Peripheral Artery Disease: The Symptoms Physicians Wish You Wouldn't Ignore

Your legs might be trying to tell you something. That cramping pain when you walk to the mailbox, that numbness you’ve been brushing off, the way one foot always seems colder than the other — these aren’t just quirks of getting older. They could be warning signs of peripheral artery disease, and doctors say far too many people ignore them.

Peripheral artery disease, commonly called PAD, occurs when narrowed arteries reduce blood flow to the arms or legs. In the vast majority of cases, it affects the legs. The culprit is usually atherosclerosis, a process that allows plaque to build up on artery walls, gradually restricting blood flow.

“We see patients all the time who have been living with these symptoms for months or even years,” says vascular surgeon Eileen de Grandis, M.D., medical director of the vein clinic at Lynn Heart & Vascular Institute, a part of Baptist Health Heart & Vascular Care at Boca Raton Regional Hospital. “People think it’s arthritis, that they’re just out of shape, or that maybe it’s just normal aging. But PAD is not normal, and catching it early can literally save your life.”

What Exactly is PAD?

If you don’t know much about peripheral artery disease, you’re far from alone. A recent survey found that 70 percent of people are unaware of this vascular condition — including many of the people most at risk.

Peripheral artery disease is a serious cardiovascular condition that increases the risk of everything from amputation to death. PAD occurs when deposits called plaque that are made up of cholesterol, fats, and calcium cause blood vessels to narrow and stiffen. The condition is considered a leading indicator for coronary artery disease, heart attack and stroke.

“PAD in the legs is often a sign of broader atherosclerosis,” notes Young Lee, M.D., a board-certified vascular and endovascular surgeon at Baptist Health Miami Cardiac & Vascular Institute.

“Atherosclerosis can present anywhere in the body,” Dr. Lee says. “While most people understand that a narrowing or blockage of the coronary arteries can lead to a heart attack, many do not realize that the same type of blockage in the other arteries of the body can result in life-changing consequences.”

At least 10 million adults ages 40 and older in the U.S. have PAD, according to the National Institutes of Health, but many go undiagnosed in the early stages when treatment is most successful.

A progressive condition that worsens over time, PAD can cause widespread vascular damage and other health problems if not addressed, Dr. de Grandis cautions. In the United States, PAD leads to an estimated 150,000 leg amputations per year.

The Symptoms Doctors Wish You Wouldn’t Ignore

One thing to watch for is leg pain when you walk that goes away when you stop to rest. Doctors call it claudication, but you might describe it as cramping, aching, or a heavy feeling in your limbs. The discomfort usually affects the calves but can also occur in the thighs or buttocks.

This pattern should prompt you to consult your doctor: you walk even a short distance — maybe at the grocery store, maybe to the end of your driveway — and your legs start hurting. When you stop, the discomfort dissipates after a few minutes. But when you resume walking, it returns.

“That predictable pattern is a red flag,” Dr. de Grandis says. “Your muscles are literally crying out for more blood.”

But PAD doesn’t always show up so obviously. Some people just notice they can’t walk as far as they used to. Others feel weakness or numbness rather than pain. What’s more, nearly half of people with PAD have no symptoms at all.

Other Warning Signs To Watch For

Pay attention if you notice your feet or legs are cold, especially if one is noticeably colder than the other. Look at the skin on your legs and feet: is it shiny? Losing hair? Changing color? “These changes suggest poor circulation,” Dr. Lee says.

Wounds, cuts or sores on your legs or feet that heal slowly (or not at all) are especially concerning. “A little scrape that’s still there weeks later isn’t normal.” Dr. Lee says. “It might be your body telling you it doesn’t have enough blood to heal properly.”

Some people might notice their toenails growing more slowly or becoming thick and discolored. Others experience a burning or aching sensation in their legs, feet or toes even while resting, particularly at night. If you hang your legs over the side of the bed to get relief, that could be a sign of advanced PAD.

Who Needs To Be Extra Vigilant?

Since many people with PAD report no symptoms, it makes screenings all the more important for at-risk individuals. If you’re over 60, you should take note of any potential warning signs. But age isn’t the only factor.

The top three risk factors for PAD are diabetes, high blood pressure and the use of tobacco products. People with diabetes are three to four times more likely to suffer from PAD, while 35 to 55 percent of people with PAD also have high blood pressure. Approximately 80 percent of patients with PAD are smokers or former smokers.

High cholesterol, chronic kidney disease and a family history of heart disease or stroke also put you at higher risk.

A recent report noted widespread disparities when it comes to diagnosing and treating PAD. Black people are twice as likely to suffer from the condition and up to four times more likely to undergo an amputation compared to white people, according to the American Heart Association and other medical groups. Hispanics also have more advanced PAD by the time they consult a doctor, leading to worse outcomes, the report said.

Joint treatment guidelines by medical organizations noted that timely diagnosis and proper management of the condition are essential. The report stressed the importance of screening patients with risk factors even if they have no symptoms. 

“It’s always wise to talk to your doctor about PAD screening,” Dr. de Grandis says. As with most conditions, the sooner vascular issues are addressed, the more successful treatment will be, she says.

What You Can Do

Since the hardened arteries that cause problems in your legs can also affect the blood vessels in your heart and brain, it’s important to discuss your risk with your physician. “Symptoms of vascular disease can be treated and even reversed, but patients need to be followed by a specialist,” Dr. de Grandis says.

One way to understand your personal risk of developing heart disease is to get a heart scan. In just 30 minutes, a non-invasive CT scan can uncover risks you didn’t even know existed. Talk to your doctor and see if a heart scan is right for you. Visit BaptistHealth.net/HeartScan or call 833-596-2473 to find out more.