Leg Pain: Could It Be Peripheral Artery Disease?

Blood circulation condition can make walking difficult

A man grabs his leg in pain, which may be due to peripheral artery disease.

Blood circulation condition can make walking difficult

During your usual morning walk, you feel pain in your calf muscles. The pain stops when you rest but returns when you start again.

If leg pain is a recurring issue, it might not be from exercising. It could be an early symptom of peripheral artery disease (PAD).

PAD is caused by narrowing of the arteries in the legs, arms, kidneys or neck due to buildup of fatty deposits and calcium. It is most often found in the legs.

PAD reduces oxygen-rich blood flow to the arms and legs, and other body parts, leading to symptoms from decreased blood flow.

“Your doctor may diagnose you with peripheral arterial disease if they recognize that the blood flow in your legs isn’t what it used to be,” says Jeffrey Weiss, MD, a vascular surgeon at Scripps Clinic Anderson Medical Pavilion in La Jolla. “But the main symptom of PAD is what’s known as claudication, or pain when walking. People will notice pain in their legs, calves and buttocks.”

Making lifestyle changes and seeking prompt treatment can lower these risks or prevent PAD from getting worse.

“PAD can become as severe as constant foot pain, even when not walking, gangrene and loss of function,” Dr. Weiss says. “There’s a wide spectrum of clinical presentations, but what we really look for is risk of amputation. That’s rare, at around 1% per year for claudication.” 

What causes PAD?

PAD is usually caused by a condition known as atherosclerosis. This is when plaque accumulates in the arteries, causing them to become narrow and stiff, reducing blood flow.

PAD affects 1 in 20 people over age 50 in the United States. People with PAD often have trouble moving and are at higher risk for heart attack, stroke and limb amputation.

“Your doctor can diagnose peripheral arterial disease by performing tests to assess symptoms, examine blood vessels and evaluate blood flow,” Dr. Weiss says.

Symptoms of PAD

PAD symptoms develop gradually and may go unnoticed at first. Some common symptoms are:

  • Pain in legs or arms with activity
  • Lack of healthy blood flow in feet, legs and arms
  • Poor wound healing in toes, feet or legs
  • Weak or no pulse in legs, arms or feet
  • Significant pain in feet and toes while trying to sleep at night
  • Onset of gangrene in legs and feet
  • Hair loss on legs
  • Erectile dysfunction in men

Risk factors for PAD

Getting older is a risk factor for PAD that cannot be changed, but there are other risk factors that can be managed.

“Age certainly plays a role in your risk of developing peripheral artery disease. Just about everyone gets some hardening of the arteries as they age,” Dr. Weiss says. “But the largest patient population with PAD are people who smoke, as well as those with high blood pressure, high cholesterol, diabetes, a history of cardiac surgery or a cardiac intervention, stroke or kidney disease.” 

To reduce your risk of PAD, the first steps are lifestyle modifications, like quitting smoking, eating a healthy diet low in carbohydrates and fat and exercising regularly.

If you have diabetes, high blood pressure or high cholesterol, work with your doctor to keep these under control.

Treatments for PAD

PAD is mostly treated with lifestyle changes, medications, special care, and sometimes surgery.

Medications may include:

  • Antiplatelet agents like aspirin to help stop blood clots from forming
  • Statins to lower cholesterol levels and prevent plaque buildup in the arteries
  • Antihypertensive treatments, such as ACE inhibitors or beta-blockers, to help manage the condition
  • Cilostazol, a medication that can improve the blood flow and assist in improving your pain-free walking distance or time

Common treatments may include:

  • Angioplasty uses a balloon to open blocked arteries. A stent may be used to keep the artery open in serious cases.
  • Bypass surgery creates a new path for blood flow when arteries are blocked.
  • Supervised exercise programs to improve symptoms, typically using a treadmill.
  • Special wound care to help with sores or ulcers that are not healing and prevent infections

PAD treatment at Scripps

At Scripps, a team of doctors with different specialties collaborate to find the best treatment for patients with PAD, also known as peripheral vascular disease. They include primary care doctors and specialists in heart surgery, blood disorders, kidney health, hormone disorders and other areas.

Severe PAD can impact quality of life, movement and cause leg ulcers. In these cases, surgical options can help improve the condition. 

“Scripps vascular surgeons are trained in both open surgery and minimally invasive catheter procedures, including balloons and stents, to treat patients with peripheral artery disease,” Dr. Weiss says.

“The decision to perform surgery on someone with PAD is extremely nuanced. It requires a discussion among the patient’s physicians and a decision that fits in with the patient’s goals and risk factors,” he says.

For mild to moderate symptoms, see a primary care doctor regularly and watch for any symptoms getting worse.

“Certainly, if you have ulcers on your feet or legs, or if you are in pain all the time, then you should see your doctor immediately,” Dr. Weiss says. “Otherwise, exercise really is the best medicine for most problems associated with PAD.” 

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