Health condition · Clinically reviewed
Peripheral arterial disease, leg pain that signals whole-body atherosclerosis.
Narrowed arteries in the legs causing pain on walking. Under-diagnosed, over-simplified — and a marker of much wider cardiovascular risk.
Why trust this guide
- 01
Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
- 02
Sourced, not summarised
Every claim is checked against NICE, the Vascular Society or a peer-reviewed source you can see at the end.
- 03
Updated for 2026
Reflects current UK guidance on ABPI testing, supervised exercise and revascularisation.
Key facts
Peripheral arterial disease at a glance.
The essentials, in plain English — what it is, how it presents, how it’s diagnosed, and how it’s treated in the UK today.
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What it is
Atherosclerosis of the leg arteries — the same disease process that causes heart attacks and strokes, just in a different vessel.
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Symptomatic and silent
Many people have PAD without symptoms; others develop pain long before the diagnosis is made.
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The hallmark symptom
Intermittent claudication — cramping calf, thigh or buttock pain that comes on with walking and eases with rest.
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A bedside test
The ankle-brachial pressure index (ABPI) can be done in a GP surgery in minutes.
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Same disease as CAD
PAD is not a local problem — it means the coronary and carotid arteries are usually affected too.
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Exercise is treatment
A structured, supervised exercise programme is a cornerstone of care, alongside medication.
Why this guide matters
Legs first, but the disease is everywhere.
PAD is easy to diagnose and easy to treat medically — but only if it’s recognised. The three points below shape everything else on this page.
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Legs today, heart tomorrow
People with PAD have roughly the same cardiovascular risk as those who’ve already had a heart attack.
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Exercise is the underused treatment
A supervised exercise programme roughly doubles pain-free walking distance for most people.
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A cold, painful leg is an emergency
Acute limb ischaemia can cost the limb within hours. Call 999.
How the diagnosis is made
From first symptom to a clear plan.
The steps a UK GP and vascular team will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
History and bedside examination
Phase 2 · Confirming
ABPI, ultrasound and CT angiography
Phase 3 · Managing
Risk assessment and specialist input
- 01
Recognising
Symptom history and risk factors
Calf, thigh or buttock pain on walking that eases with rest, plus smoking, diabetes, hypertension or high cholesterol.
- 02
Recognising
Foot pulse examination
Feeling for the dorsalis pedis and posterior tibial pulses, and looking for cold, pale or hairless skin.
- 03
Confirming
ABPI (ankle-brachial pressure index)
A bedside Doppler test comparing ankle and arm pressures. Under 0.9 confirms PAD; under 0.5 is severe.
- 04
Confirming
Arterial duplex ultrasound
Maps where the narrowings are, and how tight they’ve become.
- 05
Confirming
CT angiogram of the legs
A detailed anatomical scan used when a procedure is being planned.
- 06
Managing
Cardiovascular risk assessment
PAD is a marker for wider atherosclerosis — heart, brain and kidneys are checked too.
- 07
Managing
Vascular surgery consultation
For critical limb ischaemia or lifestyle-limiting symptoms not responding to medical therapy.
Typical timeline: 2–6 weeks from first symptom to a settled plan.
Symptoms
What peripheral arterial disease actually feels like.
From the classic walking pain of claudication through to critical limb ischaemia — and the emergency you must not miss.
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Intermittent claudication
Cramping pain in the calf, thigh or buttock brought on by walking a predictable distance, relieved within minutes of stopping.
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Rest pain
Burning or aching pain in the foot at night, often relieved by hanging the foot out of bed. A sign of severe disease.
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Non-healing foot ulcers
Wounds on the toes, heel or shin that won’t heal because blood flow is insufficient.
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Gangrene
Blackened, dead tissue on the toes or foot — critical limb ischaemia and a limb-threatening emergency.
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Slow wound healing
Minor cuts, blisters or callouses on the feet take weeks rather than days to close.
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Cold, pale foot
One foot noticeably colder or paler than the other, especially when elevated.
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Fatigue on stairs
Leg heaviness or tiredness climbing stairs or inclines that resolves on the flat.
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Red flag — call 999
A sudden painful, pale, cold or paralysed leg is acute limb ischaemia — call 999 immediately.
Treatment
How peripheral arterial disease is treated in the UK.
Exercise and risk-factor control first, procedures where needed — what each option does and when it’s used.
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Structured exercise programme
Supervised walking to the point of pain, three times a week for 12 weeks. Doubles walking distance for most people.
