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There can be many points in our lives where we experience leg pain. Most often, especially in our younger years, that comes from too much strenuous activity that causes our muscles and joints to ache. As we age, we may experience joint aches even without strenuous activity. However, sometimes we may feel a cramping pain in our legs when all we are doing is merely walking somewhere. This cramping is called Intermittent Claudication, and it is a sign of Peripheral Artery Disease, or PAD.

PAD is a type of atherosclerosis, which is when plaque builds up in the arteries and restricts blood flow. Atherosclerosis is a serious issue, as it can not only contribute to PAD, but it can also lead to heart attacks or a stroke. The restriction of blood flow affects the circulation of blood throughout the body and in the case of PAD, it affects the legs primarily. “Claudication” comes from the Latin word “claudicatio” which means “limping.”

Risks
As we get older, our bodies have a more difficult time managing the various substances within our bodies. This can lead to fat, cholesterol, and calcium buildups which result in plaque. Other risks include smoking, diabetes, and high blood pressure.

Symptoms
Most often, people do not experience any symptoms of PAD, but intermittent claudication is the primary symptom that is experienced. As PAD worsens, pain may be felt in the feet or toes, weak calves, or ulcers on the feet that do not bleed nor heal.

Detection

There are several tests available to test for PAD, a condition that often goes underdiagnosed.

The primary test used is called the Ankle-Brachial Index, or ABI. An ABI test involves checking the blood pressure of both arms while lying down, followed by four blood pressure tests on each leg in different spots. This test determines the systolic pressure (the top number in blood pressure tests) of the ankles. Normal ABI readings are 1.00 to 1.30, borderline is 0.91 to 0.99, below normal is 0.40 to 0.80, and severely low is under 0.40. Leg pain is most common in the below normal range, but when the result is severely low, there is a risk of developing gangrene.

When the ABI reading is borderline, the patient may run on a treadmill to determine the pain threshold as well as peak performance. With PAD, peak performance is usually 50%-60% reduced; the same as someone who has suffered heart failure. Waveform analysis testing can pinpoint the blood vessels contributing to PAD. It is performed by actually listening to the blood pumping through arteries in the legs. A computer makes a waveform (visual representation of sound) to trace the location of narrowed blood vessels. Otherwise, an angiography can be performed. An angiography uses a dye injected into arteries to highlight the blood flow in a magnetic resonance imager (MRI) or computed tomography scan (CT Scan). 

Treatment

  • Smokers need to stop smoking immediately when they are diagnosed with PAD.
  • Regular exercise can help moderate milder cases of PAD by increasing blood flow.
  • Changes to diet including more heart-healthy foods that are low in saturated fats will reduce plaque buildup in arteries.
  • Some medications can help in moderate to severe cases by controlling blood pressure and/or cholesterol levels. Anticoagulants, also known as blood thinners, reduce platelet buildup in the bloodstream which can also prevent PAD or varicose veins.
  • In advanced cases of PAD, the arteries in legs may be partially or completely blocked and can be treated by minimally invasive procedures such as balloon angioplasty or stent placement.
  • In a worst case scenario, a blocked artery can be bypassed with a surgical procedure.