Peripheral artery disease (PAD) is a problem with blood flow in the arteries, usually the legs. Poor circulation and blockage of blood in the leg arteries produces an aching, tired, and sometimes burning pain in the legs.

The pain from PAD is brought on by exercise, and relieved by rest. The limping that occurs from the leg pain is called claudication.

This condition may occur in both legs, and the symptoms often get worse over time. However, some people complain only of weakness in the legs when walking, or a feeling of "tiredness" in the buttocks. Impotence is an occasional complaint in men. Pain at rest is uncommon.

This condition is due to atherosclerosis or peripheral vascular disease. Narrowed or blocked arteries can occur anywhere in the body. If they occur in the heart, a person may have chest pain (angina) or even a heart attack. If arteries are blocked or narrowed in the neck or the brain, a person may have a stroke.

Intermittent claudication is when the blockage occurs in the legs, most commonly in the calf or the foot. It occurs only at certain times, such as after a period of walking, and is relieved by rest.

Atherosclerosis can occur for many reasons such as smoking, diabetes, and high cholesterol.

Talk to your doctor about the cause of your leg cramping and about what to do at home to relieve it. A healthy diet is important to keep atherosclerosis from getting worse.

A program of daily walking for short periods, and stopping for pain or cramping, may help improve function. You MUST stop smoking.

Avoid placing hot or cold items on legs. Avoid tight shoes.

Have your doctor check any non-healing wounds on the lower legs and feet.

There are many other causes of leg pain such as arthritis or low blood potassium. However, some causes of leg pain may be life threatening such a blood clot in the legs. Seek medical attention if you have:

• Chest pain or shortness of breath with leg pain
• Diabetes
• If you are pregnant
• Leg pain that does not go away
• Legs that are red, hot, or swollen

Your health care provider will perform a physical examination and ask questions about your cramping leg pain and other symptoms such as:

• Do you have leg cramps at night?
• How often does leg pain with cramping occur?
• Is it getting worse?
• Is the pain sharp?
• Is there an aching pain with the cramps?
• Is it worse after you exercise?
• Is it worse after you are standing?
• Do you smoke? How much?
• Do you drink alcohol? How much?
• Are you diabetic? How well is your blood sugar controlled?
• What other symptoms do you have?
• Has there been impotence (men)?
• Do you have pain in the back?
• Do you have a darkening of the skin of the legs, feet, or toes?
• Do you have weakness or paralysis of the legs?

The provider may check the pulse in your groin and other areas where the pulse can be felt in the legs.

The following tests may be performed:

• Aortography to see blockages in your large arteries
• Blood pressure measured in arms and legs for comparison
• ECG to check the activity of your heart
• Doppler ultrasonography on the legs and the heart
• Duplex Doppler/ultrasound exam of extremity to see how blood flows through arteries

Surgery or angioplasty may be recommended if claudication interferes with your activities or work, and if the diseased arteries are likely to improve after corrective treatment.

Creager MA, Libby P. Peripheral arterial disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed. St. Louis, Mo: WB Saunders; 2007: chap. 57.