artery with fatigue

Overview

Peripheral artery disease (PAD) is a condition where the arteries that carry blood to your legs become narrowed or blocked. This reduces blood flow, especially when you are active, which can make your leg muscles feel tired, achy, or heavy.

Peripheral artery disease is fairly common, especially in people over 50. It affects about 1 in 20 people in this age group, and the risk increases with age and certain health conditions.

PAD most often affects adults over 50, particularly those who smoke, have diabetes, high blood pressure, high cholesterol, or who are overweight. It is more common in men, but women can also develop it.

Symptoms

Common symptoms

• Leg fatigue, heaviness, or aching during walking or exercise that goes away with rest
• Cramping in the calf, thigh, or buttock during activity (known as claudication)
• Numbness or weakness in the legs
• Coldness in the lower leg or foot compared to the other side
• Sores on the toes, feet, or legs that heal slowly or not at all

Symptoms in children

• Peripheral artery disease is very rare in children. If it occurs, it is usually due to a genetic condition, and symptoms may include leg pain during exercise or poor growth of the affected limb.

Symptoms in older adults

• Symptoms may be less noticeable because older adults often reduce activity level
• Leg pain during walking can be mistaken for arthritis or general aging
• Sores on the feet or toes that are slow to heal are more common in older adults with PAD

Causes

Main causes

• Atherosclerosis – a buildup of fatty plaque inside the arteries that narrows them over time
• Blood clots that block an artery
• Inflammation of the arteries (less common)

Risk factors

• Smoking or using tobacco products
• Diabetes
• High blood pressure
• High cholesterol
• Overweight or obesity
• Lack of physical activity
• Age over 50
• Family history of heart or artery disease

When to see a doctor

See a doctor urgently if:

• You have sudden, severe leg pain with coldness, paleness, or numbness (call emergency services)
• You have a sore on your leg or foot that is not healing after 2 weeks

Book a routine appointment if:

• You experience leg fatigue, aching, or cramps during walking that go away with rest
• You notice your leg or foot feels cooler than the other side
• You have risk factors (smoking, diabetes, high blood pressure) and any leg symptoms

Diagnosis

Your doctor will start by asking about your symptoms and medical history. They will check the pulses in your legs and feet. A simple test called an ankle-brachial index (ABI) is often done to compare the blood pressure in your ankle with the blood pressure in your arm. This helps measure how well blood is flowing.

Tests that may be done

• Ankle-brachial index (ABI) – a non-invasive test using blood pressure cuffs
• Ultrasound – to see images of blood flow in the arteries
• Angiography – a special X-ray or MRI scan that uses dye to show blockages
• Blood tests – to check for diabetes, high cholesterol, and other conditions

What to expect at your appointment

The diagnosis is usually straightforward. You may have the ABI test in your doctor's office. If more detail is needed, you may be referred to a specialist (vascular surgeon) for further imaging. The tests are painless and do not require special preparation.

Treatment

The goal of treatment is to improve symptoms, prevent the disease from getting worse, and reduce the risk of heart attack or stroke. Treatment includes lifestyle changes, medicines, and sometimes procedures to open blocked arteries.

Self-care at home

• Stop smoking – this is the most important step
• Walk regularly – a supervised exercise program can help build new blood vessels around blockages
• Eat a heart-healthy diet low in saturated fat, salt, and sugar
• Maintain a healthy weight
• Manage diabetes, high blood pressure, and high cholesterol with your doctor's guidance

Medical treatments

Doctors may prescribe medicines to reduce the risk of blood clots, lower blood pressure, control cholesterol, and help with leg pain. Never take any medication without a prescription. Your doctor will choose treatments based on your specific needs.

When is surgery considered?

If symptoms are severe or if self-care and medicines do not help, your doctor might recommend a procedure to open the blocked artery, such as angioplasty (using a balloon to widen the artery) or bypass surgery (creating a new route for blood flow). These are usually done by a specialist.

Living with this condition

Living with PAD means paying attention to your legs. Check your feet daily for sores, cuts, or changes in color. Wear comfortable shoes and keep your feet clean and dry. Try to walk at a pace that does not cause severe pain, and rest when needed.

Lifestyle tips

• Quit smoking – seek help from your healthcare provider or local stop-smoking services
• Stay active – aim for 30 minutes of walking most days, but start slowly and build up
• Eat a balanced diet with plenty of fruits, vegetables, whole grains, and lean protein
• Manage stress and get good sleep

Diet and exercise

A heart-healthy diet includes less salt, less fatty foods, and more fiber. Exercise, especially walking, can improve circulation and reduce symptoms. Your doctor or a physiotherapist can help create a safe exercise plan.

Mental health and emotional wellbeing

Living with a chronic condition can be stressful and may lead to anxiety or depression. It is normal to feel frustrated or worried. Talk to your doctor if you feel down or anxious – support is available.

Prevention

You cannot always prevent PAD, but you can lower your risk by not smoking, staying active, eating healthily, and managing conditions like diabetes and high blood pressure. These steps can also slow the progression if you already have PAD.

Screening programmes

Routine screening is not recommended for everyone, but your doctor may check for PAD if you have risk factors such as diabetes, smoking, or a family history of heart disease.

Complications

If left untreated

• Non-healing sores on the feet or legs that can become infected
• Gangrene (tissue death) which may require amputation
• Heart attack or stroke – because the same artery disease can affect heart and brain arteries

Long-term outlook

With proper treatment and lifestyle changes, most people with PAD can manage their symptoms and prevent serious complications. Many people continue to walk with less pain and enjoy a good quality of life. Early diagnosis and care make a big difference.

Find support

International organisations

• World Health Organization (WHO) ↗

Local organisations

• British Heart Foundation ↗ · United Kingdom

Helplines

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