10 Warning Signs of Peripheral Artery Disease
Medically Reviewed by Richard Fox, MD
Most people blame their aching calves on getting older. Maybe you have cut your evening walk short, or you have started stopping halfway through the grocery store until a leg cramp fades.
But the pattern of pain that shows up when you move and fades when you stop may actually be a textbook sign of peripheral artery disease.
According to the American Heart Association, approximately 10-12 million American adults over age 40 are affected by peripheral artery disease (PAD).³ Many of them do not know it yet.
Quick Answer
Peripheral artery disease (PAD) happens when plaque narrows the arteries that carry blood to your legs and feet. The most common warning sign is leg pain or cramping during walking that goes away after a few minutes of rest. Other peripheral artery disease symptoms include one foot feeling colder than the other, pale or bluish skin, sores on the feet that will not heal, hair loss on the legs, a weak pulse in the feet, and leg pain at night. Many people have no symptoms at all. If you smoke, have diabetes, or are over 50, ask your doctor about a quick, painless test called the ankle-brachial index (ABI).
Why PAD Is Easy to Miss
Only about 1 in 4 people with PAD have the “classic” leg pain doctors look for. More than half have symptoms that do not fit the usual description, and roughly 1 in 5 do not notice anything at all.¹ The Centers for Disease Control and Prevention notes that up to 4 in 10 people with PAD never have leg pain.²
That is why knowing how to spot peripheral artery disease symptoms matters.
1. Leg Pain When You Walk That Stops When You Rest
Doctors call this intermittent claudication. It can feel like cramping, aching, heaviness, or fatigue, and it usually shows up in the calf. It can also hit the thigh, hip, or buttock.² The key indicator is the start-stop rhythm: it starts at about the same distance every time and eases within a few minutes of standing still.
2. Numbness, Weakness, or a “Heavy” Feeling in Your Legs
When muscles do not get enough blood, they can feel weak or numb. Others feel pins and needles in the leg or foot.¹
3. One Foot Feels Colder Than the Other
Cold feet in winter are normal. One foot that is consistently colder than the other, even in a warm room, is not. That difference can mean one leg is getting less blood flow.¹
4. Skin Color Changes
A foot or leg that looks pale, bluish, or discolored should be followed up on, especially if it is only one side.¹ Some people notice their feet turn pale when raised and redden when they hang down.
5. Sores That Will Not Heal
A wound on your foot should heal in a week or two. With PAD, wounds on the toes, feet, or legs can heal slowly or not at all, and they can become infected.¹ Untreated sores can lead to tissue loss and, in severe cases, amputation.
6. Hair Loss on Your Legs and Slow Toenail Growth
This sign surprises people. Healthy hair and nail growth need good circulation, so when blood flow drops, leg hair may thin out, and toenails may grow slowly or stop growing.¹,² If the hair on your shins has disappeared and you did not shave it, mention it to your doctor.
7. Smooth, Shiny Skin on Your Legs
Along with hair loss, the skin on the lower legs can become thin, tight, and shiny.² It is a subtle change that is easy to overlook unless you know to look for it.
8. A Weak or Missing Pulse in Your Feet
You probably can not check this one well yourself, but your doctor can. A faint or absent pulse at the top of the foot or behind the ankle is a strong clue that blood is not moving through the leg arteries the way it should. The American Heart Association actually encourages patients with leg or foot complaints to ask their doctor to take a look at their bare feet during the appointment.³
9. Erectile Dysfunction
This symptom can be a surprising one. Trouble getting or keeping an erection can be an early sign of narrowed arteries, including those linked to PAD.¹ It is not a topic men enjoy bringing up, but it is a useful piece of the puzzle for your doctor.
10. Leg or Foot Pain at Rest, Especially at Night
When PAD becomes severe, pain no longer waits for exercise. It shows up while you are sitting or lying down, and it often wakes people up at night. Some find relief by dangling a foot over the edge of the bed. These symptoms are referred to as rest pain. This stage is called critical limb ischemia, and it needs prompt medical care.¹
Who Is Most at Risk for PAD?
PAD risks overlap heavily with heart disease risks, because both come from plaque buildup (atherosclerosis). Your odds go up if you:
- Smoke or used to smoke. Smoking is one of the strongest risk factors and also makes symptoms worse.²
- Are diabetic. People with diabetes are at especially high risk.³
- Are over 50, and especially over 65.
- Have high blood pressure or high cholesterol.
- Have heart disease or a history of stroke.
- Have a family history of PAD, heart disease, or stroke.
The bigger concern is what PAD signals. People who have it face a higher chance of coronary artery disease and cerebrovascular disease, which can lead to a heart attack or stroke.²
How PAD Is Diagnosed
The first test is usually simple. An ankle-brachial index (ABI) compares the blood pressure in your ankle to the pressure in your arm.² It takes a few minutes, uses a regular blood pressure cuff and a small ultrasound device, and does not hurt. If the numbers suggest a blockage, your doctor may order an ultrasound or other imaging to see exactly where the narrowing is.
PAD Treatment Options
Treatment has two goals: to ease your symptoms and protect your heart and brain.
Lifestyle changes can be a first defense. Quitting smoking is the single biggest step. A structured walking program, often supervised, can improve how far you walk without pain and help with quality of life.² A heart-healthy diet matters too.³
Medications may include drugs to lower cholesterol, control blood pressure and blood sugar, and reduce the chance of clots.
Procedures are an option when symptoms are severe or a limb is at risk. These include angioplasty, stent placement, atherectomy (removing plaque from inside the artery), and bypass surgery for longer blockages.³
Looking for PAD Treatment Near You?
Though not fatal, PAD can cause serious discomfort when walking, and severe cases may lead to a heart attack and limb amputation. Alpine Surgical can help you avoid these situations with peripheral arterial disease surgery in Boulder, CO.
Frequently Asked Questions
What are the first signs of peripheral artery disease?
The earliest sign for most people is cramping or aching in the calf, thigh, or hip while walking that goes away with rest. Others first notice cold feet, leg numbness, or slow toenail growth. Many people have no early symptoms.
Can PAD go away on its own?
No. The plaque causing PAD does not disappear without treatment, but quitting smoking, regular walking, and medication can slow it down, improve symptoms, and lower your risk of heart attack and stroke.
Is PAD the same as poor circulation?
PAD is one of the most common causes of poor circulation in the legs, but “poor circulation” can also come from vein problems, nerve damage, or other conditions. A doctor can tell the difference.
Who should get tested for PAD?
Talk to your doctor about testing if you have leg pain when walking, foot sores that heal slowly, or risk factors such as smoking, diabetes, high blood pressure, or age over 50.
Is PAD treatment painful?
The ABI testFtreat is painless. Most treatments start with lifestyle changes and medication. If a procedure is needed, many are minimally invasive and done through a small puncture in the groin or leg.
What happens if PAD is left untreated?
Untreated PAD can lead to worsening pain, non-healing wounds, infection, and in severe cases, amputation. It also raises the risk of heart attack and stroke.
Sources
- National Heart, Lung, and Blood Institute. “Peripheral Artery Disease: Symptoms.” https://www.nhlbi.nih.gov/health/peripheral-artery-disease/symptoms
- Centers for Disease Control and Prevention. “About Peripheral Arterial Disease (PAD).” https://www.cdc.gov/heart-disease/about/peripheral-arterial-disease.html
- American Heart Association. “Peripheral Artery Disease Fact Sheet.” https://www.heart.org/en/-/media/Files/Health-Topics/Peripheral-Artery-Disease/PAD_Fact_Sheet_Eng.pdf?sc_lang=en
