Peripheral Artery Disease (PAD) is a common circulatory condition where narrowed arteries reduce blood flow, most often to the lower limbs. This restriction is caused by atherosclerosis, a buildup of plaque on the artery walls. When arteries narrow, the legs do not receive enough oxygen-rich blood, especially during activity. Early detection is important because unmanaged PAD can lead to severe complications, including non-healing wounds and a higher risk of heart attack or stroke. Simple physical assessments can help monitor circulatory health and determine when professional medical advice is needed.
Recognizing the Signs of Peripheral Artery Disease
The most distinct sign of PAD is intermittent claudication: pain or cramping in the leg muscles that occurs during exercise and resolves after rest. This muscle discomfort can manifest in the calves, thighs, or buttocks, depending on the location of the arterial blockage. The pain begins when the muscle’s oxygen demand during physical exertion exceeds the limited blood supply delivered through the narrowed arteries.
Pain or fatigue typically disappears quickly once activity stops and muscles require less blood flow. As the disease progresses and blood flow becomes severely limited, symptoms can evolve to include burning or aching pain in the feet or toes even while resting. This “rest pain” often worsens when the legs are elevated and may improve slightly when the leg is dangled over the side of a bed.
Physical changes in the lower limbs can also signal poor circulation, even before pain develops. A noticeable coldness in the lower leg or foot, particularly when compared to the other limb, suggests reduced blood delivery. Other signs include hair loss on the legs or feet, slow-growing or brittle toenails, and skin that appears shiny, thin, or pale. Non-healing sores or ulcers on the toes, feet, or lower legs require immediate attention.
Simple Physical Checks for Circulation Assessment
Straightforward checks can be performed at home to assess circulation, focusing on blood flow to the feet. The most direct assessment involves checking the strength of the pulses in your feet, which are often diminished or absent in individuals with PAD. Two main pulses are accessible: the dorsal pedis pulse, located on the top of the foot, and the posterior tibial pulse, found just behind the bony prominence on the inside of the ankle.
To check the dorsal pedis pulse, gently place your index and middle fingers on the top of your foot, slightly to the side of the tendon that runs to your big toe. For the posterior tibial pulse, place your fingers behind the inner ankle bone, known as the medial malleolus. You should use light pressure, as pressing too hard can compress the artery and make the pulse harder to feel. It is important to compare the strength and presence of the pulse in one foot against the other, noting any significant difference.
Another simple check is the capillary refill time, which assesses how quickly blood returns to the tiny vessels after pressure is applied. To perform this, press firmly on the fleshy pad of one of your toes for about five seconds until the skin turns white. Upon releasing the pressure, the color should return to the toe in less than three seconds, indicating adequate peripheral circulation. A noticeably delayed return of color suggests that blood flow to the extremity may be compromised.
A structured walking test can help quantify the severity of claudication symptoms. This involves timing how long you can walk on a flat surface at a normal pace before the muscle pain forces you to stop. Logging the distance or time walked before pain onset, and how quickly the pain resolves upon resting, provides objective data. A progressive reduction in this pain-free walking distance over time is a strong indicator that the underlying circulatory issue is worsening.
Identifying Personal Risk Factors for PAD
Recognizing your personal predisposition to PAD can prompt earlier monitoring of your circulatory health. The greatest modifiable factor that increases the risk of developing PAD is smoking, as chemicals in tobacco smoke directly damage the lining of the arteries. Individuals who smoke, or have a history of smoking, are at a substantially higher risk compared to non-smokers.
Chronic conditions affecting blood vessels are major contributors to PAD development. Having diabetes significantly increases the risk, as consistently high blood sugar levels can damage the arterial walls over time. Similarly, high blood pressure, or hypertension, subjects the arteries to excessive force, accelerating the process of plaque buildup.
Other metabolic factors include high cholesterol levels, which is a primary component of the plaque that narrows arteries. While PAD can occur at any age, the risk increases markedly in individuals over the age of 65. Furthermore, a family history of heart disease, stroke, or PAD suggests a genetic susceptibility that warrants increased vigilance.
When Professional Medical Testing Is Necessary
While self-checks offer insights into circulation, a medical professional must perform diagnostic testing to confirm PAD. A doctor should be consulted immediately if you experience persistent leg pain, have non-healing sores on your feet or legs, or if your at-home checks consistently reveal absent or very weak foot pulses. A significant and sudden change in your pain-free walking distance also signals the need for professional evaluation.
The primary non-invasive test used to diagnose PAD is the Ankle-Brachial Index (ABI), which compares the systolic blood pressure at your ankle to the pressure in your arm. This is a simple, painless procedure that involves using a standard blood pressure cuff and an ultrasound device to listen to blood flow. The ABI is calculated by dividing the ankle pressure by the arm pressure.
An ABI score of 0.90 or less is considered diagnostic for PAD, with lower numbers indicating more severe blockages. A score between 0.91 and 0.99 is considered borderline and may prompt further monitoring or a repeat test after exercise. If the ABI test confirms reduced blood flow, imaging tests, such as a Doppler ultrasound, may be used to visualize the arteries and pinpoint the location and extent of the blockages. In some cases, a more detailed study like an angiography may be performed to guide treatment options.