Do you have Leg pain? Do you have toes that tingle, Do your legs cramp? These symptoms may be a sign of P.A.D. and might be cause for concern.
Peripheral Artery Disease (P.A.D.), also called Peripheral Vascular Disease is a slow, progressive, sometimes life-threatening vascular disease that is caused by narrowing or blockages of the arteries in the peripheral arterial system, or the arteries in the limbs. When plaque builds up, blood flow to the limbs is limited and can result in a variety of health problems, and if severe may cause limb amputation.
P.A.D. affects up to 8.5 million people in the US alone. However, according to the Centers for Disease Control and Prevention (CDC), only about 25% of adults age 50 and older have any awareness of PAD.
Many, people are not aware that they have PAD, as it is often asymptomatic (having no symptoms) or similar to the symptoms of arthritis or simply old age. However, some PAD symptoms you should not ignore are leg fatigue, changes in the appearance of your legs, decreased hair growth on your legs and feet, leg pain, and lower limb sores that will not heal. If you are experiencing any of these symptoms, it is important to see a doctor right away.
In this blog, we will explain P.A.D., who is the most at-risk, signs of P.A.D., and the diagnosis and treatment options.
What is Peripheral Artery Disease?
Peripheral Artery Disease (P.A.D.) is a result of fatty deposits and calcium building up along the artery walls, which decreases circulation, making your heart work harder and increasing the risk of heart attack and stroke. P.A.D. can cause pain, restrict lifestyle, and even result in amputation if not treated properly.
Who is At-Risk of Developing P.A.D.?
When it comes to P.A.D., some people are more susceptible to developing it than others due to risk factors. Some of these risk factors include…
Individuals over the age of 50
P.A.D. is more likely to develop after the age of 50. In fact, 1 in 20 Americans over the age of 50 have P.A.D.
Those who have been diagnosed with one of the following diseases:
One in every three people over the age of 50 diagnosed with diabetes are likely to also have P.A.D.
High Blood Pressure
Having high blood pressure places strain on the arteries increasing the chances of developing P.A.D.
If high cholesterol isn’t properly under control, it is likely to cause plaque buildup resulting in P.A.D. and other arterial issues.
A history of heart attack or stroke
Developing P.A.D. more than doubles your odds of having a heart attack or stroke. If you have a history of heart attack or stroke, P.A.D. is extremely dangerous for you.
A history of smoking
Approximately 90% of patients with P.A.D have a history of smoking. Smoking increases the likelihood of P.A.D by 400%.
Individuals who are physically inactive increase their chances of poor circulation, thus increasing their risk of P.A.D.
African Americans are more than twice as likely to have P.A.D. as their White or Hispanic counterparts.
Signs and Symptoms of P.A.D.
Signs and symptoms of Peripheral Arterial Disease are often under treated and misdiagnosed.
If you are experiencing outwards signs of this disease, your arteries have already narrowed by 60% or more. In other words – you should seek immediate medical treatment if you believe that you may have P.A.D.
Have you noticed one foot is colder than the other? This could be a result of P.A.D.
A difference in temperature is due to blood not properly reaching your toes or foot as a result of poor circulation. Restricted blood flow can lead to coldness in your feet and toes.
Discolored Toes or Feet
If you notice that your leg or foot is discolored, pale, or blue, you may be suffering from P.A.D. This will likely occur/be most visible when you are standing or sitting.
As we mentioned before, P.A.D. is an arterial disease that can cause poor circulation, resulting in discolored or pale feet and/or toes. If you notice that your foot or toe is losing color, this means that you have little to no blood circulation in that area due to a blockage in the artery.
If the foot or toe turns blue, then poor circulation is at fault and blood in the area is losing oxygen.
If you notice that the color of the foot/toe does not change in different positions or over time, seek medical attention immediately.
Thick or Yellow Toenails
Sometimes thick or yellow toenails are a result of a type of foot fungus. However, when it comes it P.A.D., the improper blood flow will cause slow or unusual nail growth – resulting in thick nails, yellow nails, or nails that won’t grow.
If your toenails begin to look unusual, you should consult your doctor.
Foot or toe pain at rest
When it comes to P.A.D., the most common place to feel muscle pain is in the feet, hips, thighs or calves.
The pain that you feel when you have P.A.D., known as Claudication, is pain, expressed during exercise, caused by too little blood flow, and is often a major sign of P.A.D. However, if you feel pain or restlessness at night, it could be due to Critical Limb Ischemia (CLI).
This pain may last for minutes or hours at a time. If you believe that you might be suffering from pain like this, contact a healthcare professional.
Leg fatigue, heaviness, or cramping
If you are experiencing leg fatigue, heaviness, or cramping, often when performing activities, this is known as one of the first signs of P.A.D. Without proper blood circulation, legs can easily begin to feel tired, heavy, or achy. This pain may feel like your feet/legs are throbbing when you’re walking.
