What are the symptoms of peripheral artery disease (PAD)?

The most common symptom of peripheral arterial disease (PAD)—generally associated with blocked arteries of the leg—is called intermittent claudication. Claudication refers to limping because of pain in the thigh, calf and/or buttocks that occurs when walking. Just as chest pain or angina of the heart can signal a heart attack, intermittent claudication may be considered as "angina of the legs" and may indicate lack of blood flow to the legs.

Other symptoms of PAD may include, but are not limited to, the following:

  • cool/cold feet to touch
  • pain in the legs while lying flat and relieved by a sitting position
  • loss of pulses in legs or feet
  • pale color when legs are raised up
  • dependent rubor (redness when legs are in a dependent [hanging down] position)
  • shiny skin
  • loss of hair on feet
  • thickened toenail (may have fungal infections)
  • nonhealing wound or ulcer
  • gangrene
  • loss of muscle or fatty tissue

The most severe symptom of peripheral arterial disease caused by atherosclerosis is called critical limb ischemia (lack of oxygen to the limb/leg at rest). Critical limb ischemia (CLI) is defined as pain in the leg(s) while at rest, or "rest pain." CLI is also associated with the breakdown of tissues (muscle/skin) in the form of ulcers or gangrene in the limb, which may occur because blood flow to the limb is so decreased that the basic needs of the limb for oxygen and nutrients are not being met.

Peripheral artery disease (PAD) is caused by a buildup of fat and cholesterol (atherosclerosis) in the arteries of your arms and legs. This decreases the blood flow to your limbs. Without good blood flow, your cells can’t get things they need like oxygen and nutrients. And they can’t get rid of wastes like carbon dioxide and lactic acid. The result is symptoms like:

  • Leg pain with activity (intermittent claudication)
  • Shiny, hairless legs
  • Numb or cold fingers or toes
  • Sores or wounds that won’t heal

Build up of fat and cholesterol? Blocked blood vessels? This may sound familiar because the same process can also lead to a heart attack or stroke. In fact, if you’re experiencing any of the symptoms above, you’re lucky. Take it as a warning sign and take action. If the vessels of your arms or legs are narrowed, other vessels could be too. Maybe even those to your heart or brain! So go see your doctor. He or she can tell you about lifestyle changes and medications to slow the progression of atherosclerosis and help you prevent a heart attack or stroke.

For many people, the first sign of peripheral artery disease, or PAD, is tightness, heaviness, cramping, pain or weakness in their legs while they are walking or being active. Other people describe an aching, burning sensation in their muscles, but not in their joints. In both cases, the discomfort or pain usually disappears once they stop moving and sit down. Other symptoms are tiredness, discoloration (often bluish) of the toes or feet, numbness in the legs or feet, sores on the toes, feet or legs that will not heal and buttock discomfort with exercise.

If you have these symptoms, your doctor may suspect that the blood vessels that supply blood to your legs have narrowed, possibly starving your feet and lower legs of the oxygen they need to be healthy. Your doctor will examine you, possibly run some tests and recommend a treatment plan for you.


Many symptoms might signal peripheral artery disease (PAD). The most common symptom is fatigue or cramping of your muscles (claudication) in the calf, thigh, hip or buttock. Typically the discomfort is felt after walking a certain distance and goes away with rest. Other symptoms include numbness, tingling and weakness in the lower leg and feet; a sore on the leg or foot that won’t heal and pain in the legs or feet that awaken you at night.

PAD occurs when arteries become narrow or blocked, decreasing blood supply in the legs. It’s caused by a buildup of plaque in the walls of arteries called atherosclerosis. PAD typically occurs in the legs, but it also may affect arteries that carry blood from the heart to the kidneys, head, arms or stomach.

Classic symptoms of PAD typically include pain, fatigue or discomfort in the feet and legs that occurs during walking or exercise and then goes away after a few minutes of rest. Others with the disease may show signs of:

  • Sores on legs or feet that heal slowly or not at all
  • Skin that looks dark and blue
  • Lower temperature in one leg compared to the other
  • Weak or absent pulse in the legs or feet
  • Erectile dysfunction

PAD may be diagnosed following a complete medical history, physical examination and diagnostic tests.

Dr. Manesh R. Patel, MD
Cardiologist (Heart Specialist)

The most common symptom of peripheral arterial disease (PAD) is pain when walking. If you walk 30 feet and your calves get tight and painful, and the pain subsides when you stop and relax, it could be a symptom of PAD.

At least half of the people who have peripheral arterial disease (PAD) don't have any signs or symptoms of it. Others may have a number of signs and symptoms.

Even if you don't have signs or symptoms, discuss with your doctor whether you should get checked for PAD if you're:

  • Aged 70 or older
  • Aged 50 or older and have a history of smoking or diabetes
  • Younger than 50 and have diabetes and one or more risk factors for atherosclerosis

Intermittent Claudication
People who have P.A.D. may have symptoms when walking or climbing stairs. These may include pain, numbness, aching or heaviness in the leg muscles. Symptoms also may include cramping in the affected leg(s) and in the buttocks, thighs, calves and feet. Symptoms may ease after resting.

