Peripheral Artery Disease Symptoms—From Leg Pain to Cold Feet—You Shouldn’t Ignore
Plus learn how to reduce your risk of the condition, which can up the odds of a heart attack
Key Takeaways
- Leg pain when walking isn’t always harmless—it could be a symptom of peripheral artery disease
- PAD often goes unnoticed in women, since symptoms can be subtle or mistaken for aging
- Simple habits like walking more and eating smarter can help lower your risk and improve circula
Picture this: You’re out for your afternoon walk when a sudden cramp seizes your calf. You stop, shake it off and keep going. But the next day, it happens again. And the day after that. You might think it’s just a charley horse or a sign of getting older—but doctors say it could actually be symptoms of peripheral artery disease (PAD), a risk factor for serious heart trouble. The condition affects nearly 10 million Americans over 40, according to the National Heart, Lung and Blood Institute. We asked two vascular experts to break down everything you should know about PAD and share easy tips to help lower your risk.
What is peripheral artery disease?
“Peripheral arterial disease is the development of atherosclerotic disease in the arteries of the legs,” explains vascular surgeon and PAD expert Britt Tonnessen, MD, an associate professor of surgery (vascular) at the Yale School of Medicine. “Over time, fatty deposits occur in the blood vessels and can progress to more complex areas of stenosis, or blockages.” You’ve likely heard of atherosclerosis, which is the fancy name for when plaque builds up in the arteries and eventually restricts blood flow. When this build-up occurs in the legs, it is referred to as peripheral artery disease.
“PAD is not just a leg problem,” adds Alan M. Dietzek, MD, FACS, DFSVS, chair of vascular surgery at Hackensack Meridian Jersey Shore University Medical Center. “It is an important marker for widespread vascular disease. The same plaque that causes buildup in the arteries of the legs can occur in the arteries of the heart and those supplying blood to the brain. As a result, patients with PAD are at greater risk for myocardial infarction [heart attack], stroke and cardiovascular death.”
Woman's World Answers
Peripheral artery disease symptoms to watch for
“The most common symptom is thigh or calf pain while walking, often described as a ‘Charley horse’ or muscle cramp. But many patients are asymptomatic,” says Dr. Dietzek.
Other typical peripheral artery disease symptoms, according to our experts, include:
- Burning pain in the feet
- Coldness in the feet or in one foot but not the other
- Sores on the feet that fail to heal
- Your toenails and leg hair stop growing
- A pale or bluish color to the skin
While the symptoms above are some of the most common, there’s a peripheral artery disease sign that can sometimes fly under the radar: shiny skin on your legs. This is what’s known as a trophic change. When oxygen- and nutrient-rich blood flow to your legs is diminished, it can make the skin on your legs appear shiny and pale rather than supple with a healthy flush.
Dr. Dietzek explains that PAD is underdiagnosed in older adults, as the symptoms are often mistaken for other health issues such as arthritis, nerve damage or a side effect of old age.
“What women especially need to know is that PAD can look very different in women than in men,” says Lily Johnston, MD, MPH, FSVS, vascular surgeon at Scripps Clinic. “Women are more likely to have no obvious symptoms at all, or to feel only vague leg fatigue or weakness rather than the classic cramping pain with walking. This makes PAD easier to miss—and by the time it is caught, it may already be more advanced.”
The link between peripheral artery disease and menopause
It’s no secret that entering menopause can increase the risk of developing several health conditions, and our experts confirm that PAD is no exception.
“Estrogen has protective vascular effects which limits plaque formation in the arteries,” explains Dr. Dietzek. “After menopause, that protection declines, and the risk of atherosclerosis rises.”
“Women who went through early menopause (before age 45) or who have other risk factors like diabetes, high blood pressure or a history of smoking, are at even higher risk and should talk to their doctor about screening,” adds Dr. Johnston. “A simple, painless test called the ankle-brachial index (ABI)—which compares blood pressure in the ankle to blood pressure in the arm—is the standard way to check for PAD.”
How to reduce your risk of peripheral artery disease symptoms
While some of the risk factors for developing PAD, like entering menopause, are unavoidable, there are easy lifestyle changes you can add into your routine today to lower your risk.
Start walking
If you have a particularly busy schedule, you may struggle to follow a consistent daily walking routine. But Dr. Johnston says following a structured walking program is worth the effort.
“Walk until you feel moderate leg discomfort, rest until it eases, then repeat,” says Dr. Johnston. “Aim for 30 to 45 minutes of total walking time per session, at least three days per week. This type of exercise trains your leg muscles to work more efficiently with the blood flow they have. Over time, it can also encourage the development of small new blood vessels that help reroute blood around areas of blockage, improving how far and how comfortably you can walk.”
Quit smoking
Quitting smoking is no small task, and that’s why Dr. Johnston recommends creating a “quit plan” with your doctor.
“Nicotine replacement, medication and behavioral support all improve success rates significantly,” says Dr. Johnston. “Smoking is one of the most powerful drivers of PAD progression. It damages the inner lining of blood vessels, actively accelerates plaque buildup and reduces the amount of oxygen the blood can carry to your tissues. Stopping smoking is the single most impactful change a smoker with PAD can make.”
Switch up your diet
Dr. Johnston recommends eating in a way that supports blood vessel health by focusing on fatty fish, leafy greens, berries, nuts and fiber-rich foods like vegetables and beans while limiting added sugar, salt and processed foods.
“These foods are rich in fiber, antioxidants and healthy fats that reduce inflammation in the blood vessel walls and help keep arteries more flexible,” says Dr. Johnston. “Cutting added sugars and processed foods also reduces the overall inflammatory burden on your cardiovascular system.”
The bottom line on PAD symptoms
If you’re experiencing leg pain when you walk, don’t brush it off as “just getting older.” Talk to your doctor about screening for peripheral artery disease. The good news? Caught early, PAD can be managed with lifestyle changes that will benefit your entire cardiovascular system. Your legs, and your heart, will thank you.
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