Stephen Nicholls, MD, FACS
PeaceHealth Medical Group
Thoracic & Vascular Surgery
PAD: When it hurts to walk
A stroll around the block or a walk through a shopping mall may be easy for some people. For others, it’s a pain in the legs. And that’s not a good sign.
Discomfort when you walk for even a short distance could be a symptom of peripheral arterial disease (PAD), a serious medical condition. However, it can be treated with lifestyle modifications, medications and, if necessary, angioplasty or surgery.
Behind the pain
PAD is a sign that blood flow to any part of the body beyond the heart may be blocked. However, PAD usually reveals itself when circulation of blood in a leg is partially blocked by the buildup of plaque on artery walls. This can take years to develop, so it is more common as people enter their 50s and 60s.
Reduced blood flow in the legs often causes fatigue, numbness, cramping or severe pain in the calf, thigh or hip muscles when you exercise. Stopping for a short rest usually relieves these symptoms. However, once you resume exercise, the discomfort returns. Severe pain in the feet or toes while you are lying down (often noticed at night when in bed) may signify advanced disease.
Many people with PAD lose much ability to function before they see a doctor. They finally seek help when symptoms are unbearable and they need relief.
Testing is painless
The ankle-brachial index (ABI) test is used to detect PAD. This can be done in most doctors’ offices. During the test, one blood pressure cuff is placed on your arm and another on your ankle. The test measures how well the blood is flowing in your legs compared with your arms.
If PAD is diagnosed and a procedure to open the arteries is needed, Doppler ultrasound, magnetic resonance imaging (MRI) or computed tomography (CT) can more precisely located the blocked area of the artery.
The American Heart Association endorses testing for people who:
Have discomfort in their leg muscles during exertion
Have wounds that don’t heal on their feet and legs
Are 50 or older, have diabetes, and a history of smoking
Some patients younger than 50 who have diabetes and multiple risk factors should also get tested.
Reducing your risk
PAD is a major risk factor for heart attack and stroke. It is especially dangerous for those who have diabetes or continue to smoke or have other risk factors, including hypertension and elevated cholesterol levels.
Quitting smoking, getting regular exercise, and eating a healthy diet that is low in fat and salt are helpful in the prevention of cardiovascular disease and PAD.
Published November 2007.