Peripheral Arterial Disease (P.A.D.)
What is
Peripheral Arterial Disease?
Commonly referred to as “poor circulation,” Peripheral Arterial Disease
(P.A.D.) is the restriction of blood flow in the arteries of the leg. When
arteries become narrowed by plaque (the accumulation of cholesterol and other
materials on the walls of the arteries), the oxygen-rich blood flowing through
the arteries cannot reach the legs and feet.
The presence of P.A.D. may be an indication of more
widespread arterial disease in the body that can affect the brain, causing
stroke, or the heart, causing a heart attack.
Signs and
Symptoms
Most people have no symptoms during the early stages of P.A.D. Often, by
the time symptoms are noticed, the arteries are already significantly blocked.
Common symptoms of P.A.D. include:
- Leg
pain (cramping) that occurs while walking (intermittent claudication)
- Leg
pain (cramping) that occurs while lying down (rest pain)
- Leg
numbness or weakness
- Cold
legs or feet
- Sores
that won’t heal on toes, feet, or legs
- A
change in leg color
- Loss
of hair on the feet and legs
- Changes
in toenails—color and thickness
If any of these symptoms are present, it is important to
discuss them with a foot and ankle surgeon. Left untreated, P.A.D. can lead to
debilitating and limb-threatening consequences.
Risk
Factors of P.A.D.
Because only half of those with P.A.D. actually experience symptoms, it is
important that people with known risk factors be screened or tested for P.A.D.
The risk factors include:
- Being
over age 50
- Smoking
(currently or previously)
- Diabetes
- High
blood pressure
- High
cholesterol
- Personal
or family history of P.A.D., heart disease, heart attack, or stroke
- Sedentary
lifestyle (infrequent or no exercise)
Diagnosis
of P.A.D.
To diagnose P.A.D., the foot and ankle surgeon obtains a comprehensive
medical history of the patient. The surgeon performs a lower extremity physical
examination that includes evaluation of pulses, skin condition, and foot
deformities to determine the patient’s risk for P.A.D. If risk factors are
present, the foot and ankle surgeon may order further tests.
Several non-invasive tests are available to assess P.A.D.
The ankle-brachial index (ABI) is a simple test in which blood pressure is
measured and compared at the arm and ankle levels. An abnormal ABI is a
reliable indicator of underlying P.A.D. and may prompt the foot and ankle
surgeon to refer the patient to a vascular specialist for additional testing
and treatment as necessary.
General
Treatment of P.A.D.
Treatment for P.A.D. involves lifestyle changes, medication and, in some cases,
surgery.
- Lifestyle
changes. These include smoking cessation, regular exercise, and eating a
heart-healthy diet.
- Medications.
Medicines may be used to improve blood flow, help prevent blood clots, or
to control blood pressure, cholesterol, and blood glucose levels.
- Surgery.
In some patients, small incision (endovascular) procedures or open
(bypass) surgery of the leg are needed to improve blood flow.
P.A.D.
and Foot Problems
Simple foot deformities (hammertoes, bunions, bony prominences) or
dermatologic conditions such as ingrown or thickened fungal nails often become
more serious concerns when P.A.D is present. Because the legs and feet of
someone with P.A.D. do not have normal blood flow—and because blood is
necessary for healing—seemingly small problems such as cuts, blisters, or sores
can result in serious complications.
Having both diabetes and P.A.D. further increases the
potential for foot complications. People with diabetes often have neuropathy
(nerve damage that can cause numbness in the feet), so they don’t feel pain
when foot problems occur. When neuropathy occurs in people with P.A.D., ulcers
can develop over foot deformities and may never heal. For this reason, P.A.D.
and diabetes are common causes of foot or leg amputations in the United States.
Once detected, P.A.D. may be corrected or at least improved.
The foot and ankle surgeon can then correct the underlying foot deformity to
prevent future problems should the circulation become seriously restricted
again.
Avoiding
P.A.D. Complications
Getting regular foot exams—as well as seeking immediate help when you
notice changes in the feet—can keep small problems from worsening. P.A.D.
requires ongoing attention.
To avoid complications, people with this disease should
follow these precautions:
- Wash
your feet daily. Use warm (not hot) water and a mild soap. Dry your
feet—including between the toes—gently and well.
- Keep
the skin soft. For dry skin, apply a thin coat of lotion that does not
contain alcohol. Apply over the top and bottom of your feet, but not
between the toes.
- Trim
toenails straight across and file the edges. Keep edges rounded to avoid
ingrown toenails, which can cause infections.
- Always
wear shoes and socks. To avoid cuts and abrasions, never go barefoot—even
indoors.
- Choose
the right shoes and socks. When buying new shoes, have an expert make sure
they fit well. At first, wear them just for a few hours daily to help
prevent blisters and examine the feet afterward to check for areas of
irritation. Wear seamless socks to avoid getting sores.
- Check
your feet—every day. Check all over for sores, cuts, bruises, breaks in
the skin, rashes, corns, calluses, blisters, red spots, swelling, ingrown
toenails, toenail infections, or pain.
- Call
your foot and ankle surgeon. If you develop any of the above problems,
seek professional help immediately. Do not try to take care of cuts,
sores, or infections yourself.
Information provided by The American College of Foot and Ankle Surgeons