Patient Basics: Peripheral Arterial Disease (PAD)

Peripheral artery disease (PAD), also called peripheral arterial disease, is a narrowing of the arteries that carry blood to the legs and feet. The classic sign is cramping in the calf, thigh or buttock when you walk that goes away after a few minutes of rest. PAD also means fatty plaque is likely building up in arteries elsewhere, so it raises the risk of heart attack and stroke.

Key points

• PAD is caused by atherosclerosis, the same plaque buildup that blocks heart arteries.
• Smoking and diabetes are the strongest risk factors.
• Leg pain when walking that stops with rest is called intermittent claudication.
• A simple test that compares blood pressure at your ankle and arm can find PAD.
• Quitting smoking, a walking program and medicines help most people. Some need a procedure to open or bypass a blocked artery.
• A leg that suddenly turns cold, pale and painful is an emergency.

What causes PAD

Over many years, fat, cholesterol and other material build up inside artery walls as plaque. The artery narrows and stiffens, and less blood gets through. In the legs, the arteries most often affected are the iliac arteries in the pelvis, the femoral artery in the thigh, the popliteal artery behind the knee, and the smaller arteries below the knee.

Your risk is higher if you:

• Smoke now or did in the past
• Have diabetes
• Have high blood pressure or high cholesterol
• Have chronic kidney disease
• Are over 65, or over 50 with diabetes or a smoking history
• Have a family history of PAD, heart disease or stroke

Black Americans have higher rates of PAD than other groups.

Peripheral artery disease symptoms

Many people with PAD have no symptoms, or blame their leg pain on aging or arthritis.

Intermittent claudication

This is the most typical symptom. Walking brings on a cramp, ache, heaviness or tired feeling in the leg muscles. It starts after about the same distance each time, gets worse if you keep going, and eases within a few minutes of standing still. Where you feel it hints at where the blockage is:

• Buttock, hip or thigh: the iliac arteries or the lower end of the aorta. Men may also have erection problems.
• Calf: the femoral or popliteal artery. This is the most common spot.

Other signs of poor circulation in the legs

• A foot or leg that feels colder than the other
• Weak or missing pulses in the feet or behind the knee
• Shiny skin, hair loss on the legs and slow-growing toenails
• A foot that turns pale when raised and red or purplish when it hangs down
• Cuts or sores on the toes or feet that heal slowly or not at all

Severe PAD

When blood flow is very low, the foot can hurt even at rest. This rest pain is often a burning ache in the toes or front of the foot at night. Hanging the leg over the side of the bed eases it. Sores, blue or black toes, or dead tissue (gangrene) can follow. Doctors call this chronic limb-threatening ischemia, and it needs urgent care to save the leg.

How it’s diagnosed

• Exam. Your doctor feels the pulses in your groin, behind your knee and on your foot, and looks at the skin and nails.
• Ankle-brachial index (ABI). Blood pressure is measured at your ankles and arms with a cuff and a small ultrasound probe. An ankle pressure much lower than the arm pressure points to PAD. The test takes about 15 minutes and doesn’t hurt.
• Exercise ABI. The test is repeated after walking on a treadmill if the resting result is normal.
• Toe pressures, used when diabetes or kidney disease make the ankle arteries too stiff to measure well.
• Duplex ultrasound shows where the arteries are narrowed and how blood is flowing.
• CT or MR angiography, or a catheter angiogram, maps the arteries before a procedure.

How peripheral artery disease is treated

Lifestyle steps

• Stop smoking. This is the single most helpful step. It slows the disease and cuts the risk of amputation, heart attack and stroke.
• Walk. A supervised exercise program is one of the best treatments for claudication. You walk until the pain is moderate, rest until it passes, then walk again, for 30 to 45 minutes about three times a week. Over about 3 months, most people can walk much farther. Medicare and many plans cover supervised programs.
• Look after your feet, especially if you have diabetes. Check them every day, wear shoes that fit well, and see a foot doctor (podiatrist) for nail and skin care.

Medicines

• A statin to lower cholesterol, even if your levels look normal
• Aspirin or clopidogrel to make clots less likely. Some people also take a low dose of rivaroxaban.
• Blood pressure and diabetes medicines to keep levels on target
• Cilostazol, which can help some people walk farther. It isn’t used in people with heart failure.

Procedures and surgery

If symptoms still limit your life, or the leg is at risk, a vascular specialist may suggest:

• Angioplasty and stents. A thin tube is passed into the artery, usually from the groin. A small balloon opens the narrowed area, and a mesh tube (stent) may be left to keep it open.
• Bypass surgery. The surgeon uses a vein from your leg, or a synthetic tube, to route blood around the blockage. Heart surgeons use the same leg vein to bypass blocked heart arteries.

Living with PAD

Keep walking every day, even if it hurts a little, because the muscles adapt and new small blood vessels form. Keep your feet warm with socks, but don’t use heating pads or hot water bottles on your feet. Poor blood flow can dull feeling and lead to burns. Keep up with checkups for your heart, kidneys and blood sugar.

When to see a doctor

• Leg pain, cramping or tiredness when you walk that eases with rest
• A sore on your foot or leg that hasn’t healed in 2 weeks
• Toes that turn blue, purple or black
• Foot pain at night or at rest

Call 911 if a leg or foot suddenly becomes cold, pale or blue, very painful, numb or weak. A clot may have fully blocked an artery, and the leg needs treatment within hours. Also call for chest pain, or signs of stroke such as face drooping, arm weakness or trouble speaking.

Common questions about PAD

Is peripheral artery disease the same as peripheral vascular disease?

Mostly, yes. Peripheral vascular disease is the broader term and can include problems with veins as well as arteries. Many doctors use the two names to mean narrowed leg arteries. Peripheral artery disease is the more exact name for that problem.

How can I tell PAD from a blood clot in my leg?

A clot in a leg vein (deep vein thrombosis) usually causes swelling, warmth, redness and constant pain in one calf or thigh. PAD causes pain with walking that stops with rest, and a cool foot. You can’t rule out a clot at home, so get seen the same day for a swollen, painful leg.

Does PAD mean I have heart disease?

Not always, but the risk is high. The plaque that narrows leg arteries often narrows the heart arteries too, which is called coronary heart disease (CHD). People with PAD have a higher chance of heart attack and stroke, which is why statins and other heart-protecting medicines are part of treatment.

Can peripheral artery disease be reversed?

The narrowing usually can’t be undone, but it can be slowed, and symptoms often improve a lot. Stopping smoking, walking regularly and taking a statin help most people walk farther. Procedures can reopen or bypass a blocked artery when needed.

Questions to ask your doctor

• How severe is my PAD, and which arteries are affected?
• Can you refer me to a supervised exercise program?
• Which medicines should I take to protect my heart?
• Should I also be checked for heart disease or a carotid artery problem?
• When would I need a procedure?

Learn more

• Peripheral artery disease (National Heart, Lung, and Blood Institute)

This guide is general information and doesn’t replace advice from your own doctor. Last updated October 2026.