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Smoking cessation
The single most important change. Continued smoking accelerates the disease and halves procedure success.
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Statin + antiplatelet
A statin (usually atorvastatin) and low-dose antiplatelet (clopidogrel or aspirin) to reduce cardiovascular events.
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BP and diabetes optimisation
Tight blood-pressure and glucose control slow disease progression and protect the heart and kidneys.
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Cilostazol
A vasodilator used in selected people whose claudication limits life despite exercise, when surgery isn’t appropriate.
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Angioplasty ± stent
A wire and balloon opens the narrowed artery, sometimes with a stent left behind. Day-case in most patients.
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Bypass surgery
A vein or synthetic graft routes blood around a long blockage. Used when angioplasty isn’t feasible.
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Amputation
Reserved for gangrene or unreconstructable disease. Modern care aims to preserve as much limb as possible.
What this guide is based on
The sources behind every number on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or vascular specialist knows your history and can tell you which parts apply to you. If in doubt, get your pulses and ABPI checked.
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National Institute for Health and Care Excellence (NICE). Peripheral arterial disease: diagnosis and management (CG147).
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Vascular Society of Great Britain and Ireland. Standards for vascular services.
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European Society for Vascular Surgery (ESVS). Clinical practice guidelines on peripheral arterial disease.
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Circulation Foundation. Peripheral arterial disease — patient information.
Red flags
When PAD becomes an emergency.
Most of the time, PAD is a slow burn. These are the situations where it stops being slow — and you should act today.
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Sudden painful, pale, cold leg
Acute limb ischaemia — call 999. Every hour matters to save the limb.
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Rest pain in the foot
Pain in the forefoot at night, relieved by hanging the leg down — urgent vascular referral.
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Non-healing ulcer
Any foot or leg wound not closing after two weeks needs assessment.
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Gangrene
Black or dusky toes or foot skin — same-day vascular assessment.
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Rapid deterioration
Walking distance falling week on week suggests progressing disease — see your GP promptly.
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Diabetic foot with vascular signs
Reduced pulses, cold foot or a new ulcer in someone with diabetes — urgent diabetic-foot review.
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Bilateral rest pain
Suggests advanced multi-level disease and needs prompt vascular input.
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New symptoms after bypass
Recurrent pain or a cold, pale limb after a previous bypass may mean graft occlusion — call the vascular team.
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Aortic aneurysm with PAD
The two often coexist — a known aneurysm with new abdominal or back pain needs immediate assessment.
Living with it
A long-term condition, but a very manageable one.
Four things that make the biggest difference day to day — walking, feet, medication and reviews.
A quiet reminder
Consistency beats intensity, every time.
Small, steady walking — kept up for months — does more than a heroic week that doesn’t last.
- 01 Daily habits
Walk through the pain, not around it
Walking to near-maximal pain and resting, repeated daily, is what re-trains the leg circulation.
- 02 Feet
Check your feet every day
A small blister or callous can turn into an ulcer quickly in PAD — especially with diabetes.
- 03 Medication
Take the statin and antiplatelet
They’re there to protect your heart and brain as much as your legs.
- 04 Reviews
Annual vascular review
A yearly check of pulses, ABPI and cardiovascular risk keeps things on track.
Frequently asked
Everything we get asked about peripheral arterial disease.
Quick answers on ABPI, claudication, exercise, surgery and when to worry.
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What is peripheral arterial disease?
Narrowing or blockage of the arteries supplying the legs, caused by atherosclerosis — the same disease that causes coronary artery disease.
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What does intermittent claudication feel like?
A predictable cramp, ache or tiredness in the calf, thigh or buttock that comes on after walking a set distance and eases within a few minutes of stopping.
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Is PAD a serious condition?
Yes — not just for the legs. People with PAD have roughly the same cardiovascular risk as people who’ve already had a heart attack, so treatment is as much about protecting the heart and brain.
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What is a normal ABPI?
An ankle-brachial pressure index between 0.9 and 1.4 is normal. Under 0.9 confirms PAD; under 0.5 suggests severe disease.
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Can PAD be reversed?
The underlying atherosclerosis doesn’t reverse, but symptoms and walking distance can improve markedly with a supervised exercise programme, smoking cessation and medical therapy.
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When is surgery needed?
When symptoms severely limit life despite exercise and medication, or in critical limb ischaemia (rest pain, ulcers, gangrene). Options include angioplasty, stenting and bypass.
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