Peripheral arterial disease (PAD)

What is peripheral arterial disease, and how common is it?

Peripheral arterial disease (PAD) is narrowing of the arteries, mainly in the legs, usually from a build-up of fatty deposits. This restricts the blood supply to your leg muscles¹. It's usually only a problem when you walk, because that's when your muscles need more oxygen². You may also hear it called peripheral vascular disease³.

PAD is common, and it becomes much more common with age. One global estimate is 9.7% of adults, mostly aged 40 and over⁴. Many people have no symptoms⁵. PAD is linked with a higher risk of amputation, heart attack, stroke and death⁶, so it's worth finding early and looking after your circulation.

What causes PAD, and who gets it?

PAD is usually caused by atherosclerosis, where fatty plaque builds up in the walls of the leg arteries and narrows them³. Smoking is the most significant risk factor⁷. Diabetes, high blood pressure, high cholesterol and growing older also raise the risk¹. A family history of cardiovascular disease⁸, kidney disease, obesity and being inactive are also listed as risk factors⁵. Indigenous Australians with diabetes appear to have a higher risk⁹.

These are links seen across groups of people, not proof that one factor caused your PAD. Many of them can be changed, which is why care focuses on them⁵.

What does PAD feel like, and how is it diagnosed?

The classic symptom is intermittent claudication: cramping or aching in the leg, often the calf, when you walk, which eases within a few minutes of rest²¹⁰. It tends to come on sooner if you walk fast or uphill². You might also notice heaviness, coldness, numbness, pins and needles, or wounds that are slow to heal³.

Symptoms can be less typical, or absent⁹. Women are often diagnosed later¹¹.

A podiatrist or doctor will ask about your symptoms and risk factors and examine your legs and feet. They may also measure your ankle-brachial index (ABI), a simple, non-invasive test that compares blood pressure at your ankle with your arm⁶.

What helps first?

Exercise is the best-supported first step if you get calf pain on walking. A supervised exercise programme is strongly recommended to ease leg symptoms and improve everyday function and quality of life⁹, and it increases how far you can walk before the pain starts¹². A typical programme is about 2 hours a week for 3 months, then daily exercise, because the benefits fade quickly if you stop⁷. Where there's no supervised programme, a structured home or community walking programme can also help⁶.

A simple way to do it yourself: walk until the pain comes on, rest until it eases, then go again, building up to at least 30 minutes in total, several times a week⁷. If you have other medical conditions or limited exercise capacity, talk to your GP before you start.

Stopping smoking is the strongest change you can make¹³, and your GP or pharmacist can offer support. Your GP may also review medicines that lower the risk of heart attack and stroke, such as an antiplatelet (a medicine that makes blood less likely to clot) and a cholesterol-lowering medicine¹⁴. A pharmacist or doctor can advise what suits you.

What helps if that isn't enough?

If your walking hasn't improved after a proper go at exercise and risk-factor changes, ask your GP about reviewing your medicines and whether a procedure to improve blood flow might suit you. If you can't walk for exercise, other kinds, such as cycling, resistance training, arm cycling or Nordic walking, may be useful instead¹⁵.

Limb-threatening disease (see the warning signs below) needs urgent assessment by a vascular (blood vessel) team⁵. If blood flow can't be restored, the affected toe, foot or leg may need to be removed¹⁶.

What is the outlook, and how do I keep it from getting worse?

PAD is a long-term condition, so ongoing care matters. It also makes other cardiovascular disease more likely¹, so what protects your legs protects your heart too.

Quitting smoking completely matters most. Even smoking 1–10 cigarettes a day is linked with faster PAD progression and more major heart and circulation events, despite the best medical therapy⁵. People who keep smoking after diagnosis are much more likely to have a heart attack and die from heart disease than those who quit⁷.

Keep up regular exercise. Medicines your doctor prescribes aim to reduce the risk of PAD becoming limb-threatening, and of heart attack and stroke⁶. Check your feet daily and use the warning signs below. Regular follow-up with your GP, a vascular team and a podiatrist helps keep on top of changes.