Leg pain and calf pain are often mistaken for either bone and joint disease or neurological disease. Most people have referred these symptoms to the elderly’s condition caused by excessive walking. In fact, these symptoms might potentially indicate peripheral artery disease.

What are peripheral arteries? 

Peripheral arteries are blood vessels that supply blood to the entire body except to the heart and brain. Peripheral arteries circulate blood flow to the limbs and extremities such as the arms, hands, legs and organs in abdominal cavity such as stomach and kidney. Peripheral arteries supply oxygen-rich blood to muscles, bones and nervous system thus its function is as crucial as coronary arteries.

What is peripheral artery disease?

Peripheral artery disease is a narrowing of the peripheral arteries, resulting in reduced blood supply to the limbs and extremities, especially the legs. Peripheral artery disease is often caused by atherosclerosis which is fatty deposits (plaques) built on the artery walls. Atherosclerotic plaques reduce blood flow to the limbs and cause symptoms, most notably leg pain when walking. Factors that increase risks of developing peripheral artery disease include: 

• High blood pressure
• Diabetes
• High blood cholesterol
• Smoking
• Obesity
• Increasing age

Signs and symptoms of peripheral artery disease 

Most common affected area is leg and signs and symptoms include: 

• Painful cramping in the legs or calf muscles after certain activities e.g. walking or climbing stairs (claudication)
• Leg or foot numbness or weakness. A change in the color of the legs or feet. Coldness in the lower leg or foot.
• Sores on the feet, heel or legs that do not heal properly. It is usually found in diabetic patients with impaired would healing process. If left untreated, tissue necrosis might develop.

If the condition progresses, pain may occur at rest. Pain may occur in one or both sides of the limbs. If pain is intense, it can disrupt sleep. Hanging legs over the edge of the bed or walking around may temporarily relieve the pain.

Diagnosis of peripheral artery disease 

Early diagnosis does not only help to treat all relevant symptoms effectively, it also helps to reduce risks of developing coronary artery disease and cerebrovascular disease that affect heart and brain, respectively. Tests and procedures to diagnose peripheral artery disease include: 

• Ankle-brachial index (ABI). This is a common test used to diagnose PAD. It compares the systolic blood pressure in the ankle with the systolic blood pressure in the arm.

  To get a blood pressure reading, a regular blood pressure cuff and a special ultrasound device are used to evaluate blood pressure and flow.
  For result interpretation, normal value of ABI is equal to 1. Blood pressure in the ankle or leg should be equal to or more than blood pressure in the arm. If blood pressure in the ankle or leg is less than blood pressure obtained in the arm, the narrowed vessels might be suspected. This test is non-invasive and convenient. The result can usually lead to diagnosis without any side effects caused to the patients.

• For further investigation, imaging tests might be additionally required such as computed tomography (256-Slice Multi Detector CT Scan) and magnetic resonance imaging (MRI) scan.
• Confirmatory diagnosis might be made by angiography. During the procedure, a dye (contrast material) is injected into blood vessels. This test allows cardiac specialists to clearly view blood flow through the arteries. The cardiac specialists are able to trace the flow of the contrast material by using imaging techniques e.g. X-ray or procedures called magnetic resonance angiography (MRA) or computerized tomography angiography (CTA).

Treatment of peripheral artery disease

Major goals for treatment of peripheral artery disease include managing presenting symptoms such as severe leg pain and stopping the progression of atherosclerosis throughout the body to reduce additional risks of life-threatening conditions including heart attack and stroke.

Treatment option depends entirely on affected site and severity of narrowed arteries. 

• In early stage of peripheral artery disease, primary treatment is a combination of a supervised exercise training program to increase the distance that patients can walk pain-free with the use of medications e.g. cholesterol-lowering medications, anti-hypertensive drugs, blood sugar lowering drugs, medications to prevent blood clots and symptom-relief medications.
• In moderate to severe cases, non-surgical treatment called “angioplasty” might be additionally needed. During this procedure, a small hollow tube (catheter) is threaded through a blood vessel to the affected artery. Then a small balloon on the tip of the catheter is inflated to reopen the narrowed artery and flatten the blockage into the artery wall, while at the same time stretching the artery open to increase blood flow. A mesh framework called a stent might be further inserted in the artery to help keeping it open.
• In severe cases with complications, bypass surgery is required in order to create a graft bypass using a vessel from another part of patient’s body or a blood vessel made of synthetic (man-made) fabric. This surgical technique allows blood to flow around the blocked or narrowed artery.

Prevention of peripheral artery disease

The best possible way to prevent peripheral artery disease is to maintain a healthy lifestyle. This includes: 

• Smoking cessation
• In case of being diabetic, blood sugar must be kept in good control.
• Blood cholesterol and blood pressure levels must be kept in a normal range, if applicable.
• Exercise regularly, aiming for 30 minutes each time and 3 times a week. It should be continued for at least 6 months consecutively.
• After walking, if pain exhibits in particular areas such as foot, calf and leg, immediate medical attention must be sought as soon as possible.