A New Approach To Peripheral Artery Disease

Overview

Peripheral artery disease (PAD) is a common condition where the arteries that carry blood to your arms or legs become narrowed, usually because of fatty deposits. This reduces blood flow, most often to the legs, and can cause leg pain when walking. The 'new approach' focuses on earlier detection and more effective management to help you stay active and protect your heart and limbs.

Yes, PAD is very common, especially in people over 60. It affects millions of people worldwide, and the number is increasing as populations age.

PAD mainly affects older adults, particularly those who smoke, have diabetes, high blood pressure, or high cholesterol. Men and post-menopausal women are more likely to develop it.

Symptoms

Common symptoms

• leg pain, aching, or cramping that happens when walking and goes away with rest
• numbness or weakness in the legs
• coldness in the lower leg or foot, especially compared to the other side
• sores or wounds on the feet or toes that do not heal
• shiny, pale, or bluish skin on the legs
• poor hair or nail growth on the affected leg

Causes

Main causes

• atherosclerosis — the build-up of fatty, waxy deposits (plaque) inside the artery walls
• blood clots that block an artery
• inflammation in the blood vessels (vasculitis), though this is less common

Risk factors

• smoking
• diabetes
• high blood pressure
• high cholesterol
• age over 60
• obesity or being physically inactive
• a family history of heart or blood vessel disease

When to see a doctor

See a doctor urgently if:

• Call your local emergency number right away if you suddenly have severe leg pain, a cold or pale leg, or you cannot move your leg or foot.
• A leg that becomes very painful, pale, or cold after an injury or procedure — contact your local emergency number.

Book a routine appointment if:

• leg pain or cramping when walking that goes away when you rest
• a cold or numb leg that has been going on for a while
• a non-healing sore on your foot or toe
• changes in the colour or texture of your leg skin

Diagnosis

To diagnose PAD, a doctor will take your medical history, ask about your symptoms, and examine your legs. They will feel the pulses in your groin, behind the knee, and in the foot. The most common test is the ankle-brachial index (ABI), which compares the blood pressure in your ankle to the blood pressure in your arm. It is quick and painless.

Tests that may be done

• Ankle-brachial index (ABI) — a simple test that measures blood pressure in the ankle and arm
• Ultrasound of the leg arteries — shows blood flow and blockages
• Walking test — to see how far you can walk before pain starts
• Angiography — an X-ray with contrast dye to see narrowed areas, sometimes used if treatment is planned

What to expect at your appointment

You will usually be asked to lie down while a blood pressure cuff is placed on your ankle and arm. The test takes about 10–15 minutes. You may also have an ultrasound, which uses a gel and a small probe on your leg. No needles or special preparation are needed for an ABI.

Treatment

Treatment for PAD focuses on reducing symptoms, slowing the disease, and lowering your risk of heart attack and stroke. A 'new approach' means treating the whole person, not just the leg. This includes lifestyle changes, medicines to control risk factors, and, in some cases, a procedure to reopen the blocked artery.

Self-care at home

• Schedule daily walking — a structured walking programme can do wonders for leg pain
• Stop smoking — this is the single most important step
• Look after your feet — keep them clean, dry, and check for cuts or sores
• Eat a heart-healthy diet and keep your blood sugar and blood pressure in a healthy range
• Wear well-fitting shoes and never go barefoot

Medical treatments

Your doctor may prescribe medicines to help prevent blood clots, control blood pressure, lower cholesterol, and manage diabetes. Some people may also be offered a medication specifically for leg pain from PAD. Always take medicines exactly as prescribed and talk to your doctor about any concerns. Do not change doses on your own.

When is surgery considered?

If lifestyle changes and medicines are not enough, or if the limb is at risk, a specialist procedure may be considered. This could be angioplasty (a balloon is inflated inside the artery to widen it), atherectomy (removing the plaque), or bypass surgery (redirecting blood around the blockage). Your doctor will explain the options that are suitable for you.

Living with this condition

Living with PAD means being kind to your legs while staying active. Plan activities that give you rest breaks. Keep your legs warm, but avoid direct heat like hot water bottles or heating pads, because you may not feel them properly if sensation is reduced.

Lifestyle tips

• Walk regularly, even if you can only go a short distance at first
• Stop smoking — there is no better way to protect your arteries
• Maintain a healthy weight
• Manage stress with relaxation, quiet time, or talking to someone
• Limit alcohol to within recommended guidelines

Diet and exercise

Aim for a balanced diet rich in fruits, vegetables, whole grains, lean proteins like fish and poultry, and healthy fats. Cut back on salt, saturated fats, and sugary drinks. For exercise, start with a short walk, rest as needed, and slowly increase your distance. Your doctor or a physiotherapist can help you design a safe plan.

Mental health and emotional wellbeing

A long-term condition like PAD can bring worry, frustration, or low mood, especially if you need to reduce activities. It is normal to feel this way. Talk to your doctor or nurse about how you are feeling. They can connect you with counselling or peer support if you need it.

Prevention

Yes, you can reduce your risk of developing PAD by not smoking, staying physically active, eating well, and managing blood pressure, cholesterol, and diabetes. If you already have PAD, the same steps can keep it from getting worse.

Vaccines

There is no vaccine against PAD, but staying up to date with recommended vaccines — such as flu and other routine immunisations — helps keep you healthy and protects your whole body.

Screening programmes

Screening is not routinely offered to everyone. However, if you have risk factors such as smoking, diabetes, or a family history, your doctor may check your ABI as part of a regular review. Ask your doctor if this test is appropriate for you.

Complications

If left untreated

• critical limb ischaemia — severe blockage causing rest pain, ulcers, or gangrene
• higher risk of heart attack and stroke
• chronic non-healing wounds that may lead to amputation
• reduced mobility and loss of independence

Long-term outlook

The outlook for PAD is much better now than in the past. With early detection, lifestyle changes, and modern treatment, most people can keep their legs healthy and live full, active lives. Even when symptoms are present, a structured plan can make a big difference. Stick with your treatment and see your doctor regularly — you are in good hands.

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