Peripheral Arterial Disease (PAD): Leg Pain, Causes and Care

Pain in your legs when you walk is easy to put down to age or tiredness, but sometimes it is a sign of a circulation problem. Peripheral arterial disease, or PAD, is one cause. This article explains what the NHS says about it.

What is PAD?

The NHS describes PAD as a common condition in which fatty deposits build up in the arteries and restrict the blood supply to the leg muscles. It is a form of cardiovascular disease. The NHS lists it alongside coronary heart disease, aortic disease and stroke as one of the main types of cardiovascular disease.

Symptoms

Many people have no symptoms. When symptoms occur, they usually develop slowly. The NHS lists:

• A painful ache in the legs when walking, which usually eases after a few minutes of rest. This is called intermittent claudication, and can affect one or both legs.
• Hair loss on the legs and feet
• Numbness or weakness in the legs
• Brittle, slow-growing toenails
• Ulcers on the feet or legs that do not heal
• Skin that looks paler or blue, or shiny skin
• Erectile dysfunction in men
• Wasting of the leg muscles

Causes and risk factors

The NHS says PAD is usually caused by atherosclerosis, where cholesterol-based deposits called atheroma build up in the walls of the leg arteries and narrow them. Risk factors include smoking, which it calls the most significant, type 1 or type 2 diabetes, high blood pressure, high cholesterol and older age.

How is it diagnosed?

According to the NHS, a doctor usually diagnoses PAD through a physical examination and by comparing the blood pressure in your arm with the blood pressure at your ankle. This is called the ankle brachial pressure index, and a difference between the two may point to PAD. The NHS advises having recurring leg pain during exercise checked by a doctor.

Treatment and looking after yourself

The NHS says treatment is mainly lifestyle changes and medication. Lifestyle steps include:

• Regular exercise
• Not smoking
• A healthy diet
• Losing weight if you are overweight
• Moderating alcohol

Conditions such as high blood pressure, high cholesterol and diabetes should also be treated. Medicine and, in some cases, surgery can improve blood flow to the legs. With treatment, the NHS says most people's symptoms stay stable and some people's pain improves. For critical limb ischaemia, a serious form of the condition, an angioplasty or bypass graft is usually recommended, though these may not always succeed, and amputation is needed in a few cases. Your specialist will explain which treatments suit you.

The NHS page has no section on prevention, but its advice on risk factors suggests that not smoking, being active, eating well and controlling blood pressure, cholesterol and diabetes all matter. The WHO also lists peripheral arterial disease as one of the cardiovascular diseases and names tobacco use, an unhealthy diet and inactivity among the main risk factors.

When to see a doctor

See a doctor if you get recurring leg pain when you exercise, or if you notice any of the other symptoms above, especially sores on your feet that are slow to heal. Take extra care of your feet if you have diabetes.

Contact a doctor immediately if you develop signs of critical limb ischaemia, which the NHS lists as severe burning pain in the legs or feet that continues at rest, pale, shiny, smooth, dry skin, wounds or ulcers that do not heal, loss of leg muscle, or cold, numb skin on the toes or lower legs that turns red then black, swells or produces smelly pus. The NHS says symptoms that develop quickly or suddenly worsen may need immediate treatment. If you cannot reach a doctor, call a health helpline or seek emergency care.

In an emergency, call your local emergency number (112 in India, 911 in the United States).