Pay Attention to Leg Pain

Know the Warning Signs of Peripheral Artery Disease

You probably wouldn't ignore pain in your chest. But would you dismiss discomfort in your legs? Many people don't realize that when it comes to your cardiovascular system, it's also important to pay attention to your legs.

"A blockage in the leg can be as dangerous as a blockage in the heart," says Brett Carroll, MD, Director of Vascular Medicine in the CardioVascular Institute at Beth Israel Deaconess Medical Center and Instructor in Medicine at Harvard Medical School.

Known as peripheral artery disease or PAD, the condition is caused by blockages that develop when the arteries that carry blood to the legs become clogged by plaque, the same sticky mix of calcium and cholesterol that can lead to blocked coronary arteries in the heart.

The good news is that when it is diagnosed in its early stages, PAD can often be controlled through lifestyle modifications like walking therapy and medications. Even better, you can lower your risk of developing PAD through healthy habits.

More About Peripheral Artery Disease

"People wouldn't necessarily think that sore legs are related to heart disease," adds CVI vascular surgeon Andy Lee, MD, an Instructor in Medicine at Harvard Medical School. "But if leg arteries are blocked, it's likely that coronary arteries are blocked as well. Left untreated, PAD can potentially increase a person’s risk of suffering a stroke or heart attack. It is also a leading cause of limb amputation."

Early Symptoms

PAD is estimated to affect one in 20 people over age 50 and one in five people over age 70, according to the National Heart, Lung and Blood Institute.

Although initial symptoms may be mild, nearly everyone who has PAD finds they are unable to walk as far or as fast as they previously could due to tired, achy legs. The leg pain associated with PAD is known as claudication.

"Claudication is different from other types of pain that result from arthritis or a bone or muscle problem," says Carroll. "It typically follows a specific pattern, beginning with pain in the calves or thighs while a person is walking. It improves with rest, and then recurs when walking resumes."

People often attribute this type of mild leg pain to "getting older and slowing down," adds Lee (right). "But claudication is an indication that narrowed arteries may be reducing blood flow to the legs."

Other signs of poor blood flow in the lower limbs include loss of leg hair and foot ulcers that don't heal. Tell your doctor if you have fatigue or cramping in the calf, thigh or hip when walking.

Diagnosing PAD

One way that doctors diagnose PAD is through an ankle-brachial index test.

"This noninvasive test compares two blood pressure measurements," explains Carroll.

One measure is taken in a person's arm with a blood pressure cuff. Then a second measure is taken in the ankle using a blood pressure cuff and ultrasound waves to hear the pulse in the feet.

"When blood vessels are healthy, these two measurements should be similar," he adds. "If there is a large discrepancy in the measurements and the ankle pressure number is low, it can indicate a narrowing or blockage in the leg arteries."

Taking Steps to Control PAD

It may seem counterintuitive, but walking and exercise are key to controlling PAD and easing pain.

"Even if you have already been diagnosed with PAD, the more you walk, the more conditioned your legs will become," says Carroll. "This will improve circulation and blood flow and diminish pain.";

A recent review of prior studies found that walking can significantly improve walking ability in PAD patients, particularly supervised walking programs.

Many patients may benefit from a dedicated walking program. BIDMC offers a 12-week program, often covered by Medicare and most private insurers, which consists of interval walking on a treadmill under the supervision of a specially trained exercise or physical therapist.

"Multiple studies have shown that enrollment in a structured walking program is more beneficial than walking at home, but that may not be feasible for all patients," says Carroll. "For those that cannot enroll in a dedicated program, I recommend, begin with a half-hour walk several times a week. Then, gradually increase the time or distance at subsequent weeks. Over time, pain should start to improve, allowing you to walk farther and longer. As walking becomes easier, gradually increase your time by five-minute intervals."

Making treatment or therapy decisions for managing peripheral artery disease can be challenging. BIDMC is at the forefront of engaging patients in making informed, personalized decisions for their care.

Know the Risk Factors

The same risk factors that can damage your heart can damage your legs: Diabetes, high levels of bad cholesterol and high blood pressure can all lead to the development of PAD.

If you have been diagnosed with any of these conditions, be diligent about taking medications. These include statins and cholesterol-lowering medications, which can help prevent blockages and are often an early step in treating PAD.

Another key to preventing PAD: Don't smoke.

"Smoking is a principal risk factor for many types of vascular disease, especially PAD," adds Lee. "My first advice to patients is, 'If you smoke, quit.'"

Clearing Blocked Arteries

If lifestyle changes and medications aren't enough to improve severe symptoms of PAD, you may need to consult with a vascular surgeon.

"Severe PAD can be treated in a number of ways," adds Lee. "Patients may undergo angioplasty or angioplasty with stenting, a minimally invasive procedure that uses a catheter to push plaque away from the walls of leg arteries. In some cases, stents may be inserted to keep arteries open. "Depending on the extent of PAD and after careful discussion with our patients, we also perform more traditional open surgical procedures to remove plaque or bypass blockages."

Learn more about Vascular Medicine at BIDMC.