Peripheral Arterial Disease (P.A.D.)
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.
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:
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.
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:
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.
Treatment of P.A.D.
Treatment for P.A.D. involves lifestyle changes, medication and, in some cases,
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
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:
Information provided by The American College of Foot and Ankle Surgeons
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