Symptoms of peripheral arterial disease
Many people with PAD have no symptoms. Some develop a painful ache in their legs when they walk, which usually disappears after a few minutes' rest.
The pain can range from mild to severe. It usually goes away after a few minutes when you rest your legs.
Both legs are often affected at the same time, although the pain may be worse in one leg.
Other symptoms of PAD can include:
- hair loss on your legs and feet
- numbness or weakness in the legs
- brittle, slow-growing toenails
- ulcers (open sores) on your feet and legs, which don't heal
- changing skin colour on your legs, such as turning pale or blue
- shiny skin
- in men, erectile dysfunction
- the muscles in your legs shrinking (wasting)
The symptoms of PAD often develop slowly, over time.
If your symptoms develop quickly, or get suddenly worse, it could be a sign of a serious problem requiring immediate treatment.
When to see your GP
You should see your GP if you experience recurring leg pain when exercising.
Many people mistakenly think this is just part of growing older. But there's no reason why an otherwise healthy person should experience leg pain.
PAD is usually diagnosed by assessing your symptoms and through a physical examination by your GP. They will compare the strength of the pulses, or may measure blood pressure in your limbs.
Causes of peripheral arterial disease
PAD is a form of cardiovascular disease (CVD), meaning it affects the blood vessels.
It's usually caused by a build-up of fatty deposits in the walls of the leg arteries. The fatty deposits are made up of cholesterol and other waste substances.
The build-up of fatty deposits on the walls of the arteries makes the arteries narrower. This restricts blood flow to the legs. This process is called atherosclerosis (arteriosclerosis).
There are certain things that can increase your chances of developing PAD and other forms of CVD, including:
- smoking – the most significant risk factor
- type 1 diabetes and type 2 diabetes
- high blood pressure
- high cholesterol
Your risk of developing PAD also increases as you get older. Men tend to develop the condition more often than women.
Treating peripheral arterial disease
PAD is largely treated through lifestyle changes and medication.
Exercising regularly and stopping smoking, if you smoke, are the main lifestyle changes that can ease the symptoms of PAD and reduce the chances of the condition getting worse. It's also important to:
- eat a healthy diet
- lose weight, if you're overweight or obese
- moderate your intake of alcohol
The underlying causes should also be treated, including high blood pressure, high cholesterol, and diabetes. Medication, and in some cases surgery, can be used to improve the blood flow in your legs.
With treatment, most people's symptoms stay relatively stable. Some people may experience an improvement in their pain.
If treatment is unsuccessful or you can't make appropriate lifestyle changes, there's a risk of potentially serious complications.
Complications of peripheral arterial disease
PAD isn't immediately life-threatening. But the process of atherosclerosis that causes it can lead to serious and potentially fatal problems.
Coronary heart disease (CHD)
The blockages in the arteries in the legs can also affect other areas of your body, such as the arteries supplying the heart and brain.
This means that having PAD makes you more likely to develop another form of cardiovascular disease (CVD), such as:
Critical limb ischaemia (CLI)
If the blood flow to the legs becomes severely restricted, critical limb ischaemia (CLI) can develop. CLI is an extremely serious complication that can be challenging to treat.
Symptoms of CLI include:
- a severe burning pain in your legs and feet that continues even when you're resting
- your skin turning pale, shiny, smooth and dry
- wounds and ulcers (open sores) on your feet and legs that don't heal
- loss of muscle mass in your legs
- the skin on your toes or lower limbs becoming cold and numb, turning red and then black, and/or beginning to swell and produce foul-smelling pus, causing severe pain (gangrene).
If you think you're developing symptoms of CLI, contact your GP immediately. If this isn't possible contact GP out of hours service.
An angioplasty or bypass graft is usually recommended if you have CLI, although these may not always be successful or possible. In a few cases, an amputation below the knee may be required.
Driving and peripheral arterial disease
If you hold a bus, coach, or lorry licence, or drive a taxi, you should tell the Driver &Vehicle Agency (DVA) about peripheral arterial disease.
You may be able to drive following assessment.
Drivers with a car or motorcycle licence do not need to tell the DVA, unless your condition affects your driving.