If you have diabetes and you’ve recently begun to experience pain or aches in your legs and feet while walking and the pain is relieved by resting, that may be a symptom of a condition called peripheral artery disease, or PAD.
PAD is a form of cardiovascular disease that increases the risk of heart attack or stroke. It is caused by a narrowing of the arteries outside of the heart or brain, which leads to reduced blood flow in arteries in the legs and groin, for example.
People with diabetes are at increased risk of developing PAD, because diabetes worsens high cholesterol levels, a common cause of PAD. High cholesterol deposits fat—known as "plaque" — in the arteries and that can lead to a narrowing of the vessels (doctors call it “atherosclerosis”), which in turn leads to diminished blood flow in these vessels.
"It is absolutely true that diabetes increases the risk of peripheral artery disease in the same way it increases the risk of a heart attack or stroke," said Venkataramanan Gangadharan, MD, an interventional cardiologist with HonorHealth Heart Group, part of HonorHealth's Cardiovascular Center of Excellence.
Other symptoms to watch for
In addition to pain when walking (known as “claudication”), here are other symptoms of PAD, according to Dr. Gangadharan:
- Numbness and lack of sensation in the legs and hands (what doctors call “peripheral neuropathy”)
- Rest pain, described as aches and pain that a patient typically notices in the calves while not doing activity
- Diminished hair growth on the legs, due to a reduced blood supply to the skin
- Development of ulcers or wounds on the feet that won’t heal
Risk factors for PAD
"As much as diabetes has been identified as a strong risk factor for PAD, there are other compounding factors that play a role as well," he explained. These include:
- Age
- Male gender
- Smoking
- Chronic kidney disease
- High cholesterol and triglyceride levels
"Tobacco use has been strongly linked with the development of peripheral artery disease, even more so than diabetes," Dr. Gangadharan emphasized.
PAD can affect people with diabetes and those without, Dr. Gangadharan pointed out. "However, the incidence is far greater in those with diabetes and other compounding risk factors."
People with diabetes are less likely to go to the doctor complaining of symptoms of PAD, Dr. Gangadharan said, because they may have numbness in their legs or feet that prevents them from noticing pain that may signal PAD. He advises that you see your doctor if you have diabetes and are experiencing any symptoms of PAD, including numbness in your legs.
Diagnosing and treating PAD
If your doctor suspects you have PAD, here are some of the tests you may undergo:
- A six-minute walk test to gauge the distance you can walk before symptoms develop
- An ankle brachial index test, where blood pressure is measured on your arm and at the ankle, to determine the difference between the two. In people with PAD, blood pressure in the legs is typically lower than in the arms.
- An arterial ultrasound and/or another imaging test called a CT scan to visualize the degree of narrowing of the vessels
Treatment for mild to severe PAD centers around walking and exercise, Dr. Gangadharan said. "By being active, many patients can overcome symptoms, as they can develop new blood vessels to bypass areas of blockage. If symptoms persist, we can offer medical therapy with a medication called cilostazol."
Interventional therapeutic options also are available, he added, and may include placement of a stent to create a wider channel in an artery or bypass surgery.
"The most important thing for people with diabetes and PAD to remember is to be active and walk and exercise regularly," Dr. Gangadharan said. "Protect your feet and be mindful about injuries that could lead to non-healing wounds, keep your blood sugar under control and take your medications regularly."