artery that worsens lying down

Overview

Peripheral artery disease (PAD) happens when arteries that carry blood to your legs become narrowed or blocked by fatty deposits. This can cause leg pain that gets worse when you lie down and feels better when you dangle your legs over the side of the bed.

Peripheral artery disease is fairly common, especially in people over age 50. Many people have it without knowing because symptoms can be mild or mistaken for normal aging.

PAD most often affects adults over 50, especially those who smoke, have diabetes, high blood pressure, high cholesterol, or a family history of artery disease. It can also affect younger people with certain risk factors.

Symptoms

Common symptoms

• Leg pain or cramping that starts when you walk and stops when you rest (called claudication)
• Pain, numbness, or ache in your feet or toes that gets worse when you lie flat and feels better when you hang your legs down
• A feeling of coldness in your lower leg or foot compared to the other side
• Skin on your legs or feet that looks pale, shiny, or bluish
• Weak or absent pulse in your leg or foot

Symptoms in older adults

• Pain when lying down that makes it hard to sleep, often relieved by sitting or dangling legs
• Legs feeling cold or numb even when the room is warm
• Sores or wounds on the feet or toes that heal slowly or not at all

Causes

Main causes

• Atherosclerosis — a buildup of fatty plaque inside the artery walls that narrows or blocks blood flow
• Inflammation of the blood vessels (vasculitis) or injury to an artery (rare)

Risk factors

• Smoking or using tobacco products
• Diabetes
• High blood pressure
• High cholesterol
• Age 50 or older
• Family history of heart or artery disease
• Obesity
• Not being physically active

When to see a doctor

See a doctor urgently if:

• You have leg pain that gets worse when you lie down and does not improve when you change position
• You notice a sore on your foot or toe that is not healing after a few days
• Your leg or foot feels cold, looks pale, or you can't feel a pulse

Book a routine appointment if:

• You have leg cramps or pain when walking that makes you stop
• You are worried about your risk for PAD because of your age, smoking, or other conditions
• You have been diagnosed with PAD and your symptoms are changing

Diagnosis

Your doctor will ask about your symptoms, check the pulses in your legs and feet, and may do simple tests to see how well blood is flowing to your limbs.

Tests that may be done

• Ankle-brachial index (ABI) — compares blood pressure in your ankle to blood pressure in your arm using a blood pressure cuff and a Doppler ultrasound
• Doppler ultrasound — uses sound waves to create images of blood flow in your arteries
• Blood tests — to check for diabetes, high cholesterol, and other conditions
• Angiography — a special X-ray with dye that shows blockages (only done if treatment is planned)

What to expect at your appointment

Most tests are painless and done in your doctor's office or a hospital clinic. You may be asked to lie down for the ankle-brachial index test and to avoid smoking or caffeine beforehand. Your doctor will explain the results and discuss next steps.

Treatment

Treatment for PAD focuses on relieving symptoms, improving blood flow, and lowering your risk of heart attack and stroke. It usually starts with healthy lifestyle changes and medicines. If symptoms are severe or don't improve, a procedure may be recommended.

Self-care at home

• Stop smoking — this is the most important step you can take to slow down PAD
• Walk regularly — aim for 30-60 minutes of walking most days, even if you have to stop and rest
• Keep your feet clean, dry, and well-moisturized to prevent sores
• Wear comfortable shoes and avoid going barefoot
• Manage other health conditions like diabetes, high blood pressure, and high cholesterol

Medical treatments

Your doctor may suggest medicines to help prevent blood clots, lower cholesterol, reduce blood pressure, or control blood sugar. These are prescribed as pills or injections. It is important to take them exactly as directed. A supervised exercise program (walking therapy) can also improve symptoms.

When is surgery considered?

If lifestyle changes and medicines are not enough and you have severe pain at rest or non-healing sores, your doctor may recommend a procedure such as angioplasty (opening the artery with a tiny balloon) or bypass surgery (creating a detour around the blocked artery). These are done by a vascular specialist.

Living with this condition

Living with PAD means taking good care of your feet, staying active, and keeping up with doctor visits. Most people can manage symptoms well with the right habits. If walking hurts, try to walk a little each day — rest when you need to, but keep moving.

Lifestyle tips

• Quit smoking — get help from your doctor or a stop-smoking program
• Walk every day, slowly increasing how far you go
• Check your feet daily for cuts, blisters, or changes in color
• Eat a heart-healthy diet with plenty of fruits, vegetables, and whole grains
• Keep your weight in a healthy range

Diet and exercise

Eat a diet low in saturated fat, salt, and added sugar. Include foods like oatmeal, fish, nuts, and leafy greens. Aim for at least 30 minutes of walking or other moderate activity on most days. If walking is difficult, ask your doctor about a supervised exercise program.

Mental health and emotional wellbeing

Living with chronic pain or limited mobility can be frustrating and can affect your mood. It is normal to feel worried or down sometimes. Talk to your doctor if these feelings last, and consider joining a support group or speaking with a counselor.

Prevention

You can lower your risk by not smoking, staying active, eating healthfully, and managing conditions like diabetes and high blood pressure. Even if you have PAD, these steps can keep it from getting worse.

Screening programmes

There is no routine screening for PAD. Your doctor may check your circulation if you have risk factors or symptoms. If you are over 65 and have ever smoked or have diabetes, it is reasonable to ask about a one-time ankle-brachial index test.

Complications

If left untreated

• Foot or leg wounds that do not heal, leading to infection or gangrene (tissue death)
• Increased risk of heart attack or stroke
• Severe pain that makes walking or sleeping difficult
• In rare cases, the need for amputation of a toe, foot, or part of the leg

Long-term outlook

With early diagnosis and consistent care, most people with PAD can maintain an active, independent life. Quitting smoking and managing related health conditions greatly improve the outlook. Even if symptoms are bothersome, treatments today offer real hope for relief and prevention of serious problems.

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