PVD is a disorder of the circulatory system affecting blood vessels outside the heart and brain, typically in the limbs. It primarily involves the arteries, which carry oxygen-rich blood away from the heart. When these peripheral arteries become narrowed or blocked, tissues—most often in the legs and feet—do not receive enough oxygen. This lack of oxygen, known as ischemia, is a progressive circulatory issue. Understanding the signs of PVD is important because the condition can lead to severe health complications if left unmanaged.
Initial Signs and Symptoms
The earliest and most common symptom of PVD is intermittent claudication, which is muscle pain triggered by physical activity. This discomfort is often described as an ache, cramp, or fatigue, typically localized in the calf, thigh, or buttock muscles. The pain occurs because narrowed arteries cannot supply the working muscles with the increased oxygen they demand during exertion.
A defining characteristic of claudication is that the pain consistently begins during movement, such as walking or climbing stairs, and is reliably relieved by a short period of rest. When muscles are at rest, their oxygen demand drops, allowing limited blood flow to catch up, and the discomfort disappears quickly. As the condition progresses, the distance a person can walk before the pain starts tends to shorten.
Chronic Visible Changes to the Legs and Feet
As blood flow remains chronically restricted, the visible appearance of the lower limbs changes. One obvious indicator is a change in skin color, particularly when the leg’s position is altered. The foot may exhibit pallor, or paleness, when elevated, due to reduced blood flow pressure. Conversely, when the foot is lowered, it may develop a dusky or reddish-blue discoloration, known as dependent rubor.
The skin on the affected limb often takes on a shiny, thin, or tight appearance. The affected foot or leg will also frequently feel noticeably cooler to the touch compared to the unaffected limb. The inability to deliver sufficient nourishment to peripheral tissues also impacts hair and nail growth.
Patients often experience hair loss on the legs and feet due to diminished circulation to the hair follicles. Toenails may become brittle, thickened, or grow significantly slower than normal, reflecting the chronic lack of oxygen supply.
Severe Manifestations and Non-Healing Wounds
The most severe visible manifestations of advanced PVD occur when tissue is starved of blood flow even at rest, a stage called Critical Limb Ischemia (CLI). The profound lack of oxygen causes severe, persistent rest pain, commonly in the toes and feet, often waking the patient at night.
A classic indicator of managing this pain is the need to dangle the foot over the side of the bed, which temporarily uses gravity to increase blood flow and relieve discomfort. The most serious visible signs are the development of arterial ulcers and tissue death.
Arterial ulcers, or sores, typically appear on pressure points like the toes, heels, or shin, and have a distinct “punched out” look with smooth borders. These wounds are often pale or necrotic at the base and tend to have little bleeding or drainage, reflecting extremely poor circulation. Because of impaired blood flow, these ulcers are difficult to heal and provide a gateway for infection.
The most extreme appearance is gangrene, which is the death and decay of tissue. Dry gangrene appears as shriveled, blackened, or mummified tissue. Wet gangrene involves infection and presents with swelling and a foul odor.
Understanding the Cause and Seeking Medical Guidance
The underlying cause for most PVD cases is atherosclerosis, a progressive condition where fatty material, cholesterol, and other substances accumulate within the artery walls. This buildup, called plaque, hardens and narrows the arteries, which progressively restricts the amount of blood that can flow through them. The resulting reduction in blood flow starves the tissues of oxygen, leading to the symptoms and visible changes.
Given the progressive nature of PVD, seeking medical consultation is appropriate whenever leg pain reliably occurs during walking and stops with rest. It is particularly important to consult a physician if one notices chronic skin changes, such as hair loss, coldness, or unusual discoloration in the feet or legs.
Urgent medical attention is necessary if a non-healing sore or ulcer develops, or if there is the sudden onset of severe rest pain, numbness, or a cold, pale limb, as these may indicate an acute, severe blockage.