Pain in the legs that gets better with rest as well as non-healing wounds on the lower extremities or cold legs or feet could be signs of peripheral arterial disease (PAD), a serious, chronic disease. Similar to coronary artery disease, PAD is caused by the buildup of plaque (which is mostly fat and cholesterol) in the arteries. With that buildup, arteries become narrow or blocked and the legs are starved of blood and oxygen, resulting in pain.

The final stage of peripheral arterial disease is critical limb ischemia (CLI). This is a serious illness that causes blockages in the arteries in the legs. CLI can cause painful leg cramps while walking or while resting, can contribute to non-healing wounds and can lead to amputations if left untreated.

Symptoms of Peripheral Arterial Disease 

PAD is sometimes overlooked or misdiagnosed because the symptoms can be similar to other conditions. Those symptoms include:

• Lower extremity pain with walking that resolves with rest
• Lower extremity pain at rest that is relieved by hanging the legs over the side of the bed (rest pain)
• Non-healing wounds of the legs, feet and toes
• Change in color of the legs
• Hair loss or slower hair growth on the feet and legs 
• Decrease in temperature of the lower legs compared to the rest of the body
• Shiny, smooth, dry skin on the legs or feet
• Thickening of the toenails
• Gangrene (dry, black skin) of the legs or feet
• No pulse or a weak pulse in the legs or feet

Who Is at Risk for PAD?

PAD develops over time. Men over the age of 60 and post-menopausal women have a higher risk than younger adults, with men in general having a higher risk than women. A family history of cardiovascular disease indicates a higher risk. Conditions such as high blood pressure, high cholesterol, diabetes and obesity are also factors. Lifestyle factors can contribute, too. A sedentary lifestyle, a high-fat diet and smoking increase the likelihood of developing PAD.

Treating Peripheral Arterial Disease

PAD can be diagnosed easily with a variety of painless and noninvasive techniques, including the ankle-brachial index, which compares the blood pressure in your feet with the blood pressure in your arm to see how well blood is flowing. Imaging also can be used to diagnose PAD, with ultrasound, computed tomographic-angiography or magnetic resonance angiography. Angiography, which inserts a contrast dye into the arteries and uses X-rays to show blood flow, also may be used. 

To treat PAD, it is essential to control the risk factors. Depending on the location and severity of the disease, treatment options may include lifestyle modifications, medications, minimally invasive procedures such as endovascular revascularization with angioplasty, stenting or open surgical procedures such as a bypass.

CLI programs like the one at Orlando Health provide an aggressive, comprehensive approach to limb salvage, streamlining care to prevent major amputations. Patient care is coordinated among multiple specialties for a comprehensive approach that prevents and treats ischemia in the lower extremities. 

The process includes evaluation and noninvasive testing. If a revascularization procedure is necessary, patients receive appropriate follow-up and education to improve the healing rate of lower extremity ischemic wounds. This helps reduce major amputations and  improves patients’ quality of life.