Peripheral Arterial Disease: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Peripheral Arterial Disease?
PAD is cared for by a cardiologist (a heart doctor) or a vascular specialist (a doctor who treats blood vessels). Treatments include lifestyle changes, medicines, and sometimes surgery. Quitting smoking is an important step, and exercise can help. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is peripheral arterial disease?
Peripheral arterial disease (PAD) means the blood vessels outside your heart become narrow. It most often affects the legs. The cause is atherosclerosis, a buildup of plaque in artery walls. Plaque is made of fat, cholesterol, calcium, and other substances. As plaque grows, arteries narrow or get blocked. Less blood and oxygen reach the legs. In the United States, more than 8 million people age 40 and older have PAD.
Symptoms
Many people with PAD have no symptoms. The main symptoms are muscle pain or cramping with activity, often called claudication. This comes when walking or climbing stairs and goes away after several minutes of rest. It can affect the muscles of your feet, calves, or thighs. Over time it can start sooner, with less walking.
Other signs include:
- Numbness in the leg or foot.
- Legs or feet that feel cool to the touch.
- Pale or bluish skin on the legs or feet.
- Shiny, tight skin and hair loss on the legs.
- Thick toenails and sores on the feet or legs that heal slowly or not at all.
- Erectile dysfunction in men.
With severe PAD, pain can strike at night or even at rest. It often improves when you dangle your legs over the side of the bed. PAD also raises the risk of heart attack and stroke.
Causes and who gets it
Atherosclerosis is the main cause of PAD. Artery walls get stiff and narrow, so muscles cannot get enough blood and oxygen when they work hard. The biggest risk factor is smoking. Other risk factors include older age, diabetes, high blood cholesterol, and high blood pressure. PAD most often affects men over age 50. It is also more common in people with heart disease, stroke, or kidney disease that needs dialysis (a treatment that filters the blood when the kidneys fail).
How doctors diagnose it
Doctors diagnose PAD with a physical exam and tests. They check pulses in the legs and feet. Weak or absent pulses can be a sign. The ankle-brachial index (ABI) compares blood pressure in your ankles with your arms. Doppler ultrasound checks blood flow in an arm or leg. Angiography of the legs, including MR angiography and CT angiography, takes pictures of the arteries. Blood tests can show high cholesterol, diabetes, or kidney disease.
Treatment
Treatment can help your symptoms and reduce your risk of serious problems. Lifestyle changes can help control PAD. Stop smoking. Smoking narrows the arteries and raises the risk of clots. Walking helps. Walk to the point of pain, rest, and repeat. Over time, circulation may improve as new small blood vessels form. Talk to your provider before starting an exercise program. Keep blood pressure, cholesterol, and blood sugar under control. Wear shoes that fit and check your feet for cuts.
Medicines can also help. Aspirin or clopidogrel can keep clots from forming. Medicine to help lower your cholesterol may also be needed. Cilostazol, a medicine that widens the affected arteries, is for moderate-to-severe cases that are not candidates for surgery. For severe cases, balloon angioplasty opens a narrowed artery, sometimes with a small mesh tube called a stent. Bypass surgery reroutes blood around a blockage. In the worst cases, part of the leg may need amputation.
When to see a doctor
Call 911 or go to the emergency room if a leg or foot suddenly becomes cold, pale, and painful, because blood flow to the leg may be blocked. Also call 911 for chest pain or discomfort lasting two minutes or more, trouble breathing, or sudden weakness, dizziness, change in vision, or being unable to speak, since PAD raises the risk of heart attack and stroke. See a doctor for leg pain that does not go away, even when you are not walking. Seek care for sores that do not heal.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. This kind of doctor can run blood tests and help you keep blood pressure, cholesterol, and blood sugar under control.
Common questions
Can PAD be treated without surgery?
Yes. Most cases can be controlled without surgery. Quitting smoking, exercise, foot care, and medicines help many people. Surgery may be done if the condition is severe, you have pain at rest, or you have sores that do not heal.
Is PAD dangerous?
It can be. PAD raises the risk of heart attack and stroke. Poor blood flow can lead to sores, tissue death, and sometimes amputation. Finding it early and getting care can reduce these risks.
What is claudication?
Claudication is leg muscle pain or cramping that comes when walking or climbing stairs and goes away after rest. It is the main symptom of PAD. About 1 in 4 people who have PAD experience these symptoms.
What is the ankle-brachial index?
It is a simple test that compares blood pressure in your ankles with your arms. It helps show how well blood flows to your legs.
Can exercise really help?
Yes. Exercise can help control PAD. Over time, circulation may improve as new small blood vessels form.
Sources
- MedlinePlus - Peripheral Arterial Disease
- National Heart, Lung, and Blood Institute - Peripheral Artery Disease
- MedlinePlus - Peripheral artery disease - legs
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
