Your calves cramp halfway through a walk to the mailbox, then ease once you stop. One foot always seems colder than the other. A small scrape on your toe is still there weeks later. It's easy to blame age, the cold, or a long day. But these can also be signs that not enough blood is reaching your legs and feet.
That condition is called peripheral artery disease, or PAD. Many of its warning signs show up in the legs and feet. Here's what PAD is, what to watch for, who is at risk, and why it's worth getting checked.
What Is Peripheral Artery Disease?
PAD happens when the arteries that carry blood to your limbs become narrowed or blocked. This page focuses on the legs and feet, where it is most common. The usual cause is atherosclerosis, a buildup of fatty plaque inside the artery walls.1,3,6 The Foot & Ankle Surgeons' patient site notes that PAD is what many people call "poor circulation."5
It's common. Estimates vary by source. The National Heart, Lung, and Blood Institute says more than 8 million people in the U.S. aged 40 and older have PAD.1 The CDC puts the number at about 6.5 million.4
PAD matters beyond your feet. Plaque in the leg arteries may mean plaque is also building up in the arteries to your heart and brain. That raises the risk of heart attack and stroke.1,4,5
What Does PAD Feel Like?
The classic symptom is called claudication. It is pain, aching, cramping, heaviness or tiredness in the leg muscles that starts when you walk or climb stairs, then goes away after you rest.2,3,6 It's usually felt in the calf, but it can also show up in the buttock, hip, thigh or foot.2,3 Cleveland Clinic says the pain typically stops within about 10 minutes of rest.3
Many people with PAD have no leg pain at all. The NHLBI says about 1 in 4 people with PAD have this classic walking pain.1 The CDC notes that up to 4 in 10 have no leg pain.4 That's one reason PAD often goes unnoticed.
What Signs Show Up in the Feet?
Your feet can give clues even when your legs don't hurt. Signs described by the NHLBI, CDC, MedlinePlus and the Foot & Ankle Surgeons include:2,4,5,6
- A cold foot. One foot or leg may feel cooler than the other.
- Color changes. Skin on the foot or leg may look pale, discolored or bluish.
- Hair and nail changes. Leg hair and toenails may stop growing, and toenails may change in color or thickness.
- Smooth, shiny skin on the legs or feet.
- Weak or missing pulses in the feet.
- Numbness, tingling or weakness in the leg or foot.
- Sores that heal slowly or not at all on the toes, feet or legs.
As PAD gets worse, pain can happen even at rest. Cleveland Clinic describes a burning or aching in the feet or toes that is often worse when lying flat, and that may ease when the leg hangs over the side of the bed.3 Pain at rest is a sign of severe PAD and should be checked soon.2,3
Who Is at Risk?
The main risk factors named by the CDC, Cleveland Clinic, MedlinePlus and the Foot & Ankle Surgeons are:3,4,5,6
- Smoking, now or in the past
- Diabetes
- High blood pressure
- High cholesterol
- Older age (the CDC lists age over 60; the Foot & Ankle Surgeons list over 50)
- A personal or family history of heart or blood vessel disease
- Chronic kidney disease
- Not getting much physical activity
MedlinePlus calls smoking the main risk factor.6 Cleveland Clinic says people who smoke or have diabetes are two to four times more likely to develop PAD.3 If you have diabetes, you can read more in our posts on diabetic foot care and peripheral neuropathy.
Because so many people have no symptoms, the Foot & Ankle Surgeons recommend screening for people with risk factors.5 The NHLBI also suggests asking your provider about testing if you have risk factors, even without symptoms.1
How Is PAD Checked?
An exam usually starts with your history and a look at your legs and feet: skin, sores, and the pulses in your feet and legs.3,5 The most common first test is the ankle-brachial index, or ABI. It's a simple, noninvasive test that compares the blood pressure at your ankle with the blood pressure in your arm.3,4,5
If more detail is needed, a provider may order an ultrasound or other imaging of the blood vessels.3,6 The Foot & Ankle Surgeons note that an abnormal result may lead to a referral to a vascular specialist.5
How Is PAD Treated?
Treatment aims to ease symptoms, protect your legs and feet, and lower the risk of heart attack and stroke. Options described by Cleveland Clinic, MedlinePlus and the Foot & Ankle Surgeons include:3,5,6
- Quitting smoking. Cleveland Clinic calls this one of the most important steps.3 The CDC notes that smoking makes PAD symptoms worse.4
- Walking and exercise. Supervised exercise training can help many people walk farther.3,4 A common approach is walking until the legs hurt, resting, then walking again.3
- Managing other conditions, such as blood pressure, cholesterol and blood sugar.4,5,6
- Medicines to help prevent clots, improve blood flow, or control cholesterol and blood pressure.3,5
- Procedures or surgery to open or bypass a blocked artery, for some people.3,5,6
Talk with your own doctor before starting a new exercise plan or medicine. The right mix depends on your health and how severe the PAD is.
Why Does PAD Matter So Much for Foot Health?
Healing takes good blood flow. When circulation is poor, a small blister, crack or cut on the foot can be slow to heal and can become infected.2,3 Without treatment, severe PAD can lead to sores, infection and, in some cases, loss of a toe, foot or leg.2,3,6 Cleveland Clinic also notes that most people with PAD don't lose a limb.3 Catching problems early is the goal.
How Can I Take Care of My Feet If I Have PAD?
The Foot & Ankle Surgeons and Cleveland Clinic recommend these daily habits:3,5
- Check both feet every day for new sores, cracks, cuts or color changes.
- Wash your feet daily in warm water with mild soap, and dry them well, including between the toes.
- Moisturize the tops and bottoms of your feet, but not between the toes.
- Trim toenails straight across and smooth the edges.
- Don't go barefoot, even indoors. Wear well-fitting shoes and socks, and break new shoes in gradually.
- Don't treat cuts, sores or infections yourself. Contact a foot specialist right away.
Good shoes go a long way. Our guide to choosing proper footwear has more tips.
The Bottom Line
PAD narrows the arteries that feed your legs and feet. It can cause leg cramps when you walk, a cold or discolored foot, changes in skin, hair and nails, and sores that won't heal. Many people have no symptoms, so if you smoke, have diabetes, or have heart or blood vessel disease, ask about getting checked. A sudden cold, pale, numb foot is an emergency.
If you've noticed any of these changes in your feet, our podiatrists can take a look. Request an appointment and our team will follow up within one business day. You can also learn about our diabetic foot care or find your nearest office on our locations page.
This article is for general education and isn't a substitute for medical advice. Talk with a podiatrist or your doctor about your own symptoms.
Sources
- What Is Peripheral Artery Disease? National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health. www.nhlbi.nih.gov
- Peripheral Artery Disease: Symptoms. National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health. www.nhlbi.nih.gov
- Peripheral Artery Disease (PAD). Cleveland Clinic. my.clevelandclinic.org
- About Peripheral Arterial Disease (PAD). Centers for Disease Control and Prevention. www.cdc.gov
- P.A.D. (Peripheral Arterial Disease). FootHealthFacts, American College of Foot and Ankle Surgeons (ACFAS). www.foothealthfacts.org
- Peripheral Arterial Disease. MedlinePlus, National Library of Medicine. medlineplus.gov
