7 Peripheral Artery Disease Symptoms (PAD) & How To Manage Them

• Peripheral artery disease (PAD) is caused by plaque buildup in the blood vessels that carry blood away from the heart to other parts of the body, such as the legs.
• According to the Centers for Disease Control and Prevention (CDC), approximately 6.5 million people age 40+ in the United States have PAD.
• While there isn’t a cure for PAD, there are ways to treat and manage the condition’s symptoms.

Peripheral artery disease (PAD) is a type of cardiovascular disease with a long list of potential symptoms. It may slow hair growth, cause a burning, aching, or numbness in one leg or two legs, and decreased or absent pulses in the feet. According to the American Heart Association, early symptoms are often mild and many people mistake them for other conditions, like arthritis. Continue reading to learn more about this condition, how to catch it before severe symptoms or serious complications occur, and when to see a primary care provider or internal medicine specialist about symptoms that could be due to PAD.

Peripheral artery disease (also known as peripheral arterial disease, PAD, or peripheral vascular occlusive disease) occurs when the narrowing of arteries or blockages in the arteries or artery walls occurs, usually in the legs or lower extremities of the body. This reduces blood flow from the heart to other areas of the body. When parts of the body get too little blood flow, someone may experience pain, numbness, weakness, or other sensations that are not normal. PAD can also make everyday tasks like climbing stairs difficult.

While PAD can occur in other areas of the body, such as the arms, it is more common for it to happen in the legs. 

Peripheral Artery Disease (PAD) Vs. Coronary Artery Disease (CAD)

While peripheral artery disease deals with blockages and narrowed blood vessels that carry blood to other parts of the body, coronary artery disease involves blockages and narrowed arteries in the heart, which can lead to heart disease or heart attack.

These two conditions are different, but they are often related. If you are diagnosed with PAD, you are at higher risk for CAD, and vice versa.

Types of Peripheral Artery Disease

There are a few different forms of peripheral artery disease.

• Lower Extremity Peripheral Artery Disease: Lower extremity PAD is the common form of PAD, which affects the legs, feet, and other lower extremities.
• Upper Extremity Peripheral Artery Disease: Upper extremity PAD affects the upper body, usually the arms and the hands, and is far less common than other types.

The cause of peripheral artery disease is atherosclerosis. When plaque builds in the arteries, they become narrow or blocked, thus preventing blood flow. When blood is restricted from PAD, it can’t move from the heart to other areas of the body through the peripheral arteries. 

The most common symptoms of peripheral artery disease include:

1. Burning or aching pain in feet and toes
2. Numbness or weakness in legs or feet
3. Redness, shiny skin, or other changes in skin color
4. Toe and foot sores that don’t heal
5. Slow growing toenails that are often brittle
6. Hair loss on legs or feet
7. Coldness of skin on lower leg or foot
8. No pulse or weak pulse in one or both legs
9. Leg pain or foot pain when resting or sleeping
10. Pain in legs when exercise, which is called claudication

Often, these symptoms go unnoticed for a significant period, as PAD can develop over the course of years or even decades.

Risk factors for PAD include:

• Age: Those over the age of 65 are more likely to develop PAD, (although PAD can occur at any age).
• Chronic conditions: Those with type 2 diabetes, chronic kidney disease, blood clotting conditions such as thrombocytosis, high blood pressure, or high cholesterol (high blood cholesterol), are more likely to develop PAD.
• Family history: Those with a family history of PAD, heart disease, stroke, etc. are predisposed to develop PAD.
• Weight: Those who are overweight or obese are at greater risk of developing peripheral artery disease.
• Race: African Americans are predisposed to developing PAD.
• Poor lifestyle habits: Those who smoke, vape, or use tobacco products are more likely to develop PAD.

If you start to experience severe pain in the legs, numbness or weakness in the legs, or notice other symptoms of PAD, it’s best to make an appointment with your doctor immediately.

