Peripheral artery disease (PAD) occurs when the blood vessels in the leg are narrowed or plugged by the buildup of plaque. Atherosclerosis, the process that causes PAD, tends to start earlier in life and progress more rapidly in people with diabetes. In most people, PAD is symptomless in its early stages. If the disease progresses to a severe stage, however, the most common symptom is pain in the leg muscles—not the joints— when you exert yourself. This symptom, called intermittent claudica- tion, means that the muscles in your legs and feet are not getting enough blood and oxygen when they are working. The pain of intermit- tent claudication comes on with activities such as walking and is relieved by rest or stopping the activity. Without treatment, PAD can progress to the point where the blood supply is so poor that it can lead to dam- age of skin and muscle tissue deprived of blood in your lower legs and feet. Surgery on the blood vessels or even amputation may be necessary in severe cases. A large number of amputations of toes, feet, or legs occurs in people with diabetes and PAD.
As many as one in three people with diabetes has peripheral artery disease, but they may not realize it if they have not experienced any signs. Your risk of having PAD is higher if you smoke, have high blood pressure, have high cholesterol, are overweight, are physically inactive, are over 50 years old, have a family history of cardiovascular disease, or have already had a heart attack or a stroke.
If you notice that your calves hurt when you exercise but stop hurting when you rest; if you often sense numbness, tingling, or cold- ness in your legs or feet; or if you have sores or infections on your feet or legs that don’t heal, see your doctor right away to be tested for PAD.
If you have experienced neuropathy, a common diabetic symptom that is a burning sensation in the feet or thighs, you might easily con- fuse the two types of pain. Describe the pain as speci?cally as possible to your doctor. He or she may want to test for the condition even if you are not experiencing symptoms, especially if you have some of the risk factors in addition to your diabetes.
The most common test for PAD is checking the pulses in your ankles and feet. If you have PAD, your treatment will begin with lifestyle changes, including quitting smoking, controlling your diabetes, control- ling your blood pressure, being more physically active, beginning an exercise program to improve blood ?ow, and eating a low-fat diet to control your cholesterol. Your doctor may also prescribe medications, such as drugs that treat your leg pain so that you can walk farther; antiplatelet agents, which help prevent blood clots; or statins, which help lower your blood cholesterol.