It’s one of those quirks of ageing that most people barely give a second thought to. One day you look down and the skin on your lower legs starts to look tight, smooth and oddly glossy. And the hair that used to grow there? It seems to have disappeared.
Shiny shins, as patients often call them, are easy to dismiss. Millions of older Britons have them and assume it’s simply what legs look like after 60.
But I want you to take them seriously. Because shiny shins can be a warning sign of one of the most dangerous circulation problems there is – a condition that dramatically raises your risk of a heart attack or stroke, or can even end in amputation.
It’s called peripheral arterial disease, and it’s the cardiovascular illness we almost never talk about.
When doctors discuss preventing cardiovascular disease, we tend to focus on the heart and the brain. Faulty blood vessels can stop oxygen from reaching these crucial organs. But the same process that furs up the arteries supplying those organs happens in the legs too.
Over time your arteries can become clogged with fatty deposits called plaques. When that happens in the arteries of the heart, the result is angina (chest pain) or a heart attack. In the brain it causes a stroke. And when it happens in the legs, it’s called peripheral arterial disease.
The skin changes are a direct result of that blockage. Starved of oxygen and nutrients, the skin on the lower legs becomes thin, fragile and tight-looking – hence the shine – and hair follicles stop producing hair.
Cuts and scrapes can also become slow to heal because there isn’t enough blood reaching the tissues. This can lead to painful ulcers that are difficult to treat and, in severe cases, tissue death that may require amputation.
Shiny shins can be a warning sign of one of the most dangerous circulation problems there is – a condition that dramatically raises your risk of a heart attack or stroke
And this is not just a problem for your legs, either.
Arteries don’t fur up in isolation. If the blood vessels in your legs are clogged, then the chances are the ones supplying your heart and brain are too.
That’s why anyone with peripheral arterial disease is at significantly higher risk of heart attacks, mini-strokes and strokes.
So who gets it? The single biggest culprit is smoking, which makes you four times more likely to develop the condition.
High cholesterol, high blood pressure, obesity and diabetes all raise the risk too, as does a sedentary lifestyle and a family history of circulation problems.
In other words, exactly the same things that cause heart disease.
And it is remarkably common. NHS figures suggest as many as one in five over-60s may have some degree of peripheral arterial disease – and many have no symptoms beyond skin changes such as shiny shins.
But they aren’t the only clue. The classic symptom is an aching, cramping pain in the calves when walking, which eases when you stop and rest. It’s essentially angina of the legs – the muscles demand extra blood during exercise, and the narrowed arteries simply can’t deliver it.
It may affect one leg or both. And as the condition worsens, pain can strike even at rest – particularly in bed at night, when blood pressure naturally drops.
Patients often tell me they sleep with a leg dangling out of the bed, or get up in the night to hang their legs over the side, because it’s the only thing that eases the pain. That’s a sign that should prompt a trip to the GP. Legs that look red when standing but turn deathly pale when raised are another red flag.
The good news is there’s plenty we can do for peripheral arterial patients.
Your GP can arrange a simple blood pressure test to diagnose the condition, plus blood tests to check for underlying causes such as diabetes and high cholesterol.
The priority is stopping it getting worse – usually with statins and blood pressure medication, just as we would for heart disease. And if you smoke, quitting is the single most important step you can take.
Then there’s exercise. It sounds counter-intuitive when walking hurts, but moderate exercise has been proven to open up smaller arteries in the legs and improve circulation.
It’s safe if you build up gradually – and the evidence shows that people do best in supervised exercise classes, which your GP can refer you to. Many find they can end up with less pain overall.
Finally, look after that fragile skin. Regular moisturising can prevent the breaks and sores that, with poor circulation, can turn into stubborn infections and ulcers.
But not every case of shiny shins means diseased arteries.
If you shave your legs, it’s inevitable that the shins are going to look a bit shiny. And skin also naturally thins with age, and swelling in the legs – from fluid retention or vein problems – can also stretch the skin and give it a glossy appearance.
But that’s precisely why it’s worth getting checked. Shiny shins might be nothing. Or they might be your arteries sending you a warning you can’t afford to ignore.
Your questions answered
I need to cure this terrible pain in my rear
I have terrible pain inside my bottom. It comes and goes – and it’s been there for a few years. What can I do?
Dr Ellie replies: Pain inside the bottom should always be reported to a GP.
This is because it can be a sign of a tumour in the bowel or the anus, so an examination is imperative.
However, cancer is not the most common cause of this problem.
A tear in the anal tissue, called a fissure, can trigger pain.
Fissures usually heal on their own, but many patients need laxatives to make going to the toilet less painful, as well as creams that can aid healing.
Haemorrhoids, also known as piles, are another possible culprit.
These are swollen blood vessels in and around the anus. In severe cases, patients may need surgery to cut them out, but haemorrhoids can also heal without treatment.
However, there is also a little-known condition called proctalgia fugax, which triggers sudden episodes of severe anal pain that can occur at any time. Not much is known about what causes the condition, though an ointment containing nitroglycerin can help.
If this fails, Botox injections, as well as physiotherapy, may also be helpful in reducing pain levels.
Is the heat to blame for my stiff ankles?
I’ve recently developed stiff ankles and – as embarrassing as it is to admit as a GP – I’m not exactly sure of the cause.
It started a few weeks ago at the height of the heatwave. But now, even though it has cooled down, they are still feeling stiff.
A friend of mine says that she suffered with this issue during the menopause, and that taking vitamin D tablets helped. But stiff ankles are not an officially recognise symptom of the mid-life hormone condition.
So could it be that I’m experiencing the first signs of the menopause? Or is the heat to blame?
All I know is it is unpleasant and I’d like to find some way – any way – to make it stop.
To that end, have you suffered from ankle pain in the heat? And did you find a solution? Please write in and let me know using the email address on the right.
