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What is Peripheral Arterial Disease (PAD)?

Peripheral Arterial Disease (PAD) is a disorder that affects arteries supplying blood to the body, most commonly restricting blood flow to the legs.9

Arteries are blood vessels that carry blood away from the heart to the rest of the body.9 The disease develops when cholesterol levels and scar tissue build up in the arteries, causing them to narrow.2 When plaque, the buildup of cholesterol and scar tissue, blocks the lining of the artery, it results in poor blood flow, commonly called atherosclerosis.2 The restricted blood flow limits blood supply, oxygen, and nutrients from flowing to the arms and legs.9

PAD Infographic

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The most common cause of PAD is atherosclerosis.  This hardening of the arteries can be made worse by smoking, diabetes, high blood pressure, elevated blood cholesterol, or inherited factors.9


The most common symptom of PAD is intermittent claudication – fatigue, pain, or discomfort in leg muscles during physical activity that goes away promptly with rest.  This pain occurs because the clogged arteries restrict blood from reaching the working muscles.9

Additional common signs of PAD include:3,4

  • Burning or aching in feet and toes

  • Painful leg cramping

  • Numbness, weakness, or heaviness

  • Cooling of the skin on legs or feet

  • Diabetic foot

  • Loss of hair

  • Chronic sores

  • Gangrene

Symptoms of PAD are not necessarily displayed in the early stages of disease.  Your body may first form problem solving tactics by creating small, alternate arteries that “re-route” blood around the affected vessel.8 This is only a temporary solution and untreated PAD may be associated with in an increased risk of heart attack or stroke.1

Risk Factors

Factors that increase your risk of developing peripheral arterial disease include:6

  • Smoking

  • Diabetes

  • Obesity (a body mass index (BMI) over 30)

  • High blood pressure

  • High cholesterol

  • Increasing age—PAD is increasingly likely after you turn 50

  • Ethnicity

  • A family history of peripheral artery disease, heart disease, or stroke


Many adults may not have the apparent symptoms for PAD, or misattribute their pain as being a normal sacrifice to aging and do not report it to their doctor.  As a result, PAD can go undiagnosed.7 Therefore it is always important to get examined, especially if you are at risk for coronary artery disease, experience leg pain during walking, or have ulcers on your legs or feet.7 In most cases, your doctor will diagnose you using the following methods:

Physical exam and health history

Your doctor will likely perform a physical exam to check pulses in your feet and legs; look for high blood pressure, heart abnormalities, and blockages in the neck arteries; and look for any color changes, ulcers, infections, or injuries to your legs and feet. It's possible that further tests will be ordered if any of these conditions are present.  Tell your doctor about any symptoms, past medical history, family medical history, and risk factors you may have for coronary artery disease and PAD.2

Blood flow measurements (ABI)

ABI (ankle-brachial index) is a common test for detecting PAD because it can help diagnose disease in patients who may or may not have symptoms. It works by comparing blood pressure in your ankles with blood pressure in your arms.2 PAD can also be diagnosed by other tests that measure blood flow and blood pressure, such as a segmental pressure test for the legs, a toe-brachial index (TBI) for the toes, or a Doppler ultrasound for blood flow in the arteries.5


Your doctor may decide to photograph your arteries to see whether you have restricted blood flow.  Contrast angiography is a medical procedure that takes x-ray pictures of your blood vessels so the doctor can observe any narrowing or blockage.  This can help the doctor to determine if a medical procedure is appropriate in your case.2


  1. About Peripheral Artery Disease (PAD). (2016, November 17). Retrieved from
  2. Patient Information: Peripheral Arterial Disease and the Lutonix® 035 Balloon. (n.d.). Retrieved from
  3. Kerr, D. (2012). Recognition of the signs of Peripheral Arterial Disease (PAD) and the evaluation of ulcers.Wound Practice & Research, 7.
  4. Ogrin, R. (2007). Review of podiatry relevant aspects of peripheral arterial disease in people with diabetes: part two -- management. Australasian Journal Of Podiatric Medicine, 41(1), 7-12.
  5. PAD: What can I expect? (2013). Retrieved from
  6. Let’s learn about vascular disease - Risk Factors. Retrieved from
  7. Vascular Disease. (n.d.). Retrieved from
  8. Serrano Hernando, F. J., & Conejero, A. M. (n.d.). Peripheral Artery Disease: Pathophysiology, Diagnosis and Treatment. Retrieved from
  9. Mohler, Emile R., and Alan T. Hirsch. 100 Questions & Answers about Peripheral Artery Disease (PAD). Sudbury, MA: Jones and Bartlett, 2010. Print.