17357 Peripheral Artery Disease Pad

Overview

Peripheral Artery Disease (PAD) is a condition where the arteries that carry blood to your legs become narrowed or blocked by fatty deposits. This reduces blood flow to your leg muscles and tissues, which can cause pain and other problems, especially when walking.

Yes, PAD is a common condition, especially in people over the age of 60. It affects about one in five adults over that age in the UK.

PAD most often affects older adults, people who smoke, those with diabetes, high blood pressure, high cholesterol, or a history of heart disease or stroke. It is also more common in people who are overweight or inactive.

Symptoms

Common symptoms

• Dull or cramping leg pain, usually in the calf, that comes on with walking and goes away with rest (called claudication)
• Numbness or weakness in the legs
• Cold feeling in the lower leg or foot, compared to the other side
• Sores or ulcers on the toes, feet, or legs that take a long time to heal
• Shiny, tight, or pale skin on the legs
• Loss of hair on the legs or slower nail growth
• A weak or absent pulse in the leg or foot

Symptoms in children

• PAD is very rare in children. If it occurs, it is usually linked to an inherited condition or a serious illness. Symptoms may be similar to those in adults, such as leg pain, cold feet, or poor wound healing, but any child with these symptoms should be evaluated by a doctor.

Symptoms in older adults

• Older adults may have more severe symptoms, such as pain at rest, especially at night when the leg is lifted.
• Walking may become very difficult, and older adults are at higher risk for non-healing sores and gangrene.
• They may also have other conditions like diabetes or heart disease that complicate PAD.

Causes

Main causes

• Atherosclerosis: a buildup of fatty substances (plaque) inside the arteries that narrows them and reduces blood flow
• Blood vessel inflammation (vasculitis), though this is less common
• Injury to the arteries
• Radiation exposure or certain medications, in rare cases

Risk factors

• Smoking or chewing tobacco
• Diabetes
• High blood pressure
• High cholesterol
• Age over 60
• Obesity or being overweight
• Physical inactivity
• Family history of heart or blood vessel disease
• Kidney disease

When to see a doctor

See a doctor urgently if:

• If you have a non-healing sore on your leg or foot, see a doctor the same day.
• If you have pain in your leg or foot while at rest, especially at night, see a doctor the same day.
• If you notice your leg or foot becoming pale, blue, or extremely cold, call for emergency help immediately.

Book a routine appointment if:

• Make a routine appointment with your GP if you have leg pain or cramping when you walk that goes away when you rest.
• Also see a doctor if you have any risk factors for PAD and notice a cold leg, weak pulse, or skin changes on your leg.
• If you have diabetes, check your feet regularly and report any new cuts, sores, or color changes to your doctor.

Diagnosis

A doctor will ask about your symptoms, your medical history, and risk factors. They will also examine your legs and feet, checking for pulses, skin changes, and wounds. The main test for PAD is the ankle-brachial index (ABI), which compares the blood pressure in your ankle with the blood pressure in your arm.

Tests that may be done

• Ankle-brachial index (ABI): a simple, painless test using blood pressure cuffs
• Doppler ultrasound (also called duplex ultrasound): to see blood flow through the arteries and identify blockages
• Blood tests: to check for diabetes, high cholesterol, or other conditions
• An MRI (magnetic resonance imaging) or CT (computed tomography) scan, in some cases, to get a detailed view of the arteries
• An angiogram: an X-ray of the blood vessels using a special dye, often done before treatment

What to expect at your appointment

These tests are usually painless and can be done in a clinic or hospital. The ABI test involves lying down for a short time while a nurse measures pressures in your arms and ankles. Ultrasound uses gel and a wand over the skin. You can usually go home the same day. Your doctor will explain the results and discuss the next steps with you.

Treatment

Treatment for PAD focuses on reducing symptoms, improving walking, and lowering the risk of heart attack, stroke, and worsening leg problems. This involves a combination of lifestyle changes, medicines, and sometimes procedures to reopen stiff or blocked arteries.

Self-care at home

• Stop smoking: this is the single most important step
• Walk with a regular exercise programme, ideally with support, but start slowly and build up
• Take care of your feet: wash daily, dry well, moisturise, and check for cuts or blisters
• Keep your feet warm and wear shoes that fit well
• Keep chronic conditions like diabetes, high blood pressure, and high cholesterol well controlled

Medical treatments

Your doctor may prescribe medicines to lower cholesterol, reduce blood pressure, and help prevent blood clots. These may include medicines known as statins, antiplatelet therapy, and drugs for diabetes or blood pressure. Some people may also be offered a supervised exercise programme to improve walking distance and reduce pain. Always take medicines as prescribed by your doctor—never stop or change them on your own.

When is surgery considered?

If symptoms are severe, or if rest pain or wounds do not improve with medicines and exercise, a specialist may recommend a procedure to improve blood flow. This can include angioplasty (using a small balloon to widen the artery, often with a stent) or bypass surgery (using a healthy blood vessel to bypass the blocked area). Your doctor will explain the options and what to expect.

Living with this condition

Living with PAD means paying attention to your legs and feet every day. Check your feet for cuts, blisters, redness, or swelling. Wear comfortable shoes and avoid walking barefoot. Follow your exercise plan, but stop if you feel severe pain. Keep your medical appointments and take your medicines as directed.

Lifestyle tips

• Exercise regularly: walking is often recommended, and can improve symptoms over time
• Do not smoke or use tobacco in any form
• Eat a balanced diet low in salt and saturated fat
• Manage your blood sugar if you have diabetes
• Control blood pressure and cholesterol with your doctor's guidance
• Maintain a healthy weight

Diet and exercise

A heart-healthy diet with plenty of vegetables, fruits, whole grains, and lean protein can support your arteries. Try to exercise for 30 minutes most days, but for PAD, a very specific walking plan is often recommended: walk until pain starts, rest, and then repeat. Your doctor or a physiotherapist can help you set a safe and effective routine.

Mental health and emotional wellbeing

Living with a long-term condition like PAD can be stressful or worrying, especially if walking is painful or you fear surgery. It is normal to feel low or anxious at times. Talk to your healthcare team about how you are feeling, and ask for support if you need it. There are also support groups where you can connect with others who understand.

Prevention

You can greatly reduce your risk of developing PAD or slowing it down by not smoking, staying active, eating a balanced diet, maintaining a healthy weight, and managing diabetes, blood pressure, and cholesterol. If you already have PAD, these steps can stop it from getting worse and lower your risk of heart attack and stroke.

Vaccines

Vaccinations for flu and pneumonia are recommended for people with PAD because any infection can put extra strain on the heart and blood vessels. Ask your pharmacist or GP about suitable vaccines for you.

Screening programmes

There is no national screening test for PAD for everyone. However, if you are at higher risk—especially if you smoke, have diabetes, or are over 60—your doctor may offer an ankle-brachial index test as part of a check-up.

Complications

If left untreated

• Non-healing wounds or ulcers on the legs and feet
• Gangrene (tissue death) that may require amputation
• Higher risk of heart attack and stroke
• Pain in the leg even at rest, which can interfere with sleep and daily life

Long-term outlook

With proper care, most people with PAD can control their symptoms and reduce the risk of serious problems. Many people notice that regular walking and stopping smoking make a big difference. If you have severe blockages, treatments like angioplasty or surgery can help. The most important thing is to work with your healthcare team and keep up with healthy habits—PAD does not mean you cannot live a full and active life.

Find support

International organisations

• American Heart Association ↗
• World Heart Federation ↗

Local organisations

• British Heart Foundation ↗ · United Kingdom
• NHS Choices ↗ · United Kingdom

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