What's Causing Your Leg Pain? Understanding Peripheral Artery Disease (PAD)

Taking a brisk walk or climbing a long flight of stairs can often cause discomfort, especially as we get older. But if you feel pain in your lower legs and feet during ordinary activities that gets better when you sit down, you may have peripheral artery disease (PAD) — a serious vascular condition.

"PAD is often overlooked because the symptoms are similar to other conditions, or there may be no symptoms at all," says Dr. Tony Lu, a vascular surgeon at Houston Methodist. "Ignoring it can lead to serious complications — amputation in the most severe instances."

What is peripheral artery disease?

Peripheral artery disease occurs when a buildup of fatty deposits called plaque block or narrow arteries, especially ones in the legs. This process is called atherosclerosis. Narrowed arteries restrict blood flow to the lower legs and feet, which can prevent wounds from healing. This can lead to serious infections.

"The blockages happen inside the arteries that lead away from the heart," explains Dr. Lu. "It most commonly happens in the legs, but we also see it in the abdomen, pelvis and occasionally the arms."

Because PAD is caused by atherosclerosis, the people most at risk for developing the disease have heart-related conditions or behaviors, including:

• High blood pressure
• High cholesterol
• Family history of cardiovascular disease
• Diabetes
• Overweight or obesity
• Sedentary lifestyle
• Smoking

How do you know if you have PAD?

The most recognizable sign of PAD is leg pain or cramping during ordinary physical activity (such as walking from one room to another) that goes away when you rest.

"PAD doesn't feel like discomfort from a muscle strain or joint problem that persists even when you're not moving," Dr. Lu says. "PAD pain is reproducible. If every time you walk two blocks your legs cramp, then it goes away when you sit, but it happens again the next time ... that's a red flag."

Other symptoms of PAD can include:

• Numbness or weakness in the legs
• Coldness in the lower leg or foot
• Sores or wounds on the feet or legs that heal slowly, or not at all
• Changes in skin color or shiny skin on the legs

What happens if peripheral artery disease goes untreated?

As Dr. Lu explains, a patient can develop PAD without realizing it. Many patients attribute leg or foot pain to the normal effects of aging, while others have no symptoms at all.

"PAD can be difficult to diagnose, and that means we might not detect it until something serious happens," Dr. Lu says. "Over time, the blood flow becomes so restricted that even at rest, the tissue in the feet and legs cannot get enough oxygen. If this isn't addressed and tissue damage becomes irreversible, the risk of amputation is real."

He also cautions patients that PAD isn't just a problem for legs and feet. It's a sign of widespread vascular disease, with an increased risk of heart attack and stroke as well, so screening for these should also be considered.

How is peripheral artery disease diagnosed?

If you or your primary care provider suspect you may have PAD, diagnosis starts with a thorough physical exam and non-invasive tests.

"We typically do a simple test called an ankle-brachial index, or ABI," Dr. Lu says. "We compare the blood pressure in your ankles to the blood pressure in your arms to assess the blood flow."

Your doctor can also use an ultrasound or Doppler instrument to visualize the circulation and identify where blockages are occurring. In advanced or complex cases, a CT scan or MRI may be needed.

What treatments are available for PAD?

While PAD is a serious condition, the disease is manageable — and even reversible in some cases — when caught early.

The first line of defense is lifestyle modifications, such as:

• Quitting smoking
• Exercising regularly
• Eating a heart-healthy diet
• Managing high blood pressure, high cholesterol and diabetes

(Related: Am I Exercising Enough?)

Depending on your other health conditions, your provider may also prescribe medication to help keep the blood flowing freely through your arteries. The most common PAD medications include a low dose of aspirin to prevent blood clots and cholesterol-lowing drugs called statins.

Patients with advanced PAD may need surgery to restore blood flow. Surgical options include:

• Angioplasty: A balloon inserted in a narrowed artery to stretch it open
• Stenting: A mesh tube placed in an artery to keep it open
• Bypass surgery: A graft that reroutes blood flow around a blockage

Dr. Lu cautions patients that PAD treatments focus on relieving symptoms rather than a cure.

"None of the interventions we offer will last forever, though," he says. "Even in the best-case scenarios, procedures will only keep the vessels open for so long. Lifestyle modifications are truly the best way to truly reduce the chance of forming more plaque and living disease free."

Living with PAD: Tips for managing the condition

PAD doesn't have to drastically change your quality of life. With proper management and a few simple tips, many patients live active, healthy lives:

• Practice good foot care: Check daily for blisters, sores or color changes
• Control pain: Use pain relievers as needed
• Keep follow-up appointments: Regular checkups help monitor progress and catch complications early
• Maintain a healthy lifestyle: Stay motivated with a heart-healthy diet and exercise as much as you can

(Related: Painkillers: Which OTC Medication is Right for Me?)

Dr. Lu adds an important reminder: "You don't always need procedures. Just because there's a narrowing doesn't mean it must be fixed, especially if you're not having symptoms. Our goal should always be to improve quality of life, not just treat images or test results."