Leg pain is a common ailment that many of us experience, but what if it’s more than just a simple ache? Ignoring leg pain can be dangerous, especially if you’re over 50, a smoker, or have a history of high blood pressure or high cholesterol.
It’s easy to brush off leg pain as a normal part of aging and other health conditions like arthritis or even being overly fatigued. Still, it’s crucial to take leg pain seriously. Leg pain could indicate a serious cardiovascular disease called peripheral artery disease (PAD).
In this blog, we’ll delve into leg pain and why it’s essential not to ignore it, explore what peripheral artery disease (PAD) is, how it occurs, and the associated risk factors and symptoms.
Additionally, we’ll look closer at who is most vulnerable to developing PAD, the various treatment options available, and the steps you can take to protect your health and avoid the potentially life-threatening consequences of ignoring leg pain.
WHAT IS PERIPHERAL ARTERIAL DISEASE AND HOW IT HAPPENS
Peripheral artery disease, also known as PAD, is a form of organic peripheral vascular disease (PVD) that affects the arteries that supply blood to the limbs, particularly the legs. Organic refers to its cause, which results from damage to the vessels. This damage can be due to inflammation or atherosclerosis, which is just a fancy medical term for the buildup of plaque (fat and cholesterol deposits) inside the artery walls.
As this plaque builds up, the arteries become narrowed or blocked, restricting blood flow to the extremities and causing various symptoms such as leg pain, numbness, and tingling. Eventually, the narrowed artery creates poor circulation, which may lead to inadequate blood flow to your body’s tissue, known as ischemia. Over time, this can lead to tissue damage, infections, and, in severe cases, amputation.
It is estimated that one in every 20 Americans over 50 has PAD, making it a fairly common condition. In fact, along with carotid artery disease, PAD is the most common form of peripheral vascular disease. Additionally, if you have PAD, you are at risk for developing another heart disease, coronary artery disease and cerebrovascular disease, which could lead to a heart attack or stroke.
If you experience symptoms such as leg pain, cramping, or coldness, it’s important to see a doctor to determine if you have PAD and what treatment options are available. Ignoring the symptoms of PAD can have serious consequences, including heart attack, stroke, limb loss, and even death.
IS PERIPHERAL ARTERY DISEASE PROGRESSIVE?
Peripheral arterial disease (PAD) can manifest in various stages and with different symptom progressions. To help diagnose and treat the condition, the American College of Cardiology and the American Heart Association has identified four categories based on PAD presentation.
When you are asymptomatic, this means you have PAD but do not have any noticeable symptoms. Although there are no symptoms, asymptomatic PAD is a severe condition that can lead to severe health problems if left untreated.
It is estimated that only about 25% of people with PAD experience symptoms, making early detection and screening all the more critical. With early detection and treatment, many people with asymptomatic PAD can manage the disease before it advances to more advanced stages and live long, healthy lives.
During this stage of peripheral artery disease, you may experience discomfort in your thigh, calf, or buttocks when engaging in physical activities that go away with rest. This pain is caused by reduced blood flow to your muscles due to narrowed arteries, which cannot deliver enough oxygen to meet the increased demand during activity. Once you stop and rest, the pain should subside as the muscles require less blood flow and oxygen.
Intermittent claudication (IC) is another term for this condition because the pain is not constant and usually stops after resting. However, the pain may occur even during rest as the disease progresses. Patients in the claudication stage often complain of pain worsening at night.
IC remains the most common and the earliest presentation of chronic lower extremity ischemia. The main symptoms of this condition include localized pain in the calf, thigh, and buttock muscles. However, these locations can change depending on the distribution of arterial disease and compromise.
While claudication is a more severe stage of PAD, early diagnosis and management can improve your symptoms and quality of life. Therefore, seeking medical attention is essential if you experience any symptoms of PAD, such as leg pain or weakness during physical activity.
3: Critical Limb Ischemia (CLI)
Over time, PAD may develop to an advanced stage called critical limb ischemia (CLI), a very serious condition that occurs when the arteries in the legs and feet become significantly blocked, reducing blood flow to these areas. Unlike intermittent claudication (IC), ischemic rest pain typically affects only the foot. As this progresses, severe tissue hypoperfusion continues, resulting in ischemic ulceration and gangrene.
Critical limb ischemia patients often have more severe and complicated artery blockages than patients with intermittent claudication. This may include blockages in the arteries below the knee and multiple areas, such as the femoropopliteal and below-the-knee arterial systems.
