Peripheral artery disease, or PAD, occurs when arteries supplying the limbs become narrowed or blocked. It most often affects the legs and is usually caused by atherosclerosis, a build up of fatty plaque inside the arteries. PAD also signals a higher risk of heart attack and stroke.
Symptoms
The classic symptom is aching, cramping or tiredness in the calf, thigh or buttock during walking that improves after resting. This is called intermittent claudication. Some people have unusual symptoms or no symptoms at all.
Other possible signs include a cold or numb foot, weak pulses, shiny skin, reduced hair growth, slow growing toenails, colour changes and wounds on the toes or feet that heal slowly. More advanced disease can cause pain in the foot at rest, often worse at night or when the leg is raised.
Risk factors
Smoking is one of the strongest preventable risk factors. Risk also rises with diabetes, high blood pressure, high cholesterol, kidney disease, increasing age and a family or personal history of cardiovascular disease.
See our Heart and Circulation section for information about related conditions and cardiovascular risk.
Diagnosis
A clinician examines the legs, skin and pulses and reviews symptoms and risk factors. The ankle brachial pressure index compares blood pressure at the ankle with blood pressure in the arm. Exercise testing, ultrasound or other imaging may be used when the diagnosis is uncertain or a procedure is being considered.
People with diabetes can have arteries that are difficult to compress, which may affect the ankle pressure result. Further vascular testing may then be needed.
Treatment
Treatment aims to improve walking, protect the limb and reduce the risk of heart attack and stroke. It commonly includes stopping smoking, managing diabetes and blood pressure, lowering cholesterol and taking an antiplatelet medicine when appropriate.
A structured walking programme can improve how far many people can walk before pain begins. Exercise should be planned with a healthcare professional when symptoms are severe or there are wounds, heart symptoms or other limitations.
Angioplasty, a stent or bypass surgery may be considered when symptoms remain disabling despite treatment or when blood flow is critically reduced. The best option depends on the location of disease, overall health and personal goals.
Foot care
Check the feet every day for cuts, blisters, colour changes and sores, especially if you have diabetes or reduced sensation. Wear well fitting shoes and seek early care for wounds. Avoid direct heat on numb feet because burns may go unnoticed.
When to seek urgent help
Call emergency services for sudden severe pain in a leg or foot, especially with pallor, coldness, numbness, weakness or loss of a pulse. This may be acute limb ischaemia and requires immediate treatment.
Seek urgent medical assessment for a new ulcer, blackened skin, spreading infection, pain in the foot at rest or a rapidly worsening change in colour or temperature. Call emergency services for chest pressure, symptoms of stroke or severe breathlessness.
Sources
- NHS: Peripheral arterial disease
- NHS: Diagnosis of peripheral arterial disease
- NHS: Treatment of peripheral arterial disease
- National Heart, Lung, and Blood Institute: Peripheral artery disease
Using this information
This information supports, but does not replace, an individual vascular and cardiovascular assessment. Symptoms, test results and treatment choices should be reviewed by a qualified healthcare professional.
Reviewed: 28 August 2026