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Peripheral Artery Disease (PAD): Leg Pain, Warning Signs, and Treatment
Leg pain or cramping in the calf that appears when you walk and disappears when you rest is not a normal part of getting older. It may be a sign of peripheral artery disease (PAD), a common condition in which narrowed arteries reduce blood flow to the legs. Because PAD is a sign of fatty buildup in the arteries (atherosclerosis), recognizing it early matters for more than your legs.
What is peripheral artery disease (PAD)?
Peripheral artery disease is the narrowing or blockage of the vessels that carry blood from the heart to the legs. It is caused by the buildup of fatty plaque in the arteries, a process called atherosclerosis. PAD can affect any blood vessel, but it is more common in the legs than the arms.
What does PAD leg pain feel like?
The classic symptom of PAD is pain in the legs with physical activity, such as walking, that improves with rest. The pain may be described as aching, burning, cramping, or fatigue, and it can appear in the buttock, thigh, calf, or ankle. Many people mistake this pain for arthritis, sciatica, or stiffness, but PAD pain occurs in the muscles, not the joints.
Not everyone with PAD has leg pain. Up to 4 in 10 people with PAD have no leg pain at all. For that reason, asking about PAD is important for anyone with the condition’s risk factors, even without symptoms.
Other warning signs to look for
In addition to leg pain, PAD can cause changes in the feet and legs, including:
- Loss of hair on the legs, or slower hair growth
- Skin on the legs that is smooth, shiny, or cool to the touch
- Decreased or absent pulses in the feet
- Sores or ulcers on the feet, toes, or legs that heal slowly or do not heal
- Cold or numb toes
- Slow-growing toenails
- Muscle loss (atrophy) in the calf
If you have diabetes, you may confuse PAD pain with neuropathy, the burning foot discomfort common in diabetic nerve damage. Describe your pain accurately to your provider so the correct cause can be identified.
Who is at risk for peripheral artery disease?
Common risk factors include smoking, diabetes, high blood pressure, high cholesterol, and increasing age, especially after 65 (or after 50 with other atherosclerosis risk factors). A family history of PAD, heart disease, or stroke also raises risk. Smoking is the main risk factor for PAD. Approximately 6.5 million Americans age 40 and older have PAD.
Why PAD matters beyond the legs
PAD is often a warning sign of artery disease elsewhere in the body. People with PAD are at higher risk for developing coronary artery disease and cerebrovascular disease, which can lead to a heart attack or stroke.
How is PAD diagnosed?
If you have symptoms of PAD, your doctor may perform an ankle-brachial index (ABI), a noninvasive test that compares blood pressure in the ankles with blood pressure in the arms at rest and after exercise. Imaging tests such as ultrasound, magnetic resonance angiography (MRA), and CT angiography may also be used.
How is PAD treated?
Treatment is shaped to your symptoms and general health, with the goals of reducing heart attack and stroke risk, improving your ability to walk, lowering your risk of losing a limb, and improving quality of life.
Lifestyle changes and medicine
Heart-healthy lifestyle changes form the foundation of PAD care. They include quitting smoking, increasing physical activity, and managing blood pressure, cholesterol, and diabetes. Antiplatelet medicines such as aspirin help prevent clots, and statins lower cholesterol and slow plaque buildup. A supervised exercise program, usually treadmill walking several times a week, improves leg symptoms and quality of life.
Procedures and surgery
When lifestyle changes and medicine are not enough, a procedure may be recommended. Angioplasty opens a narrowed or blocked artery, sometimes with a medicine-coated balloon or a stent. Bypass surgery uses a blood vessel from your body or an artificial vessel to create a new pathway around a blocked artery, often to treat severe pain, heal wounds, or save a damaged leg.
When to see a vascular surgeon
If you have leg pain with walking, non-healing sores, or any of the warning signs listed above, talk to your health care professional about PAD. For anyone with risk factors, asking about PAD is worthwhile even if you have no symptoms. Early evaluation can improve circulation, protect your legs, and reduce your risk of heart attack and stroke.
This article is for general information and is not a substitute for evaluation by your health care team. Dr. Emilio B. Hisse provides cardiovascular consultations and care for arterial insufficiency and leg circulation problems in Houston. If you are experiencing leg pain, cramping, or wounds that will not heal, call 713-667-3885.