My Legs Hurt: Could it Be PAD?

Peripheral arterial disease is a blood circulation condition

An older man exercises outdoors to help improve blood circulation and reduce the risk of developing PAD symptoms. SD Health Magazine

Peripheral arterial disease is a blood circulation condition

More than 200 million people worldwide suffer from a hardening of the arteries known as peripheral arterial disease (PAD). In the United States, it affects roughly 1 in 20 people over the age of 50, according to the National Heart, Lung, and Blood Institute. 

PAD is caused by a narrowing of the arteries in the legs, arms, kidneys or neck due to buildup of fatty deposits and calcium. PAD causes pain and difficulty walking and corresponds with an increased risk of heart attack and stroke. Early intervention and lifestyle modification can help reduce these risks. 

“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. But the main symptom of peripheral arterial disease is what’s known as claudication, or pain when walking,” explains Devin Zarkowsky, MD, a vascular surgeon at Scripps Clinic

“People will notice pain in their legs, calves and buttocks, or it can become as severe as constant foot pain, even when not walking, gangrene and loss of function,” he continues. 

“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.” 

Reducing risk of PAD

While people may think that leg pain is a natural part of getting older, there are numerous ways to lower the severity of discomfort and reduce the risk of developing PAD. 

“Age certainly plays a role in your risk of PAD. Just about everyone gets some hardening of the arteries as they age,” Dr. Zarkowsky 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.” 

Because PAD is such a widespread condition, the first step to treat it is through lifestyle modifications, like quitting smoking, eating a healthy diet low in carbohydrates and fat and exercising regularly.

“However, there is a subset of people with claudication that have their lives upended by their inability to walk,” Dr. Zarkowsky continues. 

PAD treatment at Scripps

For people with severe PAD that lowers their quality of life, limits movement or causes ulcers in the legs and feet, there are surgical interventions available. 

At Scripps, a multidisciplinary team, made up of primary care, vascular surgeons, cardiology, hematology, nephrology, endocrinology and more, work together to ensure the best treatment approach for each patient. 

“Scripps vascular surgeons are trained in both open surgery and minimally invasive catheter procedures, including balloons and stents, to treat patients with PAD,” Dr. Zarkowsky 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.” 

For people with mild to moderate symptoms, however, Dr. Zarkowsky recommends keeping PAD in check through routine visits with a primary care physician and keeping an eye out for worsening symptoms. 

“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,” he concludes. “Otherwise, exercise really is the best medicine for most problems associated with PAD.” 

San Diego Health Magazine Winter 2023 Cover

This content appeared in San Diego Health, a publication in partnership between Scripps and San Diego Magazine that celebrates the healthy spirit of San Diego.

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