These symptoms are called intermittent claudication (klaw-de-KA-shen). During physical activity, your muscles need increased blood flow. If your blood vessels are narrowed or blocked, your muscles won't get enough blood. When resting, the muscles need less blood flow, so the pain goes away.

About 10 percent of people who have PAD have claudication. This symptom is more likely in people who also have atherosclerosis in other arteries.

Other Signs and Symptoms
Other signs and symptoms of PAD include:

  • Weak or absent pulses in the legs or feet
  • Sores or wounds on the toes, feet or legs that heal slowly, poorly or not at all
  • A pale or bluish color to the skin
  • A lower temperature in one leg compared to the other leg
  • Poor nail growth on the toes and decreased hair growth on the legs
  • Erectile dysfunction, especially among men who have diabetes

This answer from the National Heart, Lung and Blood Institute has been reviewed and/or edited by Dr. William D. Knopf.

Peripheral arterial disease (PAD) most commonly affects the legs, but may occur elsewhere as well. Even if a person has no symptoms, the presence of PAD still indicates systemic disease that must be addressed. When symptoms do appear, they usually begin with claudication, or cramping in the back of the leg while walking. Such pain usually stops during rest and then resumes while walking. Symptoms may occur in just one leg. Mild disease can usually be treated with changes in lifestyle such as losing weight, smoking cessation, exercise and managing blood glucose and cholesterol levels.

If PAD progresses, blockages in the arteries can lead to more serious symptoms such as pain in the feet while lying down, wounds or ulcers in the legs and feet that don't heal, and in the most advanced stages, gangrene. This occurs more commonly in people with diabetes or who smoke cigarettes but can occur in anyone. These symptoms indicate critical limb ischemia resulting from impaired circulation and, if untreated, could result in amputation of the leg.

Moderate or severe disease may require treatment to open the blood vessels to restore circulation. People with diabetes face a particular risk for critical limb ischemia. Up to 20 percent of people with diabetes may eventually lose a limb if preventive measures and careful medical and surgical management are not part of their care.

Anyone who experiences pain in the legs with walking or wounds that don't heal in six weeks—and particularly anyone who is overweight, has diabetes or smokes—should seek an evaluation by a critical limb ischemia specialist "expeditiously."

Peripheral arterial disease (PAD) may cause intermittent claudication of the legs, which is associated with the following symptoms when walking or climbing stairs:

  • Pain
  • Numbness
  • Achiness
  • A feeling of heaviness in the legs
  • Cramping

These symptoms often ease when resting, because the muscles of the legs do not require as much oxygenated blood as they do during movement. Other signs and symptoms of PAD include:

  • Weak pulses in the legs or feet
  • Sores or wounds on the toes, feet or legs that don't heal well
  • A pale or bluish skin color
  • One leg feeling cooler than the other leg
  • Poor nail growth on the toes
  • Less hair growth on the affected leg(s)
  • Erectile dysfunction, particularly in men who also have diabetes
Boston Women's Health Book Collective
Administration Specialist

Peripheral arterial disease is plaque blocking the arteries supplying blood to other areas of the body, often the legs, arms or kidneys. If a leg artery is narrowed, it may be unable to increase blood flow to meet the requirements of the leg for oxygen and nutrients during exercise, causing leg cramping, which is relieved by rest. The narrowing of arteries supplying the kidneys can aggravate high blood pressure or impair kidney function.

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Many people with diabetes and peripheral artery disease do not have any symptoms. Some people may experience mild leg pain or trouble walking and believe that it's just a sign of getting older. Others may have the following symptoms:

  • Leg pain, particularly when walking or exercising, which disappears after a few minutes of rest
  • Numbness, tingling or coldness in the lower legs or feet
  • Sores or infections on your feet or legs that heal slowly

Although some people with peripheral artery disease (PAD)—narrowing or blockage of the arteries of the arms and legs—have no symptoms, others experience symptoms such as muscle cramping, aching, pain and numbness. The most common symptom of PAD is the feeling of cramping and aching in the legs or hips—especially when walking. This symptom, known as claudication, occurs when there's not enough blood flowing to the leg muscles during exercise. The pain typically goes away when the muscles are given a rest.

Dr. Justin P. Levisay, MD
Cardiologist (Heart Specialist)

The symptoms of peripheral artery disease (PAD) depend on where there is an arterial blockage. When it occurs in the legs it can cause pain and cramping in the muscles in the calves, thighs and buttocks when walking. It can also cause hip pain, which is commonly mistaken for arthritis. PAD can cause erectile dysfunction in men, blockages in the kidney arteries, difficult to control high blood pressure and poor kidney function. Blockages of the carotid artery can lead to stroke or mini strokes.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.