Artery Disease Below The Belt

Overview

When the large blood vessels that carry blood to your legs become narrowed or blocked, it is called peripheral artery disease (PAD). This usually happens because fatty deposits build up inside the artery walls, reducing blood flow. It can cause leg pain when walking and, in serious cases, lead to wounds that do not heal.

Yes. Peripheral artery disease becomes much more common with age, and doctors often see it in people over 60. Many people have it without knowing, because symptoms can be mild or mistaken for normal aches and pains.

It mainly affects adults aged 50 and older, but a person can develop it earlier if they smoke, have diabetes, or have a family history of artery disease. Men and women are both at risk, and the chance increases with age.

Symptoms

Common symptoms

• Leg or calf cramps or aching that starts when you walk or climb stairs and stops when you rest (called claudication).
• Numbness or a feeling of heaviness in the legs.
• Legs feeling noticeably cooler than your arms or other parts of your body.
• Sores or wounds on your toes, feet, or legs that are slow to heal.
• Pale or bluish color in the toes or feet.
• Weak pulses in your feet or legs when a doctor checks them.

Symptoms in children

• Artery disease below the belt is very rare in children. If it happens, it is usually linked to a genetic condition or a serious injury to the blood vessel.
• A child with this problem might complain of leg pain when running, have a swollen leg, or have a difference in the color or temperature between their legs.

Symptoms in older adults

• Older adults may feel leg tiredness or cramping only after walking a very short distance, or they might mistake it for joint pain or weakness.
• Sometimes the first sign is a sore on the foot or toe that doesn't get better, or the leg becoming pale, cold, and painful suddenly – which is an emergency.

Causes

Main causes

• Atherosclerosis – the build-up of fatty and calcium deposits (plaque) inside the artery walls, which makes the arteries narrow and stiff.
• Blood clots that travel from elsewhere in the body and block a leg artery.
• Injury or inflammation of the blood vessels (though this is less common).

Risk factors

• Smoking or using tobacco of any kind – this is the strongest risk factor.
• Diabetes, especially if blood sugar levels are poorly controlled.
• High blood pressure (hypertension).
• High cholesterol or high triglycerides (fats in the blood).
• Age over 60.
• Being overweight or having obesity.
• A family history of heart attacks, strokes, or peripheral artery disease.
• Being physically inactive.

When to see a doctor

See a doctor urgently if:

• If your leg becomes suddenly pale, very cold, and painful, get emergency help right away – do not wait for a routine appointment.
• If you have an open wound on your leg or foot that is not healing and the leg feels very cold, call your local emergency number.
• If you cannot put weight on the leg or move your foot normally, seek urgent care.

Book a routine appointment if:

• Make a doctor's appointment if leg cramps or tiredness happen when you walk but go away with rest, even if you think it is just aging.
• See your doctor if you have diabetes and notice any non-healing sore on your foot or leg, even if it is not painful.
• If you have risk factors such as smoking, diabetes, or high blood pressure and develop leg pain that is not typical, mention it at your next check-up.

Diagnosis

Your doctor will ask about your symptoms and medical history, check the pulses in your feet and legs, and look at the color and temperature of your legs. A quick and painless test called an ankle-brachial index is often used to compare blood pressure in your ankle with blood pressure in your arm.

Tests that may be done

• Ankle-brachial index (ABI): blood pressure cuffs are placed on your arm and ankle to measure the difference.
• Doppler ultrasound: an imaging test that shows blood flow in your leg arteries.
• Blood tests: to check for diabetes, high cholesterol, and other risk factors.
• In some cases, a CT scan or magnetic resonance angiogram (MRA) may be done to give detailed pictures of the arteries.
• An angiogram (injecting a contrast dye into the arteries and taking X-rays) may be needed if surgery is being considered.

What to expect at your appointment

The tests are usually non-invasive and simple. An ankle-brachial index only takes a few minutes and does not require any needles. You can expect your doctor to discuss your results with you right away and suggest next steps. If further imaging is needed, you won't just be given a test without explanation – you will be referred to a specialist who will talk you through it.

