Peripheral Vascular Disease (PVD) is a common circulatory problem where narrowed arteries reduce the flow of blood, primarily affecting the lower limbs. This condition is usually caused by atherosclerosis, the gradual buildup of fatty deposits, or plaque, inside the blood vessel walls. When the arteries supplying the legs become restricted, the muscles and tissues do not receive enough oxygen and nutrients to function properly.
Physical Sensations and Early Indicators
The earliest and most common sign of compromised circulation in the legs is intermittent claudication. This term describes muscle discomfort, which may feel like cramping, aching, or fatigue, that is reliably brought on by physical activity such as walking. The discomfort results from the leg muscles demanding more oxygenated blood than the narrowed arteries can supply during exercise.
The pain from claudication typically subsides quickly, within a few minutes, once the person stops moving and rests the affected limb. The specific location of the pain—which can occur in the calf, thigh, hip, or buttock—often corresponds directly to the location of the most significant arterial blockage. For example, a blockage higher up often causes pain in the buttocks or thighs, while blockages in the lower arteries typically present as calf pain.
As the condition advances, the restricted blood flow may also cause feelings of numbness, tingling, or weakness in the affected limbs. These sensations occur because the nerves and muscles are not receiving adequate blood supply, even when the body is at rest. In more severe cases, a persistent, burning pain may develop in the feet or toes, which is a sign of advanced tissue ischemia that no longer resolves with rest.
Observable Changes in Skin and Limbs
Chronic poor circulation causes distinct changes in the appearance and feel of the skin and limbs. A noticeable difference in temperature is common, with the feet or lower legs feeling cold to the touch compared to the rest of the body. This coolness is a direct consequence of reduced blood volume reaching the extremities.
Changes in skin color are characteristic and can be observed by manipulating the limb’s position. When the leg is elevated, the skin may appear pale or unusually white (pallor), due to the difficulty the heart has pumping blood uphill against the arterial blockage. Conversely, when the leg is lowered, the foot or lower leg may develop a reddish-blue or purplish discoloration (dependent rubor), as blood pools in the compromised vessels.
The lack of continuous nourishment to the tissues causes a collection of symptoms called trophic changes. Hair growth on the lower legs and feet often slows down or ceases entirely because the hair follicles are starved of nutrients. Toenails may become brittle, thickened, and grow at a much slower rate than normal, reflecting this nutritional deficit. The skin itself may also take on a shiny, thin, or taut appearance because of the chronic lack of oxygen and nutrients.
Signs of Advanced Tissue Damage
The progression of PVD to its most severe stage is known as Critical Limb Ischemia (CLI), which leads to visible tissue damage. One indication of CLI is the development of non-healing wounds, specifically arterial ulcers. These ulcers typically form in areas where blood flow is weakest, such as the toes, heels, or bony prominences of the foot.
Arterial ulcers are distinct, often appearing as deep, “punched-out” wounds with well-defined borders and a pale or necrotic base. They are accompanied by intense pain, which is exacerbated at night or when the leg is elevated, and they show minimal to no bleeding when touched. The inability of these wounds to heal results directly from the insufficient supply of oxygen-rich blood required for the repair process.
The most severe outcome of inadequate blood supply is gangrene, the death of body tissue. Gangrene presents as tissue that has turned black or dark brown, often accompanied by a foul odor if infection is present. This blackened, decaying tissue indicates that the tissue has completely succumbed to ischemia. These advanced signs necessitate immediate medical attention to prevent infection, systemic complications, and the possible need for limb amputation.