If your PAD has advanced to CLI, you might feel pain or numbness in the feet or notice that your legs and feet are shiny, smooth and dry and have thickening of your toenails. But the most prominent sign of CLI is ischemic rest pain, which is severe pain in the legs and feet when not moving. CLI can also cause sores and wounds that take a long time to heal due to poor blood circulation in the legs and feet.
If left untreated, CLI can result in the loss of the affected limb. Moreover, most deaths associated with PAD come from CLI, with an annual mortality rate of 20%. CLI needs comprehensive treatment by a vascular specialist. It is important to seek medical attention if you experience any symptoms of CLI to prevent complications and improve your quality of life.
4: Acute Limb Ischemia (ALI)
ALI occurs when there is a sudden and severe decrease in blood flow to a limb due to a complete blockage of the artery. The lack of blood flow can cause severe pain, numbness, and muscle weakness. Without prompt medical intervention, it can lead to permanent damage or limb loss. In fact, approximately 20% of ALI survivors may require amputation.
ALI is very time-sensitive and requires immediate medical attention. Prompt diagnosis is essential in preventing limb loss and possibly death. Unfortunately, ALI is associated with a high mortality rate of up to 25%. Therefore, it’s crucial to seek medical help immediately if you experience any symptoms of ALI, such as sudden and severe leg pain or weakness, to minimize the risk of complications and preserve limb function.
WHAT ARE THE SYMPTOMS OF PERIPHERAL ARTERIAL DISEASE?
Symptoms of PAD will vary based on the progression outlined above. As mentioned, PAD can be asymptomatic or only cause mild symptoms. That said, the most common symptom of PAD is leg pain or cramping during exercise, which typically appears in the claudication stage of PAD. The pain is usually felt in the calf but can also occur in the hips, thighs, or feet.
Other symptoms of PAD may include:
- Coldness in the lower leg or foot, compared to the other side
- Leg numbness or weakness
- No pulse or a weak pulse in the legs or feet
- Painful cramping in the hips, thighs, or calf muscles after physical activity
- Shiny skin on the legs
- Skin color changes on the legs
- Slower growth of toenails
- Sores on the toes, feet, or legs that don’t heal
- Aching or cramping in the arms when using them for manual tasks
- Erectile dysfunction
- Hair loss or slower hair growth on the legs
- Pain at rest or when lying down that may interrupt sleep
If you are experiencing any of the symptoms of PAD, it’s important not to ignore them. PAD can lead to severe complications such as heart attack, stroke, limb amputation, and even death.
If you are at risk for PAD or are experiencing symptoms, contact our vascular surgeons at The Surgical Center about getting screened and what lifestyle changes you can make to improve your overall health. Taking action now can significantly improve your quality of life and reduce the risk of serious health issues down the line.
PERIPHERAL ARTERIAL DISEASE RISK FACTORS FOR THE ELDERLY
According to the Centers for Disease Control and Prevention, approximately 8.5 million people in the United States have PAD. That number is expected to rise as the population ages. In fact, in the past few years, the elderly population has seen a significant increase in the incidence of advanced PAD, specifically chronic lower extremity ischemia.
While Peripheral Arterial Disease (PAD) can occur at any age, the likelihood of developing it increases as we grow older, with the majority of individuals diagnosed with PAD being 65+. As a result, more patients face disabilities affecting their legs and an increased chance of amputation. In addition, they are at increased risk of disease and death due to cardiac and cerebrovascular ischemic events such as heart attack and stroke.
Many patients and the general population do not correlate the risk factors for heart and stroke disease with peripheral arterial disease. However, the same things that put us at risk for heart and stroke disease can also put us at risk for PAD. This is because the same problem that causes blockages in the heart and brain can also happen in our legs.
It is crucial for the elderly population to take preventative measures to detect PAD early on. Preventive screenings include regular blood pressure and cholesterol checks and monitoring blood sugar levels for those with diabetes. Additionally, if you are 65 or older, it is advised that you undergo something called the ankle-brachial index (ABI). This test measures the blood pressure in your arm and your ankle. If your ankle has lower blood pressure than your arm, it could be a sign of PAD.
Early detection and treatment of PAD can prevent the disease from progressing to more severe stages, improve quality of life, and reduce the risk of complications such as amputation and cardiovascular events.
