Walking is wonderful exercise. You can go for a walk just about anywhere. It costs nothing and requires no special equipment. But if you feel leg pain that starts when you walk and is relieved by rest, then you could have peripheral artery disease (PAD). PAD occurs when arteries become narrow or blocked, reducing blood supply in the legs.

PAD is caused by a buildup of plaque in the walls of arteries called atherosclerosis. Plaque is made up of cholesterol, blood platelets, fat, fibrous tissue, and calcium. PAD typically occurs in the legs, but it also may affect arteries that carry blood from the heart to the kidneys, head, arms or stomach. Factors that contribute to chances of developing the disease including age, smoking, diabetes, high blood pressure, high cholesterol, high homocysteine (an amino acid in the blood) levels, and obesity. People with PAD have a six to seven times higher risk for coronary artery disease, heart attack, stroke and transient ischemic attack (mini-stroke) compared to people who do not have PAD.

Eight to 12 million Americans are affected by PAD. African Americans are more likely to be affected by the disease compared to Caucasians by a ratio of two to one. Only about 10 percent of people with PAD have leg pain, called intermittent claudication, and approximately half of people with the condition do not experience any symptoms. However, others with the disease may show signs of:

• Sores on legs or feet that heal slowly or not at all
• Pale or bluish skin color
• Lower temperature in one leg compared to the other
• Slow toenail growth or decreased hair growth on the legs
• Weak or nonexistent pulse in the legs or feet
• Erectile dysfunction

PAD may be diagnosed following a complete medical history, physical exam and diagnostic tests. One of the most commonly used tests is the ankle-brachial index, which compares blood pressure in the ankle to blood pressure in the arm. An ultrasound also could be done to determine if a blood vessel is blocked, or a magnetic resonance angiography test may be performed to measure blood flow through arteries.

Treatment for PAD is based on severity of the disease, risk factors and test results. Lifestyle changes that can help control PAD include not smoking, eating a healthy diet, lowering blood pressure, controlling cholesterol and exercising regularly. Medications to treat underlying conditions may be prescribed, such as statins to lower cholesterol or beta blockers to reduce blood pressure. Surgery could be recommended to open blocked arteries either through angioplasty, which involves inflating a tiny balloon to flatten plaque against the artery wall, or bypass, which allows blood to flow around the blocked artery. In extreme cases, the affected limb may need to be amputated if circulation cannot be improved by other methods.

PAD is a serious disease, but it can be stopped or slowed through treatment. Walking at least half an hour a day three days each week can help improve symptoms. For more information about PAD, talk with your doctor or visit the National Heart Lung and Blood Institute Web site at www.nhlbi.nih.gov.

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