Heart and Vascular Center

Claudication

The pain of Peripheral Artery Disease (PAD) usually goes away when you stop exercising, although this may take a few minutes. When muscles are being used, they need more blood flow. That means if there’s a blockage due to plaque buildup, the muscles won’t get enough blood during exercise to meet their needs. That’s what causes the pain, which is called “intermittent claudication”. The term comes from the Latin word meaning “to limp.”

Symptoms of severe PAD include:

  • Leg pain that doesn't go away when you stop exercising
  • Foot or toe wounds that won't heal or heal very slowly
  • Gangrene
  • A marked decrease in the temperature of your lower leg or foot particularly compared to the other leg or to the rest of your body

Understanding leg pain

Many people dismiss leg pain as a normal sign of aging. You may think it’s arthritis or sciatica or just “stiffness” from getting older. PAD leg pain occurs in the muscles, not the joints. Those with diabetes might confuse PAD pain with a neuropathy, a common diabetic symptom that is a burning or painful discomfort of the feet or thighs. If you're having any kind of recurring pain, talk to your healthcare professional and describe the pain as accurately as you can. If you have any of the risk factors for PAD, you should ask your healthcare professional about PAD even if you aren't having symptoms.

Diagnosing PAD

PAD diagnosis begins with a physical examination. Your doctor will check for weak pulses in the legs. The ankle-brachial index (ABI) test is also usually done. It’s a painless exam that compares the blood pressure in your feet to the blood pressure in your arms to determine how well your blood is flowing. This inexpensive test takes only a few minutes and can be performed by your healthcare professional as part of a routine exam. Normally, the ankle pressure is at least 90 percent of the arm pressure, but with severe narrowing it may be less than 50 percent.

If an ABI reveals an abnormal ratio between the blood pressure of the ankle and arm, you may need more testing.

Your doctor may recommend one of these other tests:

  • Doppler and Ultrasound (Duplex) imaging: a non-invasive method that visualizes the artery with sound waves and measures the blood flow in an artery to indicate the presence of a blockage.
  • Computed Tomographic Angiography (CT): a non-invasive test that can show the arteries in your abdomen, pelvis and legs. This test is particularly useful in patients with pacemakers or stents.
  • Magnetic Resonance Angiography (MRA): a non-invasive test that gives information similar to that of a CT without using X-rays.
  • Angiography can also be used, but it's usually reserved for use in conjunction with treatment. During this test a contrast agent is injected into the artery and X-rays are taken to show arteries in the legs and any blockages that may be present.

As stated earlier, PAD often goes undiagnosed. This can be dangerous because PAD can lead to painful symptoms, loss of a leg and/or increased risk of coronary artery disease and carotid atherosclerosis. Because people with PAD have this increased risk for heart attack and stroke, the American Heart Association encourages people at risk to discuss PAD with their healthcare professional to ensure early diagnosis and treatment.