PERIPHERAL ARTERIAL DISEASE RISK FACTORS FOR MIDDLE-AGED ADULTS
In addition to age, several other factors can increase your risk for PAD. The following are all significant risk factors for PAD:
- High blood pressure
- High cholesterol, diabetes
- Family history of PAD and other peripheral vascular diseases
Of all the risk factors mentioned, it is well-established in medical literature that smoking and a history of smoking is a significant risk factor for developing PAD. Smoking damages the inner lining of blood vessels and accelerates the buildup of plaque, which narrows the arteries and reduces blood flow, leading to PAD. Additionally, men are more likely than women to develop PAD, and people of African American and Hispanic descent are also at higher risk.
If you are under 65 but still have any of the above risk factors that put you at an increased risk of developing PAD, it is vital to see a vascular specialist for preventative screenings.
HOW TO REDUCE THE RISK OF PERIPHERAL ARTERIAL DISEASE
Despite the serious risks of limb loss, heart problems, and even death for people with PAD, this condition is sometimes not taken seriously enough. Some people think the symptoms are just a normal part of getting older, or they might blame other issues for the pain, such as arthritis, sciatica, varicose veins, muscle strain, and even normal fatigue.
Compared with the general population, patients with PAD have a three-fold increase in all-cause mortality and a six-fold increase in mortality from cardiovascular disease. Doing what you can to mitigate your risks of developing this sometimes life-altering and deadly vascular disease is important.
While some factors, such as age, race, and family history, are beyond our control, there are several lifestyle changes that we can adopt to lower the risk of developing PAD. Here are a few ways to reduce your risk of developing PAD or lessen the chance of progressing to more advanced stages.
- Do not smoke. Smoking is one of the leading causes of PAD.
- Maintain a healthy diet that is low in saturated and trans fats.
- Exercise regularly. Even daily walks can help reduce the risk of PAD.
- Get regular vascular screenings.
- Manage chronic conditions such as diabetes, high blood pressure, and high cholesterol.
Making healthy lifestyle changes remains the best way to reduce your risks of peripheral arterial disease and take care of your health.
HOW IS PERIPHERAL ARTERIAL DISEASE TREATED?
The treatment for Peripheral Arterial Disease (PAD) depends on the severity of the condition. In mild cases, lifestyle changes such as regular exercise, a healthy diet, and smoking cessation may be sufficient. In more advanced cases, medications may be prescribed to control blood pressure, cholesterol, and blood sugar levels.
Medical procedures may sometimes be necessary to restore proper blood flow. Angioplasty and stenting are standard procedures that involve catheter insertion into the affected artery. The catheter has a tiny balloon attached to it that is inflated to widen the artery. In some cases, a stent is inserted to keep the artery open. In severe cases, bypass surgery may be necessary to reroute blood flow around the narrowed or blocked artery.
In addition to medical treatment, patients with PAD are advised to adopt healthy lifestyle habits to reduce the risk of further complications, including:
- Maintaining a healthy weight
- Quitting smoking
- Controlling blood sugar and blood pressure levels
- Participating in regular physical activity
- Taking good care of your feet
You can also take steps to alleviate the discomfort associated with PAD, such as adjusting your sleeping habits. The best sleeping position for peripheral artery disease is to elevate the head of your bed slightly. This can help reduce pain by keeping the legs below the level of the heart. You might also want to avoid certain cold and sinus medications. Products that contain pseudoephedrine are known to tighten blood vessels and may worsen PAD symptoms.
IF YOU HAVE LEG PAIN, VISIT THE BOARD-CERTIFIED SURGEONS AT THE SURGICAL CLINIC
This blog aims to bring awareness, education, the importance of early evaluation and possible intervention so that we as a medical community can modify the progression of chronic lower extremity ischemia and reduce the incidence of other adverse vascular events.
The only way to know if your leg pain is PAD is to schedule an exam and undergo diagnostic imaging, such as ultrasounds or X-rays. At The Surgical Clinic, our board-certified vascular surgeons are trained and equipped to assess, identify and provide various treatment options for our patients.
Dr. Billy Kim, one of the Vascular Surgeons with The Surgical Clinic, treats patients experiencing Peripheral Arterial Disease (PAD). This may include conservative risk and behavior modifications and pharmacologic agents. Depending on the severity of IC and CLI, the next steps may consist of invasive interventions which will provide the full spectrum of treatment tailored to the needs of the patients.