Peripheral Arterial Disease
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
Peripheral arterial disease (PAD) is a narrowing of the arteries that carry blood to your legs, usually from a build-up of fatty deposits. It is common: one global estimate is that 9.7 per cent of adults, mostly aged 40 and over, have it. Many people have no symptoms. The classic symptom is cramping or aching in the calf when walking, which eases with rest. PAD is also a sign that your heart and blood vessels need care. The good news is that regular walking, stopping smoking and the right medicines can help you walk further and lower your risk of serious problems.
What is it?
Peripheral arterial disease (PAD) happens when the arteries (the blood vessels that carry blood from your heart) become narrow, mostly in your legs. The cause is usually a build-up of fatty deposits in the artery walls, called atherosclerosis. Less blood and oxygen then reach your leg muscles.
Your legs often cope fine when you are resting. The problem shows up when you walk, because your muscles then need more oxygen than the narrowed arteries can deliver.
PAD is also called peripheral vascular disease (PVD). It can range from no symptoms at all to serious damage to the leg. It is described as largely preventable.
Who does it affect?
PAD becomes much more common as we get older. In high-income countries, about 5 per cent of people aged 45 to 49 have it, rising to about 18 per cent of people aged 85 to 89. Men and women can both be affected.
Women with PAD are often diagnosed later. They are more likely to have no symptoms or unusual ones, so it can be missed.
Indigenous Australians with PAD had almost 5 times the risk of major heart and circulation events, such as heart attack or stroke, compared with non-Indigenous Australians. Indigenous Australians with diabetes also appear to carry a higher risk of PAD.
Signs and symptoms
The classic symptom is called intermittent claudication (say it: klaw-dih-KAY-shun). This is cramping or aching in your leg, often the calf, that starts when you walk and settles within a few minutes of rest. It tends to come on sooner if you walk fast or uphill.
Other symptoms can include:
- heaviness in your legs when you exercise
- coldness in a leg or foot
- numbness or pins and needles
- wounds on your feet or legs that are slow to heal
Many people don't get the classic pattern. Some have other kinds of leg discomfort, and some have no symptoms at all. That is why PAD can go unnoticed for years.
If the narrowing becomes very severe, pain can start while you are resting, or wake you at night. See "When to see a podiatrist" below for the signs that need prompt help.
What causes it?
Fatty plaque builds up in the walls of your leg arteries and narrows them. Smoking is the most significant risk factor. Other common ones are:
- diabetes
- high blood pressure
- high cholesterol
- getting older
- a family history of heart and circulation disease
- kidney disease
- being overweight
- not being active
These are links seen across large groups of people. Having one or more doesn't mean you will definitely get PAD, but each one adds to your risk.
How is it diagnosed?
Your podiatrist or GP will ask about leg pain when you walk, how far you can go, how quickly rest helps, and any numbness, coldness or slow-healing wounds. They will also check the pulses and skin of your feet and legs.
A simple, painless test called the ankle-brachial index (ABI) is the starting point. It compares the blood pressure at your ankle with the pressure in your arm. Lower numbers at the ankle suggest narrowed arteries.
If you have diabetes or kidney disease, the ABI can look normal even when your arteries are badly narrowed. This happens because the artery walls can be stiff and hard to squeeze. So a normal result shouldn't reassure you on its own if you have symptoms. Your practitioner will weigh up your history and the look of your feet, and may involve a vascular specialist (a doctor who treats blood vessel problems) if there is any doubt.
Finding PAD early matters. It gives the best chance of preventing sores, gangrene (dead tissue from a lack of blood) and amputation.
Treatment
Treatment has two aims: to help you walk further with less pain, and to protect your heart, brain and legs from serious problems.
Looking after it at home
Walking is one of the most useful things you can do. Walk until your leg pain starts, keep going as far as you can through the pain, then rest. Repeat this stop-start pattern until you have walked for at least 30 minutes in total, several times a week. Aim to keep exercising daily over the long term, because the benefits are quickly lost if exercise isn't frequent and regular.
If you have other medical conditions, or find exercise hard, talk to your GP or podiatrist before you start.
Stopping smoking is the strongest single change you can make. Ask your GP or podiatrist about support and medicines to help you quit.
Check your feet every day for new sores, colour changes or coldness.
Treatment from your podiatrist
Your podiatrist can check your feet, skin and pulses, explain your results, and help you set up a walking plan. They will refer you on promptly if they find signs of more serious disease.
