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Peripheral artery disease can cause classic calf pain when walking, but many people instead notice subtle issues such as leg fatigue, heaviness, or cramping that improve with rest and return with activity.

Other overlooked signs include feet or toes that feel unusually cold compared with the rest of the body, slow-healing or nonhealing sores on the legs or feet, shiny or hairless skin on the lower legs, and weak pulses in the ankles.

Because these changes can appear gradually, they are sometimes mistaken for normal aging rather than a circulation problem that needs medical attention.  

Clinicians typically start with a medical history and physical exam, paying close attention to leg pulses and any wounds on the feet.

A key test is the ankle–brachial index, which compares blood pressure at the ankle with blood pressure in the arm to look for blocked blood flow.

If needed, doctors may use additional imaging such as Doppler ultrasound, CT angiography, or MR angiography to visualize narrowed arteries and plan treatment. Early diagnosis through these noninvasive tests helps reduce the risk of heart attack, stroke, and limb loss.  

Peripheral artery disease becomes more common with age, especially after 60, but several factors greatly increase risk at any age. Cigarette smoking, diabetes, high blood pressure, high LDL cholesterol, and chronic kidney disease are major contributors.

People with a history of heart attack, stroke, or other arterial disease are also more likely to have PAD, even if their leg symptoms are mild or absent.

Because the disease often goes undetected, guidelines recommend that people with these risks talk with their clinician about screening.  

Although symptoms often appear in the legs, peripheral artery disease is a marker of plaque buildup throughout the body’s arteries.

People with PAD have a significantly higher risk of heart attack, stroke, and cardiovascular death than those without it.

Studies show that many patients with PAD die from heart or brain artery disease rather than leg complications alone, so experts view PAD as a systemic cardiovascular condition that requires aggressive management of blood pressure, cholesterol, blood sugar, and lifestyle factors.  

Many people with mild to moderate peripheral artery disease improve without surgery through a combination of smoking cessation, structured walking or exercise programs, eating a heart‑healthy diet, and medications that control blood pressure, cholesterol, and blood sugar.

Supervised exercise therapy in particular has strong evidence for reducing leg pain and increasing walking distance.

Surgery or catheter‑based procedures, such as angioplasty and stenting, are generally reserved for severe symptoms, nonhealing wounds, or threatened limb loss when medical therapy and lifestyle changes are not enough.  

Peripheral artery disease is common worldwide and affects people in both high‑income and low‑ and middle‑income countries.

Global studies estimate that more than 200 million adults live with PAD, with particularly rapid growth in regions where diabetes, smoking, and high blood pressure are becoming more prevalent.

While high‑income countries may have better access to diagnosis and treatment, low‑resource settings often face higher rates of advanced disease and limb loss because PAD is recognized and treated later.  

If peripheral artery disease progresses without treatment, reduced blood flow can lead to painful walking, rest pain in the feet, and eventually critical limb ischemia, where tissue does not receive enough oxygen to survive.

This can cause nonhealing ulcers, infections, and gangrene that may require amputation. At the same time, untreated PAD reflects widespread atherosclerosis, which sharply increases the risk of heart attack and stroke.

Early recognition and management can prevent many of these serious outcomes.