Overview
Peripheral artery disease (PAD) is a common condition in which fatty deposits () build up in the arteries and narrow them. This is called atherosclerosis. PAD most often affects the arteries of the legs, so the leg muscles do not get enough blood.
The same process can affect the arteries of the heart and brain, so PAD is a sign of wider artery disease and raises the risk of heart attack and stroke.
Symptoms
Many people have no symptoms. The most common one is pain, cramp, aching or heaviness in the calf (sometimes the thigh or buttock) that starts with walking or climbing stairs and eases within minutes of rest. This is called intermittent claudication. Other signs can include:
- One foot or leg feeling colder than the other
- Pale or bluish skin
- Numbness, tingling or weakness in the leg
- Hair loss on the legs and slow-growing toenails
- Sores on the toes, feet or legs that heal slowly or not at all
Constant pain in the foot or leg at rest, and sores that do not heal, mean the blood supply is badly reduced (critical limb ischaemia).
When to see a doctor
See a doctor if you have leg pain when walking that settles with rest. It is not a normal part of ageing. A sore that is slow to heal, or constant pain in the foot at rest, needs attention within a day or two.
Causes
PAD is caused by atherosclerosis. and other substances form fatty deposits on the artery walls, which narrow the artery and reduce blood flow to the legs. A blood clot can also form on the deposits and block the artery suddenly.
Risk factors
- Smoking and other tobacco use, the most important risk factor
- Diabetes
- High
- High
- Older age
Complications
PAD is not immediately life-threatening, but it can lead to:
- Heart attack and stroke
- Critical limb ischaemia, with constant pain at rest, sores that do not heal and, in the worst cases, gangrene
- Infection of foot sores
- Loss of a limb in severe cases
- A sudden blockage of a leg artery (acute limb ischaemia)
Prevention
- Not smoking or using tobacco, and avoiding other people's smoke
- Keeping , and diabetes under control
- Walking and being active regularly
- Eating a healthy diet, with less salt, saturated fat and sugar
- Keeping to a healthy weight and limiting alcohol
If you have risk factors, ask a doctor about testing even if you have no symptoms.
Diagnosis
A doctor examines the legs and feet, and compares the in the ankle with the blood pressure in the arm. This is the ankle brachial pressure index (ABPI), and a lower reading at the ankle suggests narrowed arteries. A scan of the leg arteries may be done if a procedure is being considered, and the doctor will also check for diabetes, high blood pressure and high .
Treatment
There is no cure, but treatment can ease symptoms and lower the risk of heart attack and stroke. The two most important steps are regular exercise and stopping smoking. Doctors often advise a supervised walking programme.
Medicines include -lowering medicines (), medicines that lower , and medicines, such as aspirin, that reduce the risk of clots. Diabetes needs good control.
If leg pain limits daily life, or the limb is at risk, a procedure may be advised. In , a small balloon, sometimes with a , widens the artery. In bypass surgery, a blood vessel from elsewhere carries blood around the blockage. Amputation is needed only in a few cases of severe critical limb ischaemia.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Pain in the legs on walking is just old age, weakness or arthritis.”What is true?
Fact
Leg pain when walking is not a normal part of ageing. It can be a sign of peripheral artery disease, which is treatable, so it should be checked by a doctor.
Myth“If walking hurts, I should stop walking and rest.”What is true?
Fact
Regular walking is one of the main treatments for PAD. Doctors often advise walking until the pain is hard to bear, resting until it eases, and then walking again, ideally in a supervised programme. Exercise can ease symptoms and lower the risk to the heart. Ask your doctor how much is right for you.
Myth“PAD only affects the legs.”What is true?
Fact
The fatty build-up that narrows the leg arteries can affect the arteries to the heart and brain too, so PAD raises the risk of heart attack and stroke. Treatment aims to protect the heart as well as the legs.
Myth“A small sore on the foot will heal by itself, even if it is slow.”What is true?
Fact
In PAD the poor blood supply makes sores slow to heal, or unable to heal, and they can become infected. A sore that is not healing needs a doctor's attention.
Myth“PAD always ends in amputation.”What is true?
Fact
Most people's symptoms stay stable, and some improve with lifestyle changes and medicines. Amputation is needed only in a few severe cases, which is why early treatment and not smoking matter.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Is PAD the same as varicose veins?
No. PAD affects the arteries, which carry blood to the legs, and reduces the blood supply. Varicose veins are swollen veins that carry blood back towards the heart. Compression stockings, which are used for varicose veins, are not suitable if the leg arteries are poorly supplied with blood, so a doctor should check first.
Can PAD be cured?
There is no cure, but treatment can ease symptoms and slow the disease. Most people's symptoms stay stable, and some get better with exercise, stopping smoking and medicines.
Can I exercise if walking is painful?
Yes, and it is one of the best treatments. A common method is to walk until the pain becomes hard to bear, rest until it eases, then walk again. Ask your doctor about a supervised programme and how much to do.
Does diabetes make PAD worse?
Diabetes is a risk factor for PAD, and poorly controlled diabetes can make the symptoms worse. Keeping blood sugar under control, and reporting any foot sore that is slow to heal, helps protect the legs.
