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The typical symptom is pain which develops in one or both calves when you walk. This is called 'intermittent claudication'. It is due to narrowing of the femoral artery - the most common site for atheroma to develop in PAD. When you walk, the calf muscles need an extra blood and oxygen supply. The narrowed artery cannot deliver the extra blood, and so pain occurs from the oxygen-starved muscles. The pain soon goes when you slow down or stop. The pain comes on more rapidly when you walk up a hill or stairs than when you walk on the flat.

If an artery higher 'upstream' is narrowed, such as the iliac artery or aorta, then you may develop pain in your thighs or buttocks when you walk.

If the blood supply to the legs becomes worse, the following may be found by a doctor who examines you:

• Poor hair growth below your knee, and poor toenail growth.
• Cool feet.
• No pulses in the arteries of your feet.

Severe cases

If the blood supply is very much reduced, then you may develop pain even at rest, particularly at night when the legs are raised in bed. Ulcers (sores) may develop on the skin of your lower leg if the blood supply to the skin is poor. In a small number of cases, gangrene (death of tissue) of a foot may result. This is usually preventable (see below).

By Rob Mansfield

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