Atherosclerosis and peripheral artery disease (PAD)

Atherosclerosis is the gradual build-up of fatty plaque within artery walls. Peripheral artery disease, often shortened to PAD, occurs when this narrowing reduces blood flow outside the heart, most often to the legs. The same underlying process can also affect arteries serving the heart or brain, so PAD is a signal to assess cardiovascular health broadly.

PAD may cause aching, cramping, heaviness or tiredness in a calf, thigh or buttock during walking that settles with rest. More advanced poor circulation can cause pain while resting, a cool or pale foot, slow-healing wounds, or changes in skin and toenails. Some people have few noticeable symptoms, so examination and circulation testing may be needed.

Arrange a medical assessment if walking repeatedly brings on leg discomfort or if a foot wound is slow to heal. A clinician may compare pulses, inspect the feet and measure blood pressure at the ankle and arm. Further testing depends on the findings and whether a procedure is being considered.

Management aims to preserve walking ability, protect the limbs and reduce cardiovascular risk. It can include stopping tobacco, a structured walking programme, attention to blood pressure and blood sugar, and medicines such as a statin or an antiplatelet drug when appropriate. Do not start aspirin or alter prescribed treatment without checking whether it is suitable for you. Wash and inspect your feet regularly, wear well-fitting shoes and report broken skin promptly.

Seek emergency care if a leg or foot suddenly becomes very painful, cold, pale or blue, numb, weak, or difficult to move. These changes can indicate an abrupt loss of arterial blood flow. A darkening wound, spreading redness, fever, or severe pain around a foot ulcer also needs prompt assessment.

Call emergency services for new chest pressure or tightness, especially with breathlessness, sweating, nausea, faintness, or discomfort spreading to an arm, shoulder, back, neck or jaw. Do not drive yourself when symptoms suggest a heart emergency.

Ask which arteries appear affected, whether your symptoms fit reduced blood flow, and whether ankle and arm pressure testing is appropriate. Clarify what walking plan is safe for you, how to care for your feet, which medicines address your individual risks, and what symptom change should trigger an earlier review.