Peripheral arterial disease (PAD): symptoms, tests and treatment
Why narrowed leg arteries cause calf pain on walking, how PAD is tested, how lifestyle, medicines and procedures help, and the signs of a limb in danger.
Also known as: Arteriosclerosis of Extremities; Claudication; Intermittent Claudication; PAD
What peripheral arterial disease is
Peripheral arterial disease, or PAD, is narrowing of the arteries that carry blood away from the heart to the limbs — most often the legs. The narrowing is caused by atherosclerosis: fatty deposits called plaque build up inside the artery walls over many years, making the arteries stiff and narrow, and sometimes blocking them completely.
With less blood getting through, the leg muscles do not receive enough oxygen when they work harder, which is why walking becomes painful. In more advanced disease, there is not enough blood even at rest, and wounds on the feet cannot heal. PAD also matters beyond the legs. The same process is usually happening in the arteries of the heart and brain, so people with PAD have a much higher chance of a heart attack or stroke. Treating PAD is as much about protecting the heart and brain as the legs.
Symptoms
Many people with PAD have no symptoms, or put their leg pain down to age or arthritis. The classic symptom is claudication:
- Claudication — cramping, aching or tiredness in the calf, thigh or buttock that comes on with walking a certain distance or climbing stairs, and goes away within a few minutes of rest
- Cold feet or one leg colder than the other
- Numbness or weakness in the legs
- Shiny skin, hair loss on the legs and feet, and slow-growing toenails
- Weak pulses in the feet
- Sores on the toes, feet or legs that heal slowly or not at all
- Erectile problems in men, which can be an early sign of narrowed arteries
Signs of advanced disease
Leg pain at rest, often a burning pain in the foot at night that eases when the leg hangs over the side of the bed, means the blood supply is severely reduced. So do non-healing wounds and blackened skin on the toes (gangrene). This stage, called critical limb ischaemia, risks losing the limb and needs specialist care quickly.
Causes and risk factors
The risk factors for PAD are the same as for heart disease, and they add up:
- Smoking cigarettes or beedis, and chewing tobacco — smoking is the strongest single risk factor
- Diabetes, which is very common in India and also damages nerves, so foot injuries are not felt
- High blood pressure
- High cholesterol
- Increasing age
- Chronic kidney disease
- A family history of heart disease, stroke or PAD
- Being physically inactive or overweight
People with diabetes deserve special attention: PAD and nerve damage together are a major reason for diabetic foot ulcers and amputations.
How it is diagnosed
The doctor will ask about your walking, pain and risk factors, check the pulses in your legs and feet, and look at the skin and any wounds. Tests then measure blood flow:
- Ankle-brachial index (ABI) — blood pressure is measured at the ankle and the arm and compared. A lower pressure at the ankle suggests narrowed arteries. It is simple, painless and quick. In some people with diabetes or kidney disease the arteries are too stiff for an accurate reading, and a toe pressure test may be used instead
- Doppler ultrasound — shows where arteries are narrowed or blocked and how badly
- CT angiography or MR angiography — detailed scans of the arteries, usually done when a procedure is being planned
- Angiogram — dye is injected into the arteries through a thin tube and X-rays are taken; it can be combined with treatment
- Blood tests for sugar, cholesterol and kidney function, and often an ECG to check the heart
Treatment
Treatment has two goals: to relieve leg symptoms and protect the limb, and to lower the risk of heart attack and stroke.
Lifestyle
- Stopping smoking and all tobacco is the most important step; it slows the disease and improves the results of any procedure. Ask your doctor for help, as medicines and counselling make quitting more likely to succeed
- Walking exercise — a structured programme of walking until the pain comes on, resting, and walking again, most days of the week, can increase how far you can walk over a few months. Supervised programmes work best where available
- A heart-healthy diet with less fried food, salt and sugar, and keeping a healthy weight
- Good foot care, especially if you have diabetes: inspect the feet daily and avoid walking barefoot
Medicines
Most people with PAD are advised antiplatelet medicines to reduce the chance of clots, and statins to lower cholesterol and stabilise plaque, even if their cholesterol is not high. Blood pressure and blood sugar are treated to target. A medicine to improve walking distance is sometimes added. Your doctor will choose medicines based on your other conditions and bleeding risk; do not start or stop blood thinners on your own.