If you experience chest pain, pain that spreads to the shoulder, sudden dizziness or lightheadedness, or cold sweats, please call 911 immediately or head to the nearest hospital as you could be having a heart attack.

To diagnose PAD, a doctor will first perform a physical exam followed by additional tests.

Physical Exam

To diagnose coronary artery disease, your primary care physician will perform a physical exam that typically includes:

• Asking about your lifestyle
• Asking about your family and medical history
• Measuring your blood pressure
• Listening to your heart with a stethoscope
• Asking about symptoms you’re experiencing

Tests

There are a few tests that a healthcare provider may run to try and diagnose/​determine the severity of PAD. These include:

• Ankle-brachial index (ABI)
• Blood tests
• Pulse volume recording
• Vascular ultrasound
• Angiogram

The American College of Radiology has created clinical practice guidelines for these imaging tests, which healthcare providers follow when testing for PAD. If a diagnosis of PAD is determined, your provider will help create a treatment plan.

Lifestyle changes and medications are the most common ways of treating peripheral artery disease. In some cases, surgery or other medical procedures may be involved.

Lifestyle changes

Your healthcare provider will likely have you initiate lifestyle changes as a first step to treating and managing PAD symptoms. Some of these changes may include:

• Eliminating tobacco:  No longer smoking, vaping, or using tobacco products. Smoking cessation (to quit smoking) can be difficult to achieve on your own, but healthcare providers may offer support and resources that will help. 
• Changing your diet: Altering your diet to focus on foods that are high-fiber and low in fat, cholesterol, and sodium
• Staying physically active: Exercising for about 30 minutes daily, five days a week. Walking, jogging, or other physical activities count towards this goal. If someone struggles to consistently engage with exercise therapy, a structured and supervised exercise program may offer some accountability.
• Lowering stress levels: Keeping stress levels low can help with PAD symptoms. Yoga, meditation, and other relaxing activities can all help manage stress levels.
• Intentional foot/​leg care: If you haven’t already, caring for your legs and feet by washing, drying, moisturizing, and immediately treating any infections or issues that arise can help keep PAD symptoms from worsening.

Medications

Your doctor may prescribe certain medications to treat other conditions that affect PAD, including blood pressure, cholesterol, or leg pain.

• Medications for high blood pressure, such as ACE inhibitors or calcium channel blockers
• Medications for high cholesterol, such as Statins or PCSK9 inhibitors
• Medications to help prevent blood clots, such as blood thinners
• Medications to help with leg pain, such as cilostazol

Surgery or Procedures

In some cases, surgery or certain medical procedures may be necessary to treat PAD. These procedures are typically performed by a vascular surgeon and may include:

• Angioplasty: This procedure involves reopening a blocked artery to allow better blood flow. Sometimes, a stent may be placed to keep the artery open.
• Bypass surgery: This procedure involves creating a path to bypass blocked arteries. It’s an open surgery that works around the blocked artery using a new artery. This may be a healthy blood vessel from somewhere else in the body or a synthetic one created for the surgery.
• Thrombolytic therapy: This procedure is used specifically if there is a blood clot in the artery. A medication to dissolve the clot is administered to the blocked artery.

If you have high-risk factors for peripheral artery disease, there are some steps you can take to potentially help prevent the disease, including:

• Eliminating tobacco usage
• Managing and maintaining a healthy weight
• Eating a well-balanced, healthy diet
• Exercising 30 minutes per day, five days a week

Complications of untreated peripheral artery disease include:

• Ischemia/​Gangrene
• Amputation
• Infection
• Ulceration
• Heart attack
• Stroke
• Blood clots
• Erectile Dysfunction

Currently, there is no cure for PAD. However, the prognosis for managing symptoms and slowing the progression of the disease is still hopeful.

Slowing the progression will highly depend on your age, risk factors, and other health conditions, as well as if caught early and treatment protocols given by your doctor, such as medication and lifestyle changes, are followed.