Peripheral arterial disease overview

Overview

Peripheral arterial disease (PAD) is a common condition where the arteries in your legs become narrowed or blocked. This usually happens because fatty deposits (called plaque) build up inside the artery walls. When the arteries are narrowed, less blood can flow to your legs and feet, especially during exercise.

Yes, peripheral arterial disease is quite common, especially in people over 50. It affects about 1 in 5 people over 60, but many don't know they have it.

PAD most often affects older adults, but younger people can also get it, especially if they smoke or have diabetes. Men and women are both at risk, though it may be slightly more common in men.

Symptoms

Common symptoms

• Pain, cramping, or aching in your leg muscles (often in the calf) when you walk or exercise — this usually goes away after you rest for a few minutes (called claudication).
• Your leg or foot feeling cold or numb.
• Slow-healing sores or cuts on your feet or legs.
• The skin on your leg or foot looking pale, shiny, or turning blue.
• Weak or no pulse in your legs or feet.

Symptoms in older adults

• Older adults may not notice leg pain because they are less active, or they may mistake it for arthritis.
• Pain at rest (even when lying down) can be a sign of more severe PAD.
• Wounds on the feet or legs that don't heal well are more common in older adults with PAD.

Causes

Main causes

• Atherosclerosis — a process where fatty deposits (plaque) build up inside the arteries, making them narrow and stiff.
• Inflammation of the blood vessels (vasculitis) or injury to the arteries — these are less common causes.

Risk factors

• Smoking or using tobacco — the biggest risk factor for PAD.
• Diabetes.
• High blood pressure (hypertension).
• High cholesterol (especially high LDL cholesterol).
• Being over the age of 50.
• Having a family history of heart or circulatory disease.
• Being overweight or obese.
• Not getting enough physical activity.

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above (sudden severe leg pain, leg turning pale or cold, loss of pulse).
• If you have a wound on your foot or leg that is not healing and looks infected.

Book a routine appointment if:

• If you have leg pain when walking that goes away with rest.
• If your feet or legs feel colder than usual, or you notice changes in skin color.
• If you have risk factors (like smoking or diabetes) and are over 50.

Diagnosis

A doctor can often suspect PAD based on your symptoms and risk factors. They will check the pulses in your feet and listen to your arteries with a stethoscope. The main test is called an ankle-brachial index (ABI), which compares blood pressure in your ankle to blood pressure in your arm.

Tests that may be done

• Ankle-brachial index (ABI) — a painless test using blood pressure cuffs on your arms and ankles.
• Doppler ultrasound — uses sound waves to see how blood flows through your arteries.
• Angiography — a special X-ray with dye to look for blockages (this is done only if treatment is being planned).
• Blood tests to check for conditions like diabetes or high cholesterol.

What to expect at your appointment

Your doctor will start by asking about your symptoms, medical history, and lifestyle. The ABI test takes about 10–15 minutes and is painless. If the test suggests PAD, your doctor may order an ultrasound to get a clearer picture. The process is usually straightforward, and you can discuss the results with your doctor.

Treatment

Treatment for PAD focuses on managing symptoms, improving blood flow, and reducing the risk of heart attack and stroke. The main approaches are lifestyle changes, medications, and sometimes procedures to open blocked arteries. Your doctor will work with you to create a plan based on your needs.

Self-care at home

• Stop smoking — this is the single most important step.
• Walk regularly — a supervised exercise program can help improve symptoms.
• Eat a heart-healthy diet low in saturated fat, salt, and sugar.
• Take care of your feet — check them daily for cuts, blisters, or sores, and keep them clean and dry.
• Manage other health conditions, such as diabetes, high blood pressure, and high cholesterol.

Medical treatments

Doctors may prescribe medications to help reduce the risk of blood clots, lower cholesterol, control blood pressure, or manage diabetes. These treatments are part of a comprehensive plan and should be taken exactly as prescribed. Always talk to your doctor before starting or stopping any medication.

When is surgery considered?

If lifestyle changes and medications are not enough to control symptoms, or if you have severe blockages, your doctor may recommend a procedure to open or bypass the blocked artery. Options include angioplasty (inserting a small balloon to widen the artery) or bypass surgery (using a healthy vein to route blood around the blockage). These are usually only done for advanced PAD.

Living with this condition

Living with PAD means paying attention to your feet and legs, staying active as much as possible, and keeping up with your medical appointments. Many people continue to lead full, active lives with proper management.

Lifestyle tips

• Quit smoking, if you smoke. This is the most effective way to slow PAD.
• Aim for at least 30 minutes of moderate exercise, like walking, most days of the week.
• Wear comfortable, well-fitting shoes and avoid walking barefoot.
• Manage stress with relaxation techniques like deep breathing or meditation.
• Limit alcohol intake.

Diet and exercise

A heart-healthy diet — rich in vegetables, fruits, whole grains, and lean proteins — can help control cholesterol, blood pressure, and weight. Regular walking is especially helpful for PAD. If you have pain, walk until you feel discomfort, then rest, then continue. A structured walking program can gradually increase your walking distance.

Mental health and emotional wellbeing

Living with chronic pain and limited mobility can be frustrating and may lead to feelings of anxiety or depression. It is important to talk to your doctor about how you are feeling. Support from friends, family, or a counselor can help you cope.

Prevention

You cannot always prevent PAD, but you can greatly lower your risk by not smoking, staying physically active, eating a healthy diet, and keeping conditions like diabetes and high blood pressure under control. Early detection and treatment of risk factors are key.

Screening programmes

Screening for PAD (for example, with an ABI test) is not recommended for everyone, but your doctor may suggest it if you have risk factors such as smoking, diabetes, or a family history of PAD. Discuss your individual risk with your healthcare provider.

Complications

If left untreated

• Critical limb ischemia — severe blockage causing pain at rest, wounds, or gangrene (tissue death). This may lead to amputation if not treated quickly.
• Increased risk of heart attack and stroke, because PAD is a sign of widespread artery disease.
• Poor healing of foot injuries and infections.
• Permanent nerve damage or loss of limb function.

Long-term outlook

With proper treatment and lifestyle changes, most people with PAD can improve their symptoms and lower their risk of serious complications. Even if you have advanced PAD, there are effective treatments to help you maintain your quality of life. The key is to work closely with your healthcare team and follow their advice.

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