Peripheral arterial disease

Also called PAD, Peripheral vascular disease, Intermittent claudication

Narrowed leg arteries. The cramping calf pain is the mild part; what it really signals is a high risk of heart attack and stroke.

What it is

Fatty deposits narrowing the arteries supplying the legs, so the muscles do not get enough blood when they work.

The important point is rarely the legs. Somebody with PAD almost certainly has the same process in the arteries of the heart and brain, which is why the risk of heart attack and stroke in this group is so high, and why treatment is aimed at the whole arterial system rather than the calf pain that brought them in.

Smoking and type 2 diabetes are the two strongest risk factors. Stopping smoking does more for PAD than any drug.

At its most severe the leg is threatened at rest, which is a limb-threatening emergency and a common route to amputation, particularly in people with diabetes whose neuropathy has hidden the warning pain.

Signs you might notice

Cramping pain in the calf, thigh or buttock on walking, that stops within minutes of standing still and comes back at the same distance. That reproducibility is the giveaway.

Hair loss on the legs, shiny or pale skin, toenails growing slowly, muscle wasting.

Coldness in one leg or foot compared with the other.

A wound or ulcer on the foot or leg that does not heal. See leg ulcers.

Urgent, the same day: pain in the foot at rest or at night that is eased by hanging the leg out of bed; a foot that is pale, blue, cold or numb; a black area on a toe.

How it can affect day-to-day life

Walking distance shrinks quietly and people adapt without noticing, taking the car for a journey they used to walk, shopping less, then going out less. By the time it is mentioned, a lot of function has gone.

The advice that works is counter-intuitive and badly explained: supervised exercise programmes, walking into the pain, resting, then walking again, improve walking distance as much as surgery for many people. It has to be taught and supervised, and most people are never offered it.

For anybody with diabetes, feet need looking at daily by somebody who can see them. Neuropathy plus poor circulation is how a small blister becomes an amputation.

Supporting someone well

Stopping smoking is the single most effective thing available. Ask for the NHS stop smoking service rather than relying on willpower.

Ask specifically for a supervised exercise programme. It is recommended and rarely offered.

Take the statin and the antiplatelet even though the legs are the complaint; they are there to prevent the heart attack and the stroke.

Check the feet every day, and get properly fitting footwear. See podiatry.

Any foot wound in somebody with PAD or diabetes is an urgent referral, not a dressing.

Learn the rest-pain warning. Pain in the foot at night that improves by hanging it down means the same day, not next week.

Where to get help

A GP practice for assessment, which should include comparing blood pressure at the ankle and the arm.

Urgent vascular referral for rest pain, tissue loss, or a non-healing wound.

Circulation Foundation have clear patient information on PAD and its treatment.