Procedures
If symptoms remain disabling despite exercise and medicines, or the limb is at risk, the blood supply can be restored. Angioplasty uses a small balloon passed through an artery to widen the narrowed section, often with a stent to keep it open. Bypass surgery uses a vein or a synthetic tube to carry blood around a blocked segment. A vascular surgeon or interventional specialist will explain which suits the pattern of your disease. Amputation is a last resort when a limb cannot be saved.
When it is an emergency
A sudden blockage of a leg artery is an emergency that can cost the limb within hours. Call 112 or 108, or go to the nearest emergency department, if a leg or foot suddenly becomes:
- Very painful, cold and pale, white or bluish
- Numb or weak, or you cannot move the toes
- Without a pulse that could previously be felt
Also call 112 or 108 for chest pain, breathlessness, sudden face or arm weakness or slurred speech, as people with PAD are at higher risk of heart attack and stroke. See a doctor within a day or two for a foot wound that is not healing, spreading redness, or a toe turning dark.
Which doctor to see
PAD is diagnosed and treated by vascular specialists — vascular surgeons and interventional radiologists or cardiologists. A cardiologist also manages the heart risk that comes with PAD. A general physician or diabetologist can pick up early signs, check the ABI and manage risk factors, and will refer you when needed. You may also want to read about coronary artery disease.
You can find cardiologists in Bengaluru or diabetologists in Bengaluru on The Doctor Index, each with a registration you can check.
Common questions
Questions people ask
- Is leg pain when walking always PAD?
- No. Leg pain on walking can come from arthritis, spinal stenosis, nerve problems or muscle strain. Pain from PAD typically comes on after walking a predictable distance and eases within minutes of standing still. A pulse check and an ankle-brachial index test help tell them apart.
- Can peripheral arterial disease be reversed?
- The plaque does not usually disappear, but PAD can be slowed or stopped. Quitting tobacco, regular walking exercise and medicines for cholesterol, blood pressure and clotting improve symptoms and lower the risk of heart attack, stroke and amputation. Procedures can restore blood flow when needed.
- Does walking make PAD worse?
- No. Regular walking is one of the most effective treatments. Walking until the pain is moderate, resting until it goes, and then walking again helps the muscles use oxygen better and encourages small new blood vessels. Your doctor can advise a programme that suits you.
- Why is PAD a warning sign for heart attack and stroke?
- The same fatty build-up that narrows the leg arteries usually affects the arteries of the heart and brain too. Having PAD signals that these arteries may also be narrowed, which is why doctors treat cholesterol, blood pressure, sugar and clotting risk firmly.
This condition is usually assessed by a cardiologist. Every profile shows the doctor’s registration and what has been checked.
Cardiologists in Bangalore
A few cardiologists listed on The Doctor Index. They are shown because of their speciality, not a stated interest in Peripheral Arterial Disease; ask the clinic whether the doctor sees it.
Related conditions
All vascular medicine conditions →
Practical reading
All postsSources
- MedlinePlus, National Library of Medicine — Peripheral Arterial Disease
- Government of India — Emergency Response Support System (112)
- MedlinePlus, National Library of Medicine — Peripheral Arterial Disease — Public-domain health-topic summary
- Human Phenotype Ontology Consortium — terminology definitions — HPO licence; definitions reproduced without alteration
Peripheral arterial disease (PAD): symptoms, tests and treatment is original text by The Doctor Index; the compiled source draft was used for research. Source: MedlinePlus, National Library of Medicine. Orphadata Science: Free access data from Orphanet. © INSERM 1999; July 2026 data, CC BY 4.0. This product uses the Human Phenotype Ontology (hp/releases/2026-09-01). Only sources listed for this article apply. Source material has been selected and arranged; HPO definitions are reproduced without alteration. No source organisation endorses this compilation. Köhler S et al. The Human Phenotype Ontology project: linking molecular biology and disease through phenotype data. Nucleic Acids Research 2014;42(D1):D966–D974. doi:10.1093/nar/gkt1026.
General information, not advice about your situation. Errors can be reported through the corrections process. Reference TDI-C-1829.