Symptoms and Diagnosis of PAD

What are the symptoms of PAD?

The most common symptom of lower-extremity peripheral artery disease is painful muscle cramping in the hips, thighs or calves when walking, climbing stairs or exercising.

The pain of PAD often goes away when you stop exercising, although this may take a few minutes. Working muscles need more blood flow. Resting muscles can get by with less.

If blood flow is blocked due to plaque buildup, the muscles won’t get enough blood during exercise to meet the needs. The cramping pain (called intermittent claudication) is the muscles’ way of warning the body that it isn’t receiving enough blood during exercise to meet the increased demand.

Many people with PAD have no symptoms or mistake their symptoms for something else.

PAD leg pain

View our interactive library to learn more about PAD and leg pain.

Other symptoms of PAD include:

  • Leg pain that doesn't go away when you stop exercising
  • Foot or toe wounds that won't heal or heal very slowly
  • Gangrene, or dead tissue
  • A marked decrease in the temperature of your lower leg or foot compared to the other leg or the rest of your body
  • Poor nail growth on the toes or hair growth on the legs
  • Erectile dysfunction, especially in men with diabetes

Understanding leg pain

Many people dismiss leg pain as a normal sign of aging. You may think it's arthritis, sciatica or just "stiffness" from getting older. For an accurate diagnosis, consider the source of your pain. PAD leg pain occurs in the muscles, not the joints.

Those with diabetes might confuse PAD pain with a neuropathy, a common diabetic symptom that's a burning or painful discomfort of the feet or thighs. If you're having any kind of recurring pain, talk to your health care professional and describe the pain as accurately as you can. If you have any of the risk factors for PAD, you should ask your health care professional about PAD even if you aren't having symptoms.

Diagnosing PAD

PAD diagnosis begins with a medical history and physical examination. Your health care professional will also ask about your symptoms and check the pulses in your legs. 

Your physical exam may include:

  • Ankle-brachial index (ABI): This painless exam compares the blood pressure in your lower legs to the blood pressure in your arms. It takes only a few minutes and can be performed by your health care professional as part of a routine exam. A normal ABI is 1.00 to 1.40. A value less than or equal to 0.90 is considered abnormal, and, in severe disease, it’s less than 0.5. If your ABI results are normal or borderline (.91 to .99), an exercise treadmill ABI and/or a toe-brachial index (TBI) test also may be done. See a detailed illustration of the ABI test.

PAD watch learn live ABI test

If your ABI is abnormal, you may need more testing. Your doctor may recommend one of these tests:

  • Duplex Ultrasonography: The non-invasive test visualizes the artery with sound waves and measures the blood flow in an artery to indicate the presence of a blockage.
  • Computed Tomographic (CT) Angiography: The non-invasive test uses X-ray and contrast agent (dye) to create pictures of blood vessels in the arteries in your abdomen, pelvis and legs. This test is particularly useful in patients with pacemakers or stents.
  • Magnetic Resonance Angiography (MRA): The test provides cross-sectional images like a CT without using X-rays.
  • Angiography: During an angiogram, also called an arteriogram, a contrast dye is injected into the artery and X-rays are taken to show blood flow in the leg arteries to locate any blockages. Learn more about peripheral angiogram.

Remember, PAD often goes undiagnosed. Untreated PAD can lead to painful symptoms or loss of a leg, and people with PAD have an increased risk of coronary artery disease, stroke and heart attack. This is why the American Heart Association encourages people at risk to discuss PAD with their health care professional to ensure early diagnosis and treatment.

Learn more about risk factors for PAD.

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