompanying video for general education. It does not replace an individual medical assessment or personal medical advice.

World Diabetes Day 2025: Diabetes, Artery Health and Foot Care

Diabetes can affect the blood vessels long before a person notices a circulation problem. For World Diabetes Day, my video explains why looking after your arteries belongs alongside managing blood glucose. The aim is to recognise risk early, identify problems that need treatment and protect long-term health.

A circulation assessment is most useful when it answers a clear clinical question. It should be guided by symptoms, examination and individual risk, with a plan for what the findings will change.

How can diabetes damage the arteries?

Persistently high blood glucose can damage blood vessels and contribute to atherosclerosis, the build-up of plaque within artery walls. Blood pressure, cholesterol, smoking and other factors also influence risk. As arteries become narrowed, less blood may reach the tissues they supply.

The consequences depend on the location. Arterial disease can contribute to heart attacks, strokes and reduced blood flow to the legs and feet. In the legs, this is known as peripheral arterial disease, or PAD.

Diabetes does not mean that every artery is blocked. It means that vascular risk deserves active attention, even when someone feels well.

Why are the feet especially important?

Two problems can occur together: reduced circulation and nerve damage. Poor circulation can make wounds harder to heal. Nerve damage can reduce sensation, so a blister, pressure injury or small cut may go unnoticed.

This is why pain alone is an unreliable warning system. A foot can need attention even if it does not hurt. Look over both feet regularly, including the soles and between the toes, and seek help if you cannot examine them yourself. Appropriately fitting footwear and regular foot reviews are also important.

A diabetic foot ulcer is a serious complication, but it is not a prediction that an amputation is inevitable. Prompt assessment, infection treatment when needed, pressure relief and attention to circulation can all form part of a coordinated care plan.

What can an ABPI or arterial duplex ultrasound show?

An ankle–brachial pressure index, also called ABPI or ABI, compares blood pressure at the ankle with blood pressure in the arm. It helps assess whether arterial narrowing may be reducing blood flow to the legs.

Diabetes can make arteries stiff and difficult to compress. This can produce a normal-looking or high ankle pressure despite underlying disease. A normal ABPI therefore does not rule out PAD by itself in someone with diabetes.

Arterial duplex ultrasound uses sound waves to examine arteries and blood flow. Depending on the findings, other measurements, such as toe pressures, may also be helpful. These tests assess particular aspects of circulation; they do not provide a single all-clear for every artery in the body.

Does everyone with diabetes need the same vascular tests?

No. The assessment should start with the history and examination, including symptoms, foot condition, pulses and previous ulcers or vascular disease. Your clinician can then decide which tests are appropriate and whether a specialist review is needed.

Tell your care team about calf discomfort when walking, a change in walking distance, persistent foot pain, colour changes or a wound that is slow to heal. An absence of typical walking pain does not exclude a circulation problem.

When should a foot problem be checked urgently?

A new ulcer, spreading redness, discharge or a hot, swollen foot needs prompt medical assessment. Seek emergency care for a suddenly cold, pale or numb foot, severe new pain, blackened tissue or a foot infection accompanied by fever or feeling seriously unwell. Do not wait for a routine appointment if the foot is deteriorating.

What helps protect vascular health over time?

Work with your usual care team on blood glucose, blood pressure and cholesterol, take prescribed treatment consistently and seek support to stop smoking if needed. Combine these measures with foot care and physical activity suited to your condition.

For concerns about diabetes and leg circulation, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. An individual assessment can help clarify the next step.

Vascular Surgery in 60 Seconds: Aorta, Arteries and Veins Explained

A vascular surgeon is a specialist in the blood vessels that carry blood around the body. In my 60-second video, I describe us as circulation doctors: we assess and treat problems affecting arteries and veins, using a range of medical, minimally invasive and open surgical approaches.

I am Dr Andrew Choong, a vascular surgeon in Singapore. Understanding the scope of vascular surgery can help you recognise why symptoms as different as walking pain, swollen legs and a wound that will not heal may need a circulation assessment.

What is the difference between an artery and a vein?

Arteries carry blood away from the heart towards the tissues. Veins return blood towards the heart. They are parts of the same circulation, but the conditions affecting them - and the tests and treatments they need - can be very different.

An artery narrowed by disease may not deliver enough blood to a muscle or wound. A vein with faulty valves may allow blood to pool in the leg. A blood clot can cause another kind of obstruction. The first job is to identify which problem is present.

Which conditions does a vascular surgeon treat?

Vascular surgery covers a broad range of circulation problems. The examples in my video include:

• Aortic disease: aneurysms and dissections affecting the body’s main artery.

• Leg artery disease: narrowed or blocked arteries that may cause walking pain, rest pain or poor wound healing.

• Venous disease: varicose veins and deep vein thrombosis.

• Carotid artery disease: selected artery problems in the neck relevant to stroke prevention.

• Dialysis access: creating and maintaining suitable access to the circulation for haemodialysis.

Wound care and limb preservation are also important parts of vascular practice. When poor blood flow contributes to a foot or leg wound, addressing the circulation may be one part of a wider treatment plan.

Is vascular surgery the same as cardiology?

The specialties are related, but their focus differs. Cardiologists primarily assess and treat the heart. Vascular surgeons mainly manage blood vessels outside the heart and brain, including the arteries in the neck and vessels throughout the body.

Some techniques overlap. Balloons, wires and stents can be used in both heart and peripheral vascular procedures. The presence of a stent does not, by itself, tell you which specialty or condition is involved.

Complex aortic and other vascular conditions may also involve several specialties working together. The appropriate team depends on the part of the circulation affected and the treatment required.

Does seeing a vascular surgeon mean I need an operation?

No. An assessment may lead to advice, medication, monitoring or further tests. For example, management of peripheral arterial disease can include cardiovascular risk reduction and structured exercise, with a procedure considered when clinically indicated.

For some patients, endovascular treatment offers a way to work inside a blood vessel through a small access site. Depending on the problem, this may involve a balloon, stent or another device. Other patients are better served by open surgery, such as a bypass or repair.

The decision starts with the diagnosis, symptoms, scan findings and goals of treatment. A procedure should have a clear purpose that the patient understands.

When should I seek a circulation assessment?

Persistent leg pain when walking, troublesome varicose veins, unexplained swelling or a wound that is not healing deserve medical attention. These symptoms have several possible causes, so an examination is more useful than assuming that every leg problem is vascular.

Some changes are emergencies. A suddenly cold, pale, painful or weak limb, sudden severe chest or back pain, or sudden breathlessness with collapse needs immediate emergency assessment. In Singapore, call 995 for severe emergency symptoms.

Where can I discuss vascular symptoms in Singapore?

You can contact Andrew Choong Vascular Surgery for a non-emergency consultation to discuss your symptoms, relevant scans and treatment options. My aim is to explain the circulation problem and the reasons for any proposed next step.

Current clinic location: Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563.