Wounds or ulcers that do not heal
Wounds that do not heal over time (6 to 8 weeks) are a tell-tale sign of P.A.D.
Not only can this be a result of P.A.D., but the wounds themselves may be painful or uncomfortable and can cause issues with mobility and completing daily activities. A healthy blood supply is necessary to heal the wounds.
In the U.S., 500,000 to 2 million people are suffering from non-healing wounds or ulcers. Non-healing wounds or ulcers can easily develop an infection leading to other health complications or emergency amputations.
These symptoms can also be caused by P.V.D., Peripheral Vascular Disease, resulting in various vein conditions like Superficial Venous Insufficiency (SVI) or Deep Venous Insufficiency (DVI). If you have one of these conditions, you are susceptible to developing P.A.D.
If you think you may have P.A.D., you can take our P.A.D. quiz here to determine how at-risk you are. This quiz is not a diagnosis, but when taken to your healthcare professional, will aid in the diagnosis of P.A.D.
Diagnosis and Treatment of P.A.D.
You’ll need to consult with your healthcare professional and receive an examination to assess your risk factors and symptoms. If you are diagnosed with P.A.D., there are a treatment options based on the diagnosis.
Diagnosis of Peripheral Arterial Disease
In order to diagnose P.A.D., your healthcare professional will ask you a number of questions about your health and lifestyle history. Many of the questions will revolve around the risk factors and symptoms we mentioned above such as – are you a smoker, have you had a heart attack/stroke recently, are you over the age of 50, etc.
Then, any problem areas you may have such as unusual toenails, non-healing wounds, or discolored feet, will be examined. The blood flow in your legs and feet will be checked by feeling the pulses in your ankles and feet. If you have not recently had a blood test for diabetes or cholesterol, your healthcare professional may recommend getting them taken.
The simplest and most commonly used test for P.A.D. is called an Ankle-Brachial Index (ABI) test. An ABI test compares the blood pressure in the ankle with the blood pressure in the arm. Normally, the pressure in the ankle is higher than the arm, but in people with P.A.D., the pressure in the ankle is lower than that of the arm.
The ABI measurements are done with a Doppler probe that is held over the ankle to listen to the blood flowing through the artery. A gel ointment is placed on the skin over the artery and the Doppler probe is placed on the gel to help the healthcare professional hear the blood flow and measure the pressure. The test is painless and takes about 10 minutes. The ABI test, along with your symptoms, will allow your healthcare professional to determine whether or not you have P.A.D.
Treating Peripheral Arterial Disease
Depending on your signs and symptoms, there are a few ways to proceed with treatment.
Some of the main treatment options include:
Your doctor may recommend that you change your diet in order to help alleviate your symptoms.
For example, many P.A.D. patients have elevated cholesterol levels require a diet low in saturated and trans fat to help lower blood cholesterol levels. If this is not feasible or does not work, cholesterol-lowering medication may be necessary to maintain the proper cholesterol levels.
If you are a current smoker, your doctor will encourage you to quit. The use of tobacco is a major risk factor for P.A.D. and puts you at higher risk for heart attack and stroke.
Smoking cessation will help to slow the progression of P.A.D. and other heart-related diseases.
Regular physical activity is often an effective treatment for P.A.D. Your doctor may recommend a program of supervised exercise training known as cardiac rehabilitation. You may have to begin slowly with simple walking regimens, leg exercises and treadmill exercise programs to ease symptoms.
You may be prescribed high blood pressure medications and/or cholesterol-lowering medications. It’s important to make sure that you take the medication as recommended by your healthcare professional. Not following directions increases your risk for P.A.D, as well as heart attack and stroke.
In addition, you may be prescribed medications to help prevent blood clots.
Minimally Invasive Procedures
Depending on your diagnosis, you may require a minimally invasive procedure.
These procedures include:
Angioplasty – During this procedure, a balloon is inflated in a narrowed vessel in order to push the plaque against the artery wall to restore blood flow.
Stent – A stent is a small wire mesh tube that remains in the body after the procedure. It acts like a support system and mimics the structure of an artery wall to keep the blood vessel open.
Atherectomy – This procedure use devices designed to break through the blockage in your artery and provide a path for other devices that restore flow.
Vascular Bypass Surgery
Vascular bypass is another option for the treatment of a narrowed or blocked artery. This procedure bypasses the blockage in your artery, creating a path for blood flow around the blockage.
The Vascular or Cardiac Surgeon will make a surgical incision near the blocked artery and reroute the blood flow by attaching an artificial graft (or one of your own veins) above and below the blockage. This treatment allows blood to go around, or bypass, the diseased part of your artery.
There may be other, more personalized treatment options available to you based on the diagnosis. If you would like to find out more information on additional treatment options, talk to your healthcare provider.
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