Periphearl artery disease (PAD) can be a risk factor for heart disease.

Peripheral Artery Disease

Ordinarily, the bodyís healthy arteries have a smooth lining that enables the flow of blood, preventing blood from clotting. Peripheral artery disease (PAD) is a buildup of fatty deposits called plaque, causing those arteries to harden and get narrow. In PAD, this causes a reduction in blood flow most commonly to the arms and legs. A related condition, peripheral vascular disease (PVD), refers to reduced blood flow through both the arteries and the veins.

Eight to 12 million Americans are affected by PAD, and one in five people over 70 has PAD. Together with diabetes, PAD is the leading cause of foot or leg amputations in the U.S. It can become a serious condition, as those with PAD have two to six times the risk of dying from a heart attack or stroke.

What Are the Symptoms of Peripheral Artery Disease?

The main symptom of PAD is claudication. Claudication is cramping, pain or fatigue that occurs with physical activity or exercise and gets better with rest (when the muscles need less flow of blood). Claudication can occur in one or both legs.

Other symptoms of PAD may include:

  • Leg numbness or weakness; heaviness in the leg muscles
  • Foot, toe or leg sores that heal slowly (two to three months) or not at all
  • Cold lower leg or foot, especially compared to the other leg
  • Change in leg color
  • Shiny skin on legs
  • Poor toenail or leg hair growth, or hair loss on legs
  • Weak pulse in feet or legs
  • Restricted mobility
  • Increased infections
  • Gangrene (dead tissue)
  • Erectile dysfunction in men

About half the people with PAD have no symptoms. On the other hand, just as many people dismiss the typical PAD leg pain as normal aging or arthritis.

Some people with diabetes think it is the numbness or pain in the feet caused by neuropathy. However, PAD causes leg pain in the muscles, not in the joints. Thatís why you should visit your podiatrist to carefully evaluate any consistent leg pain.

What Are Causes and Risk Factors of Peripheral Artery Disease?

The main cause of PAD is atherosclerosis. Atherosclerosis is the buildup of (plaque), fatty deposits on the walls of the arteries. This causes a reduction in blood flow, increase in blood pressure and greater risk of stroke and heart attack. Atherosclerosis is often associated with heart disease, but when it occurs in the arteries connected to blood flow to the limbs, it results in PAD.

Other less common causes of PAD are limb injury, inflammation of the blood vessels, unusual structure of ligaments or muscles and exposure to radiation.

If a person has any PAD risk factors, they should consult their podiatrist about PAD, even without the presence of symptoms.

Risk factors include:

  • Smoking
  • Diabetes
  • High cholesterol
  • High blood pressure
  • Age 50 or older
  • Obesity
  • Family history of PAD, heart disease or stroke
  • High levels of the amino acid homocysteine
How Is Peripheral Artery Disease Diagnosed?

PAD often goes undiagnosed. But it is important to be aware of and considered, because PAD is linked to such diseases as heart attack or stroke. Therefore, the American Heart Association recommends people at risk for PAD discuss PAD with their healthcare professional.

A PAD diagnosis begins with a physical examination. The podiatrist will ask about symptoms and check for signs of the condition, such as a weak or absent pulse in the affected limb, and look for other signs, such as any evidence of wounds slow to heal.

The following are tests used to diagnose PAD.

  • Ankle-brachial index (ABI): This is a commonly used diagnostic test for PAD. It compares blood pressure of the ankles with blood pressure of the arm. If the ABI results are abnormal, further tests may be ordered. These include:
  • Doppler/Ultrasound: Used to evaluate the flow of blood through the blood vessels and locate any narrow or blocked arteries.
  • Angiography: Test to view the blood flow through the arteries as it happens via the use of a contrast dye injected into the blood vessels.
  • CT (computed tomographic angiography): Used to view the abdomen, pelvis and legs
  • MRA (magnetic resonance angiography): Used to acquire the information from a CT but without the use of X-rays
  • Blood tests: To check for diabetes, cholesterol and triglyceride levels
What Are the Treatment Options for Peripheral Artery Disease?

Treatment for peripheral artery disease has two major goals:

  • Manage symptoms, such as leg pain, to be able to resume physical activities
  • Stop the progression of atherosclerosis throughout the body to reduce the risk of heart attack and stroke

These goals may be accomplished with lifestyle changes, especially early in the course of PAD. If a person smokes, quitting is the single most important thing they can do to reduce the risk of complications.

Those with signs or symptoms of peripheral artery disease will likely need additional medical treatment. A podiatrist may prescribe medicine to prevent blood clots, lower blood pressure and cholesterol and control pain and other symptoms.

Lifestyle measures for PAD:

  • Quitting smoking
  • Controlling blood sugar for those with diabetes
  • Managing blood pressure and blood cholesterol
  • Exercising regularly, with doctorís approval
  • Eating a healthy diet (low in saturated fat)

Medications to treat peripheral artery disease may:

  • Lower cholesterol
  • Treat high blood pressure
  • Control blood sugar
  • Prevent blood clots
  • Relieve symptoms by thinning the blood and widening the blood vessels

In some cases of PAD, surgery may be required. This includes procedures to open blocked arteries (angioplasty); bypass surgery (heart surgery); and thrombolytic therapy,†in which a clot-dissolving drug is injected into the affected artery. In such cases, your podiatrist will refer you to a surgeon who specializes in heart or vascular procedures.

If you are at risk for PAD or notice symptoms, request an appointment at Essex Union Podiatry right away. Our foot and ankle experts will examine you for signs of PAD and recommend a treatment plan that will work for you and your circumstances.

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The physicians of Essex Union Podiatry are experienced and dedicated professionals trained in various subspecialties of podiatry care. Click on the pictures below to learn more about our doctors.

Jason P. Galante, DPM,
DABPM, AASPS

Jason Galante, DPM, AASPS

Nancy A. Kaplan, DPM, MBA, AACHE, FACFAS

NANCY A. KAPLAN, DPM, FASPS

Sarah E. Haller, DPM, AACFAS

SARAH E. HALLER