What is peripheral artery disease?
Peripheral artery disease — often shortened to PAD — is a condition in which the arteries that carry blood to the legs, feet and sometimes the arms become narrowed or blocked, usually due to the build-up of fatty plaque. Reduced blood flow means the muscles and tissues in the limbs don't receive enough oxygen and nutrients, particularly during physical activity.
PAD is often accompanied by more widespread atherosclerosis — the same process that causes coronary artery disease and contributes to stroke. People with PAD are at significantly elevated risk of heart attack and stroke, making it an important condition to identify and manage even when it causes only mild symptoms in the legs.
In Australia, PAD affects an estimated 1.2 million people, and many are undiagnosed.
What are the symptoms?
The most recognisable symptom of PAD is intermittent claudication — pain, cramping, aching or fatigue in the calf, thigh or buttock muscles that comes on during walking or exercise and eases with rest. This occurs because the narrowed arteries can supply enough blood at rest but can't keep up with the increased demand of activity.
However, up to half of all people with PAD have no classic symptoms, or experience only subtle signs such as leg fatigue, slower walking speed or wounds on the feet or legs that are slow to heal.
In severe cases — known as critical limb ischaemia — blood flow is so restricted that pain occurs even at rest, and wounds, ulcers or gangrene can develop. This is a medical emergency that requires urgent treatment.
What is the connection to diabetes?
People with diabetes are at particularly high risk of PAD, for several reasons. High blood glucose accelerates atherosclerosis, damages blood vessel walls and promotes inflammation. Diabetic nerve damage (neuropathy) can mask the pain of PAD, meaning that by the time the condition is identified, it may already be advanced. Foot ulcers that develop in people with both PAD and neuropathy are slow to heal and prone to infection, and in serious cases can lead to amputation.
This is why foot care and regular vascular assessment are such important parts of diabetes management. The Baker's existing foot health resource specifically addresses this risk for people living with diabetes.
Who else is at risk?
Beyond diabetes, the risk factors for PAD mirror those for cardiovascular disease broadly — smoking (which is the single strongest modifiable risk factor for PAD), high blood pressure, high cholesterol, older age, being male and a family history of cardiovascular disease. Chronic kidney disease also significantly raises the risk.
How is PAD diagnosed?
The most common diagnostic test for PAD is the ankle-brachial index (ABI) — a simple, non-invasive measurement that compares blood pressure in the ankle with blood pressure in the arm. A lower pressure in the ankle suggests reduced blood flow and is a reliable indicator of PAD.
Imaging tests, including Doppler ultrasound and angiography, can provide more detailed information about where blockages are located and how severe they are.
How is it treated?
Treatment aims to relieve symptoms, restore blood flow where necessary and — critically — reduce the risk of heart attack and stroke.
Lifestyle changes are central to management. Stopping smoking is the single most important step a person with PAD can take, with significant effects on disease progression and cardiovascular outcomes. Supervised exercise programs — walking in particular — have strong evidence for improving walking distance and quality of life in people with intermittent claudication.
Medications, including antiplatelet agents, statins and blood pressure medications, are used to manage cardiovascular risk. For people with more severe disease, procedures to restore blood flow — including angioplasty, stenting or bypass surgery — may be required.
For people with diabetes and PAD, meticulous foot care and regular review by a podiatrist are essential to prevent ulceration and reduce amputation risk.