Leg Pain When You Walk Is Not Just Age
Sometimes it is the first warning of a serious problem
It starts as an ache or discomfort in the calf, thigh, or buttocks while walking. You stop, the pain improves, and you carry on. Over the next few months, you notice the discomfort is worsening. Now it is happening earlier in your walk and is more severe.
Most people blame age, bad hip or knee joints, a bad back, or being out of shape. Sometimes that is all it is. But sometimes it is the first warning of a serious problem known as peripheral artery disease (PAD), which can affect the arteries in the leg and may also be a warning sign for your heart artery health.
September is PAD Awareness Month. It is a good time to explain a condition that affects around 6.5 million Americans over 40, and goes unrecognized in a great many of them.
What is peripheral artery disease?
PAD is the same disease process as coronary artery disease, in a different location. Plaque, a buildup of cholesterol and inflammatory material, forms inside the artery wall and narrows the channel.
At rest a narrowed artery usually delivers enough blood. Walking changes that. Working muscle needs several times more blood, and a narrowed artery cannot supply it. The muscle runs short of oxygen and cramps. You stop, and the pain goes.
Doctors call that pattern intermittent claudication, which simply means leg discomfort with walking. Same distance, same pain, relieved by rest, repeatable.
Why PAD matters beyond your legs
Arteries do not narrow in one place by coincidence. If plaque has built up enough in the legs to cause symptoms, it is very likely in the arteries feeding the heart and brain too. PAD is one of the strongest signals we have that someone is at raised risk of a heart attack or stroke. That warning usually arrives while there is still a lot that can be done.
What does it feel like?
In many people, like nothing. Up to 4 in 10 people with PAD have no leg pain at all, which is why it goes undiagnosed for years.
When there are symptoms, they usually include:
Cramping, aching or tiredness in the calf, thigh, hip or buttock when you walk, that eases within a few minutes of stopping
The walking distance before it starts getting shorter over months
One leg feeling colder than the other, or skin that looks pale, shiny or bluish
Cuts or sores on the feet or toes that are slow to heal
Leg pain at rest, particularly at night, that eases when you hang the leg out of bed
Is It Urgent?
Get seen urgently if:
- A sore, ulcer or wound on the foot or toe is not healing
- You have leg or foot pain at rest, especially at night
- A foot becomes suddenly cold, pale, numb or painful
Pain at rest means the leg is short of blood even when it is doing nothing. Non-healing foot wounds are how advanced PAD becomes a threat to the limb. Caught early they are usually manageable. Left alone they can lead to serious infection, and in some cases amputation. That outcome is largely preventable when people are seen in time.
Who is most at risk?
Smoking is the single strongest risk factor, and it counts for more in PAD than in most other heart conditions. Diabetes is next. It also dulls the nerves in the feet, so warning symptoms are felt less. After those: age over 60, high blood pressure, high cholesterol, chronic kidney disease, and any known heart disease or stroke.
If you have diabetes and are over 50, PAD is worth raising even with no symptoms. The two things that hide it, absent pain and reduced foot sensation, are both in play at once.
How do I get tested for PAD?
The main test is simple, quick and low risk.
Ankle brachial index (ABI). We measure blood pressure in both arms and both ankles, then compare. Healthy leg arteries carry pressure at the ankle at least as high as in the arm. A lower ankle reading points to a narrowing upstream. It takes about 15 minutes, uses only blood pressure cuffs and a small ultrasound probe, and often gives the answer on its own.
Sometimes we repeat it after a treadmill walk, because a narrowing that looks mild at rest can be obvious under load. If the ABI is abnormal and treatment is on the table, imaging shows where the narrowing sits. That means Doppler ultrasound, CT or MR angiography, or catheter angiography, where the narrowing can often be treated in the same visit.
How is PAD treated?
Two goals, running in parallel. Protect the heart and brain, and improve how far you can walk.
Protecting the rest of your arteries
Matters most for how long you live. It is medication and risk factor control: a statin, blood pressure treated to goal, diabetes controlled, and an antiplatelet such as aspirin. And stopping smoking, which does more here than anything else on the list.
Improving your walking distance
Starts with supervised walking. You walk to the point of discomfort, rest, then walk again, repeated over several weeks. It helps many patients more than they expect, and it is first-line therapy, not a stand-in for real treatment. Certain medications can help too.
Procedures
Come in when symptoms still limit daily life despite good medical therapy, or blood flow is low enough to threaten the limb. Most narrowings are treated through a catheter, using a balloon and often a stent, through a small puncture in the groin or wrist. More extensive disease is sometimes better served by bypass surgery.
FAQs
Common questions
Is leg pain when walking always PAD?
No. Spinal stenosis, arthritis and muscle problems all cause leg pain on walking. The pattern separates them. PAD pain comes on at a fairly predictable distance, eases within a few minutes of standing still, and returns at the same distance next time.
Can PAD be cured?
The plaque does not disappear. But the disease can be stabilized so it stops progressing, and walking distance often improves a lot with treatment. Most people with PAD are not heading for an amputation. Most people with PAD who are never assessed are taking a risk they do not need to take.
The short version
Leg discomfort when you walk that stops when you rest is not a normal part of getting older. It is often a circulation problem. PAD is worth finding because of what it says about the rest of your arteries, and because the test that finds it takes 15 minutes.
You can read more about peripheral artery disease and its symptoms on our
PAD page.
Book Your Next Appointment
Getting assessed at Lumen Heart and Vascular
At Lumen Heart and Vascular we can work this up properly in one visit, from screening and risk factor treatment through to stenting the leg arteries or surgery when PAD is severe. If any of this sounds like you, an ABI is a quick way to get a clear answer, and it is worth doing before the walking distance shortens further.
We see patients at 13411 Parker Commons Blvd, Fort Myers, and care for people across Lee and Collier counties, including Cape Coral, Estero, Bonita Springs and Naples. We can usually see new patients within 1 to 2 days, pending insurance approval.
Call (239) 415-4900 or use the contact page to book. Physicians referring a patient can find what we need on the referral page.
This page is general education and not a substitute for individual medical advice. If you have symptoms or concerns, contact your physician or seek emergency care.