A supervised exercise programme is the best-supported treatment for claudication. A typical programme is about 2 hours a week for 3 months, with a trainer guiding you. On average, exercise programmes helped people walk 82.11 m further before the pain started, and 120.36 m further in total. Exercise doesn't change your ABI number, but it still improves how far you can walk.
If you can't get to a supervised programme, a structured programme at home or in your community can be a good alternative.
Other options
Your GP or vascular team may prescribe medicines to lower your risk of heart attack and stroke. These include a medicine that makes your blood less likely to clot (an antiplatelet) and a medicine to lower cholesterol. They also help slow the progress of PAD. Take them as prescribed.
If walking is hard for you, cycling, resistance training, arm cranking (a pedal machine for your arms) or Nordic walking (walking with poles) can work about as well as walking for how far you can go. This is less certain than the walking evidence, so ask your treating team what suits you.
Surgery
If you are not improving after a proper try at exercise and managing your risk factors, your GP or a vascular service can review your medicines and whether a procedure to improve blood flow suits you.
If the disease is limb-threatening, you need to see a vascular specialist urgently. If the artery can't be unblocked and blood supply can't be increased, the affected finger, toe, foot or leg may need to be removed. Early assessment gives you the best chance of avoiding this.
Recovery
PAD is a long-term condition. It can be well managed, but it doesn't simply go away. How you do depends on your heart and circulation health as well as your legs, because PAD makes you more likely to have a heart attack, stroke or other heart and circulation disease.
Smoking makes the biggest difference. Even people smoking 1 to 10 cigarettes a day have faster disease progression and more heart and circulation problems, despite the best medical treatment. People who keep smoking after diagnosis are much more likely to have a heart attack and die from heart disease than those who quit.
Staying on your medicines and keeping up regular exercise aim to lower the chance of the disease reaching limb-threatening stages and to lower your risk of heart attack, stroke and death. Regular follow-up with your GP, vascular team and podiatrist helps keep it in check.
Preventing it
PAD is largely preventable. The most helpful steps are the same ones that protect your heart:
- Don't smoke, and quit if you do.
- Keep diabetes, blood pressure and cholesterol well controlled, with your GP's help.
- Keep to a healthy weight.
- Stay active.
If you already have PAD, these steps help stop it getting worse. Check your feet daily and report any wound or colour change straight away.
When to see a podiatrist
Book an appointment if
You get cramping or aching in your calf, thigh or buttock when you walk that eases with rest. Or your legs or feet often feel cold, numb or tingly, or a sore on your foot or leg is slow to heal. Also book if you smoke or have diabetes, high blood pressure or high cholesterol and want your legs checked, because many people have no symptoms. Book an appointment with your podiatrist, or see your GP.
Seek prompt assessment if
Call your local emergency number if your leg or foot suddenly becomes painful, white or pale, cold or numb, or you suddenly can't move it. See your GP or another doctor today if you have constant pain in your foot or toes that is worse at night and eases when you hang your leg down. See them today too if a sore or ulcer on your leg or foot hasn't healed in more than 2 weeks, or if the skin on your toes or legs turns cold and numb, then red and black, or swells and leaks smelly pus with severe pain. Also go today if your symptoms come on quickly or suddenly get worse. If your GP can't see you today, go to an urgent care clinic or an after-hours GP. Don't wait for a routine appointment, and don't use home exercise instead.
Frequently asked questions
Is peripheral arterial disease the same as peripheral vascular disease?
Yes, the two names are used for the same thing: narrowed arteries that reduce blood flow, most often to the legs. You may also see it written as PAD or PVD. Your practitioner may use either name.
Does PAD mean I will lose my leg?
No. Most people with PAD have no symptoms, and only up to 10 per cent progress to, or first show up with, limb-threatening disease, though that figure varies widely. Amputation is only needed if blood flow can't be restored. Exercise, not smoking, medicines and early help for any warning signs all lower the risk.
Do I need to quit smoking completely, or can I cut down?
Quitting completely is the goal. Even people smoking 1 to 10 cigarettes a day have faster disease progression and more heart and circulation problems. Your GP or podiatrist can point you to support and medicines that make quitting easier. Keep trying, even if earlier attempts haven't worked.
Are e-cigarettes a safe way to quit?
Their safety in PAD hasn't been established. They should not be considered if you have limb-threatening disease (rest pain, ulcers or gangrene) until more is known. Ask your GP about proven quitting aids instead.