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Vascular - PAD

Vascular - PAD

Vascular testing is be required in the diagnosing and treatment of certain podiatric foot conditions.

Vascular testing is particularly relevant for patients with high-risk diabetes, poor circulation, peripheral artery disease (PAD), and chronic venous insufficiency (CVI).  (link to CVI)

What is PAD?

Peripheral artery disease (PAD) is plaque buildup in your leg arteries. Your leg arteries carry oxygen and nutrient-rich blood from your heart to your arms and legs. Other names for this are peripheral vascular disease or peripheral arterial disease.

Shaped like hollow tubes, arteries have a smooth lining that prevents blood from clotting and promotes steady blood flow. When you have peripheral artery disease, plaque (made of fat, cholesterol and other substances) forms gradually inside your artery walls. Slowly, this narrows your arteries. This plaque is also known as atherosclerosis.

Many plaque deposits are hard on the outside and soft on the inside. The hard surface can crack or tear, allowing platelets (disc-shaped particles in your blood that help it clot) to come to the area. Blood clots can form around the plaque, making your artery even narrower.

If plaque or a blood clot narrows or blocks your arteries, blood can’t get through to nourish organs and other tissues. This causes damage and eventually death (gangrene) to the tissues below the blockage.

This happens most often in your toes and feet.

PAD can get worse faster in some people more than others. Many other factors matter, including where in your body the plaque forms and your overall health.



How common is peripheral artery disease?

PAD is common, affecting between 8 and 12 million Americans. However, healthcare providers sometimes don’t diagnose or treat PAD enough. Actual numbers are probably higher.

How does peripheral artery disease affect my body?

The typical symptom of PAD is called claudication, a medical term for pain in your leg that starts with walking or exercise and goes away with rest. The pain occurs because your leg muscles aren’t getting enough oxygen.

The dangers of PAD extend well beyond difficulties in walking. Peripheral artery disease increases the risk of getting a nonhealing sore of your legs or feet. In cases of severe PAD, these sores can turn into areas of dead tissue (gangrene) that make it necessary to remove your foot or leg.

What are the stages of peripheral artery disease?

Healthcare providers can use two different systems — Fontaine and Rutherford — to assign a stage to your PAD. The Fontaine stages, which are simpler, are:

  • Asymptomatic (without symptoms).

  • Mild claudication (leg pain during exercise).

  • Moderate to severe claudication.

  • Ischemic rest pain (pain in your legs when you’re at rest).

  • Ulcers or gangrene.

Symptoms and Causes

What is considered the first symptom of peripheral artery disease?

The first symptom of PAD is usually pain, cramping or discomfort in your legs or buttocks (intermittent claudication). This happens when you’re active and goes away when you’re resting.

What are the typical symptoms of peripheral artery disease?

Physical symptoms of peripheral artery disease include:

  • A burning or aching pain in your feet and toes while resting, especially at night while lying flat.

  • Cool skin on your feet.

  • Redness or other colour changes of your skin.

  • More frequent skin and soft tissue infections (usually in your feet or legs).

  • Toe and foot sores that don’t heal.

Approximately half of the people who have peripheral vascular disease don’t have any symptoms.

PAD can build up over a lifetime and symptoms may not become obvious until later in life. For many people, symptoms won’t appear until their artery narrows by 60% or more.

Talk to a podiatrist if you’re having symptoms of PAD so they can advise on treatment as soon as possible.

Early detection of PAD is important so you can begin the right treatments before the disease becomes severe enough to lead to complications like a heart attack or stroke.

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