A Leg Up On Peripheral Artery Disease

Overview

Peripheral artery disease, also called PAD, happens when the blood vessels in your legs become narrowed or blocked by fatty deposits. This reduces blood flow to your leg muscles. It often causes leg pain when you walk or climb stairs.

Yes, PAD is common. It affects millions of people worldwide. In the UK, it is estimated that around 1 in 5 people over 60 have some form of PAD, though many don't know they have it.

PAD most often affects people over 60, but it can happen earlier if you have risk factors. You are more likely to get PAD if you smoke, have diabetes, high blood pressure, high cholesterol, or a family history of heart or blood vessel disease.

Symptoms

Common symptoms

• Cramping pain in your calf, thigh, or buttock when you walk or exercise, which goes away when you rest (this is called intermittent claudication)
• A feeling of coldness in your lower leg or foot, especially if it is more noticeable than the other side
• Painful sores or wounds on your toes, feet, or legs that heal slowly or do not heal

Symptoms in children

• Peripheral artery disease is very rare in children. If it happens, it is usually linked to a genetic condition or early heart disease, but it is not a typical childhood condition.

Symptoms in older adults

• In older adults, symptoms can be more severe, including pain in the foot or toes even when resting, numbness, a feeling of weakness in the leg, and shiny, pale or bluish skin. Sores or ulcers may appear on the toes or feet and may not heal.

Causes

Main causes

• Atherosclerosis, which is a build-up of fatty deposits (plaque) on the inside of artery walls, narrowing the artery over time
• A blood clot that lodges in a leg artery and blocks blood flow
• Inflammation of the blood vessels, which is less common but can cause damaged arteries

Risk factors

• Smoking or using tobacco
• Diabetes
• High blood pressure
• High cholesterol
• Being over the age of 60
• Having a family history of heart attack, stroke, or PAD
• Being overweight or having obesity
• Not getting enough physical activity

When to see a doctor

See a doctor urgently if:

• If you have leg pain that does not go away, even when you rest, especially if it affects your sleep
• If you develop sores on your toes or feet that do not heal
• If you notice a change in skin color, such as a blue or dark patch on your leg or foot

Book a routine appointment if:

• If you have cramping pain in your legs when walking that disappears when you stop, make an appointment to discuss it
• If you have diabetes, high blood pressure, high cholesterol, or smoke, and you have any leg discomfort or skin changes
• If you are over 60 and have risk factors for heart disease, even if you have no symptoms yet

Diagnosis

Your doctor will ask about your symptoms, medical history, and lifestyle. They will check the pulses in your legs and feet, look for changes in skin color, and measure your blood pressure. A simple, painless test called an ankle-brachial index (ABI) compares the blood pressure in your ankle with your arm and is often used to diagnose PAD.

Tests that may be done

• Ankle-brachial index (ABI): a quick, painless test using blood pressure cuffs on your arm and ankle
• Doppler ultrasound: uses sound waves to see blood flow in your leg arteries
• Angiography (CT or MR): imaging tests that give a detailed picture of the arteries, usually if surgery is being considered

What to expect at your appointment

Diagnosis is usually straightforward and does not require any special preparation. The tests are non-invasive and take about 30 to 60 minutes. Your doctor will discuss your results with you and, if PAD is confirmed, help you create a treatment plan that fits your needs.

Treatment

Treatment for PAD focuses on three main areas: reducing your risk of complications, improving your symptoms, and protecting your overall heart health. Your healthcare team will work with you to create a personal plan that may include lifestyle changes, medicines, and sometimes a procedure to improve blood flow.

Self-care at home

• Take a short walk every day. A supervised exercise programme, which may be available through your healthcare provider, can help improve leg pain over time.
• Stop smoking and avoid tobacco in all forms. This is one of the most important steps you can take.
• Check your feet every day for cuts, blisters, or sores. If you notice anything new, see your doctor or podiatrist.
• Wear comfortable, well-fitting shoes and avoid going barefoot, especially if you have diabetes.

Medical treatments

Your doctor may recommend medicines to lower blood pressure, reduce cholesterol, manage diabetes, or prevent blood clots. These are prescribed based on your personal health and are taken as directed. Always take your medicines as prescribed and ask your doctor or pharmacist if you have any questions.

When is surgery considered?

If your symptoms are severe, do not improve with lifestyle changes and medicines, or if you have a serious blockage, your doctor may suggest a procedure such as angioplasty (opening the artery with a small balloon), stenting (placing a small mesh tube to keep it open), or bypass surgery (creating a new route around the blockage).

Living with this condition

Living with PAD means being mindful of your circulation. Walking regularly is one of the best ways to improve blood flow and reduce pain over time. You may need to walk a little further each day to build up your tolerance. Keep your feet clean, dry, and moisturised to avoid cracks and infections, and check them daily for any changes.

Lifestyle tips

• Stay physically active, but don't push through severe pain. Rest when you need to.
• Eat a balanced diet low in saturated fats, added salt, and sugar.
• Manage your blood sugar if you have diabetes, and keep your blood pressure and cholesterol in a healthy range.
• Talk to your doctor about a safe weight loss plan if you are overweight.

Diet and exercise

Aim for a heart-healthy diet with plenty of fruits, vegetables, whole grains, and lean proteins. Reduce foods that are high in unhealthy fats and processed salt. For exercise, start with short walks and gradually increase your distance. A supervised exercise programme for PAD, if available, may be especially helpful.

Mental health and emotional wellbeing

Living with a long-term condition like PAD can be stressful. You may feel anxious, frustrated, or low about your mobility and your health. These feelings are normal. Talking to your doctor about your emotions, or speaking with a counsellor or support group, can help you cope.

Prevention

PAD can often be prevented or delayed by controlling your risk factors. The most important steps are to stop smoking, manage diabetes, keep blood pressure and cholesterol in a healthy range, stay physically active, and eat a healthy diet. If you have already been diagnosed with PAD, these steps can also prevent it from getting worse.

Screening programmes

Screening for PAD is usually recommended for people at higher risk, such as those over 60 or those with diabetes, high blood pressure, high cholesterol, or a history of smoking. Talk to your doctor about whether you should have an ankle-brachial index test even if you have no symptoms.

Complications

If left untreated

• Critical limb ischaemia, a severe reduction of blood flow that causes pain in the toes or feet, often at rest
• Non-healing ulcers or wounds that can become infected
• Gangrene, which is tissue death that may eventually require amputation
• Increased risk of heart attack and stroke, because PAD is often a sign of widespread artery disease

Long-term outlook

With early detection and good management, most people with PAD can improve their symptoms, keep their legs healthy, and reduce the chance of serious complications. It is never too late to start making healthier choices. Your healthcare team can guide you every step of the way, and many people with PAD continue to live active, full lives.

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