Treatment

Treatment aims to relieve symptoms, improve your walking ability, and stop the artery disease from getting worse. The most important steps are lifestyle changes, particularly stopping smoking and increasing physical activity under medical advice. Doctors may also prescribe medicines to lower blood pressure, reduce cholesterol, and prevent blood clots. Some people need a procedure to open up a narrowed artery.

Self-care at home

• If you smoke, ask your doctor or pharmacist about the best ways to quit. Stopping smoking is the single most powerful thing you can do.
• Walk regularly, but rest when the pain starts. A planned exercise program, often called supervised walking therapy, can improve circulation and help you walk further.
• Take good care of your feet daily – look for cuts, blisters, or sores, and keep them clean and moisturized.
• Keep your blood sugar, blood pressure, and cholesterol in a healthy range by following the plan your doctor gives you.
• Avoid extreme cold and keep your legs warm in winter, but do not use hot-water bottles or heating pads on your feet.

Medical treatments

Your doctor can recommend several types of medication that help protect your arteries. These include medicines to lower blood pressure, to reduce cholesterol (called statins in general, but we are not naming brands), and to prevent blood clots (often a low-dose antiplatelet medicine). Always take them exactly as prescribed and talk to your doctor if you have any concerns. Never start any new medication without checking first.

When is surgery considered?

If symptoms are severe or lifestyle measures and medication are not enough, a specialist may offer a procedure to restore blood flow. This can involve angioplasty (inserting a small balloon to open the blocked artery, often with a mesh tube called a stent) or bypass surgery (using a healthy blood vessel from another part of the body to go around the blockage). These are considered only after a careful assessment with your medical team.

Living with this condition

Living with peripheral artery disease means protecting your leg health every day. Check your feet daily, keep them clean and dry, and speak to a doctor promptly about any sore or change in color. You can still lead a full and active life – pacing activities and taking rest breaks can help you manage symptoms.

Lifestyle tips

• Build up physical activity gradually. A realistic goal is to walk until the pain starts, rest, and then walk a little more.
• Stop smoking and avoid secondhand smoke – this is key.
• Keep your weight in a healthy range by eating a balanced diet low in saturated fats and processed foods.
• Avoid crossing your legs for long periods, as this can slow blood flow.
• Manage stress, which can affect your blood pressure and heart.

Diet and exercise

A heart-healthy diet is important: plenty of vegetables, fruits, whole grains, lean proteins, and fish, and limit salt and unhealthy fats. Try to get regular exercise on most days, with your doctor's advice. Even a short, daily walk can help your body grow tiny new blood vessels to bypass blocked areas. Supervised exercise programs are offered through many health services and can be very effective.

Mental health and emotional wellbeing

It can feel worrying to learn you have artery disease, and the pain can make you frustrated or low. It is normal, and you are not alone. If you feel down or anxious, talk to your doctor or a counselor. Looking after your mental health is just as important as your physical health.

Prevention

You can lower your risk of getting peripheral artery disease and slow its progress if you already have it. The biggest ways are to avoid smoking, keep your blood sugar and blood pressure under control, stay physically active, and maintain a healthy weight. These steps help prevent plaque from building up in your arteries.

Screening programmes

There is no routine screening test for everybody. But if you are age 60 or older and have risk factors such as diabetes, high blood pressure, smoking, or a family history of heart disease, your doctor might offer an ankle-brachial index test during a health check.

Complications

If left untreated

• Leg pain can get worse and limit how far you can walk.
• A blocked lower-limb artery may lead to a non-healing ulcer or sore, which can become infected.
• Very severe blockage can lead to gangrene (tissue death) and may require amputation.
• People with PAD are at higher risk of heart attack and stroke, because the same disease process affects other arteries.

Long-term outlook

The future is bright if you take action. Many people with PAD improve significantly with lifestyle changes, medications, and a walking program. Even if a procedure is needed, success rates are good, and most people are able to keep their leg health stable. With the right support, most people continue to live active, independent lives for many years.

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