Peripheral Artery Disease: Sneaky Symptoms

Peripheral artery disease (PAD) develops over time. And in the early stages, you may not realize it’s happening. But there are things you can do to lower your odds of ever getting PAD. The first step is to understand how it takes hold, if you’re at risk, and how it happens.

PAD happens when certain arteries — usually in your legs — narrow because of plaque buildup. This keeps blood from flowing to your limbs like it’s supposed to.

Some people don’t feel symptoms, while others may ignore them if they’re subtle at first. If you don’t pinpoint it and get treatment, PAD can lead to gangrene — areas of dead tissue — and require amputation. And this same process of plaque buildup might be taking place in the blood vessels that supply the heart or the brain, leading to heart attack or stroke. Treating PAD can help prevent this from happening. That’s why early detection is key.

“The biggest problem that we see is people coming in late in a delayed fashion,” says Michael S. Conte, MD, professor and chief of the Vascular and Endovascular Surgery Division at the University of California, San Francisco.

“[They’re] waiting too long, thinking it’s nothing, thinking it’s old age, thinking that this spot on their foot will go away and waiting for things for so long that then we have to do really complicated surgeries and interventions to save a leg,” Comte says.

The three main risk factors for PAD are age, diabetes, and smoking.

Age. It’s pretty uncommon to see this disease in people under age 50 unless they have a history of diabetes or smoking.

Diabetes. High blood sugar can prime artery walls for plaque buildup. Diabetes can also add more problems to the equation when coupled with PAD. About 15% of people with diabetes get foot ulcers, and if you have PAD too, the risk of limb amputation is five to 10 times higher.

Smoking. Smoking, which worsens the constriction and damage of your arteries, raises the odds of PAD by 400% and brings on PAD symptoms almost 10 years earlier.

PAD can also happen if you get radiation in the neck or legs. Radiation to treat tumors can cause artery blockages down the line — anywhere from 3 to 10 or more years later.

Other things that can make your chances of getting PAD go up include:

  • Obesity (a body mass index over 30)
  • High blood pressure
  • High cholesterol
  • Peripheral artery disease, heart disease, or stroke in your family history
  • High levels of homocysteine

Men are more likely to get PAD than women, and sooner — about a decade earlier than women. PAD also disproportionately affects Black and Native American people, and that gap widens with age.

PAD usually takes hold over time, not suddenly. But it doesn’t always go from mild to moderate to very bad. How quickly it happens varies from person to person, too, and depends on things like where the blockage is and your overall health.

You can also have PAD without major symptoms at first. But in time, you would.

“In terms of true peripheral artery disease, where there’s a significant impairment of blood flow to the leg arteries, pretty much all those people [who have it] have some sort of functional limitation,” says cardiologist Aaron W. Aday, MD, assistant professor of medicine at Vanderbilt University Medical Center.

The most common PAD symptom is leg pain or weakness, usually in the calf muscle, when you walk. It can be slightly uncomfortable or extremely painful, making it hard for you to be active. A few minutes of rest usually eases the pain.

Other signs to look out for include:

  • Pain in your hips, thighs, or calf muscles after you walk or climb stairs
  • Weak or numb legs
  • Coldness in a lower leg or foot compared to the other side
  • Sores on your toes, feet, or legs that won’t heal
  • A change in the color of your legs
  • Hair loss or slower hair growth on your feet and legs
  • Slower toenail growth
  • Shiny skin on your legs
  • No pulse or a weak pulse in your legs or feet
  • Erectile dysfunction
  • Pain, such as aches and cramps, when you use your arms for basic tasks

The reason some people may not feel typical PAD symptoms is still a bit of a mystery. But here are a few reasons why you may not think you have it but do.

It’s too early to tell. Since PAD unfolds over time, red flags may not be obvious yet. Many people with PAD don’t have noticeable symptoms until the artery has narrowed by 60% or more.

You assume it’s aging or a joint problem. The symptoms that come with orthopedic conditions, such as lumbar spine disease and spinal stenosis arthritis, often feel the same as PAD. So can problems with nerves, which, when pinched, can cause similar pain. It takes a doctor to figure out what’s causing your pain.

Other diseases can mask signs of PAD. Another condition might keep you from being active enough to feel symptoms. Or pain from another health problem masks aches from PAD.

The location of the blockage affects what you feel. Where your PAD is and how far it goes may affect what you feel. The farther out into your limbs the blockage is, the higher the chance that PAD might show up late and with a worse symptom, not at an earlier stage with more common red flags like leg pain.

If you do have PAD, your doctor may prescribe medication, such as antiplatelet medication to ward off heart attacks and strokes and others for high blood pressure or high cholesterol, as part of your treatment. You’ll also want to make lifestyle changes to help ease your symptoms and stop PAD from getting worse:

Stop smoking. This includes avoiding other people’s secondhand smoke. Doing this can not only help ease your symptoms, but also lower your chances of more problems.

Take walks often. This may seem counterintuitive if it’s painful to walk, but this is the best exercise you can do to improve your PAD. In fact, the distance you can walk without pain can show how successful your treatment is.

It might not be comfortable.

“The goal is not to avoid pain,” Aday says. “It’s to become comfortable with that pain in the legs, push yourself to that point of having pain — if you need to rest, that’s fine — but then continuing on. The big-picture goal is increasing [your] functional capability.”

Walks can also help you control PAD risk factors such as high cholesterol and high blood pressure.

Eat healthy food. The same things that are good for your heart, your brain, and your whole body are also good for curbing PAD. Focus on foods that are high in fiber, and avoid salt and saturated fat. This will help to keep your blood pressure and cholesterol levels under control.

Check your feet and wash them every day. Take a close look at each foot. If you see a sore or injury, see your doctor. This is important especially if you have diabetes since your body may have a harder time healing injuries and sores on your lower legs and feet. Less blood flow to those areas makes that recovery process even harder, making infection and even amputation more likely.

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