Peripheral arterial disease (PAD): symptoms, causes, tests and treatment

The NHS says 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 medical term is "intermittent claudication". The pain can affect one or both legs, range from mild to severe, and usually goes away after a few minutes' rest.

The NHS lists other symptoms: hair loss on the legs and feet; numbness or weakness in the legs; brittle, slow-growing toenails; ulcers on the feet and legs that do not heal; changing skin colour, such as turning paler than usual or blue (which may be harder to see on brown and black skin); shiny skin; erectile dysfunction in men; and the leg muscles shrinking. Symptoms often develop slowly. Many people mistakenly think the leg pain is just part of growing older, but the NHS says there is no reason why an otherwise healthy person should experience leg pain.

PAD is a form of cardiovascular disease because it affects the blood vessels. The NHS says it is usually caused by a build-up of fatty deposits (atheroma, made of cholesterol and other waste substances) in the walls of the leg arteries, which makes them narrower and restricts blood flow to the legs. This process is called atherosclerosis.

NICE guideline CG147 covers the diagnosis and management of PAD, including intermittent claudication, and recommends assessing people for PAD if they have symptoms suggestive of it, or have diabetes, non-healing wounds on the legs or feet, or unexplained leg pain.

The NHS says PAD is largely treated through lifestyle changes and medication. Exercising regularly and not smoking are the main lifestyle changes that can ease the symptoms and reduce the chances of it getting worse. It is also important to eat a healthy diet, lose weight if overweight, and moderate alcohol. The underlying causes, including high blood pressure, high cholesterol and diabetes, should also be treated. With treatment, most people's symptoms remain stable and some experience an improvement in their pain.

Revascularisation procedures are for people whose symptoms are severe or have not responded to other treatments. The NHS describes angioplasty, where a blocked or narrowed section of artery is widened by inflating a tiny balloon inside the vessel, and an artery bypass graft, where blood vessels from another part of the body are used to bypass the blockage.

The cause is atherosclerosis. The NHS lists the things that increase the chance of PAD and other cardiovascular disease: smoking (the most significant risk factor), type 1 and type 2 diabetes, high blood pressure, high cholesterol and growing older.

Because the same process affects arteries all over the body, the NHS says having PAD makes you more likely to develop coronary heart disease, stroke, heart attack or angina. PAD is not immediately life-threatening, but the atherosclerosis that causes it can lead to serious and potentially fatal problems.

The NHS says PAD is usually diagnosed through a physical examination by a GP and by comparing the blood pressure in your arm and your ankle. The ankle brachial pressure index (ABPI) test is widely used to diagnose PAD and to assess how well you are responding to treatment. It may be done at your GP surgery or by a podiatry service.

You lie on your back while blood pressure in your upper arms and ankles is measured with a cuff and a Doppler probe, which uses sound waves to check blood flow. The ankle result is divided by the arm result. If circulation is healthy, the pressures are the same or almost the same, giving an ABPI of about 1. In PAD the ankle pressure is lower.

The NHS says that if blood flow to the legs becomes severely restricted, critical limb ischaemia (CLI) can develop. It is an extremely serious complication that can be challenging to treat. Symptoms include severe burning pain in the legs and feet that continues even at rest; skin turning pale, shiny, smooth and dry; wounds and ulcers on the feet and legs that do not heal; loss of muscle mass in the legs; and skin on the toes or lower limbs becoming cold and numb, turning red and then black, or beginning to swell and produce smelly pus (gangrene).

If you think you are developing symptoms of CLI, the NHS says to contact a GP immediately, or if that is not possible to call 111 or use 111 online. If PAD symptoms develop quickly or get suddenly worse, it could be a sign of a serious problem requiring immediate treatment. Call 999 for a life-threatening emergency. An angioplasty or bypass graft is usually recommended for CLI, although these may not always be successful or possible, and in a few cases an amputation may be required.

The NHS says you should see a GP if you experience recurring leg pain when exercising. NICE advises assessing for PAD in people with diabetes, non-healing leg or foot wounds or unexplained leg pain. Do not put leg pain down to age, and do not wait if you have a sore on the foot that is not healing.

On the NHS, a GP can examine you, arrange the ABPI, start medicines and refer you to a supervised exercise programme and to a vascular service if angioplasty or bypass is considered. Podiatry services may also carry out ABPI tests.

Some people look at private vascular opinions. The UK sources used here do not describe private services or costs, so this guide does not either. Supervised exercise and stopping smoking are not replaced by a procedure, so ask how they fit into your plan.