Most of us think of achy legs after a long walk as nothing more than tired muscles or getting older. We stretch, we rest, we move on. But sometimes the legs are signaling something that has little to do with age or exertion.
Peripheral artery disease, or PAD, is one of the most common and most overlooked circulation problems in older adults. According to the CDC, about 6.5 million Americans aged 40 and older have it, and up to 4 in 10 people with PAD have no leg pain at all.
PAD happens when the arteries that carry blood to the legs narrow and harden, usually from the same plaque buildup behind heart attacks. Because the trouble is far from the chest, the warning signs show up on the skin, the toes and the shins.
Eight warning signs to watch for
The signs below are drawn from the CDC and the American Heart Association's 2024 guideline on lower extremity PAD. Any one of them, especially in someone over 60 or with diabetes, is worth raising with a doctor.
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- Leg cramping that stops when you rest. The classic sign is known as claudication. It shows up as aching or burning in the calf, thigh or buttock during walking and eases within minutes of standing still.
- Legs that feel weak or heavy. Muscles rely on a steady blood supply. When flow drops, the legs can feel tired or unsteady even on short walks.
- Hair loss on the shins and feet. Skin starved of blood produces less hair. A gradual thinning on the lower legs is a familiar clue.
- Smooth, shiny skin on the lower legs. The skin can take on a tight, polished look as the tissue below slowly loses nourishment.
- Cool skin on one foot or leg. A clear difference in temperature between the two feet, especially a persistent coolness on one side, can point to poor flow on that side.
- Sores on the feet or toes that will not heal. Wounds need oxygen-rich blood to close. A blister or small cut that drags on for weeks is a serious signal.
- Cold or numb toes. A steady chill in the toes, or a loss of feeling, often shows up before any pain does.
- Color changes in the legs or feet. The skin can turn pale, bluish or a dusky red, sometimes shifting with how the leg is positioned.
Who is most likely to have PAD
The strongest risk factors are smoking, diabetes, high blood pressure, high cholesterol and being over 60. The risk climbs sharply for anyone who smokes and has diabetes together.
Many of the same arteries affected in the legs run through the heart and brain. People with PAD carry a higher risk of a heart attack or stroke, which is why even signs that seem minor matter.
A quick test can settle it
The main screening tool is an ankle-brachial index test, often shortened to ABI. It compares the blood pressure at the ankle with the blood pressure at the arm, and it is painless and non-invasive.
Anyone noticing one or more of the signs above, especially alongside the usual risk factors, should bring it up with their doctor. For higher-risk adults the ABI can be done during a regular visit, with no needles and no prep.
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This article is made and published by Mie Hermansen, who may have used AI in the preparation.