Leg Pain: Arthritis or Peripheral Arterial Disease?

If you suffer from leg pain while walking, you may blame arthritis. But the problem might be peripheral arterial disease (PAD), which can have serious consequences.

PAD causes an aching, heaviness, numbness, burning, or cramping in your calves, thighs, hips, buttocks, or feet that occurs while walking or climbing stairs. The discomfort gets better after you rest.

Arthritis leg pain generally is associated with specific joints — either knees or hips. Pain from arthritis can get better after walking a short distance.  

Spinal problems like spinal stenosis and disc disease can also mimic symptoms of PAD. Work with your doctor to establish your diagnosis.

Facts about PAD

  • The National Heart, Lung, and Blood Institute estimates that about 1 in 20 adults over the age of 50 may have PAD, and that number continues to increase with age. 

  • African-Americans have a higher risk for PAD than whites.

  • Men have a higher risk for PAD than women.

  • Other factors that increase the risk for PAD are age, smoking, diabetes, high blood pressure, obesity, high cholesterol, heart disease, and stroke. A family history of these conditions may also increase risk.

  • The most common cause of PAD is atherosclerosis. Atherosclerosis is a condition in which fatty deposits build up in arteries, the blood vessels that carry oxygen rich blood from the heart to all parts of the body. Over time, these fatty deposits eventually block blood flow to leg arteries, preventing oxygen from reaching the muscles of the legs. This causes cramping and pain when walking because the muscles need more oxygen when they are working. If the blockage is severe, it can prevent sufficient blood reaching the foot or leg even when the muscles aren't working and lead to gangrene or amputation.

  • The exact cause of atherosclerosis is not known, but smoking, high cholesterol, high blood pressure, and diabetes contribute to its development. Atherosclerosis affects all the arteries in the body, not just the ones feeding the legs. This means that PAD is a warning sign that arteries in the heart and brain may be blocked, increasing your chance of heart attack and stroke. 

Signs of PAD

PAD starts slowly. You may not notice it because mild PAD may not cause symptoms. Discomfort can occur in the lower legs, thighs, hips, buttocks, or feet. In addition to pain, other common sensations are heaviness, tingling, or fatigue. Rest usually helps, but raising your legs — as when you lie in bed — may make the discomfort worse. Other symptoms include:

  • The skin on your leg turns pale or bluish when you elevate it

  • Your foot turns a dusky red when you stand or sit

  • The hair on your foot stops growing; or your toenails stop growing; or you get frequent toenail infections. 

  • You have sores on your toes, feet, or legs that heal slowly or not at all

See your doctor if you have any of these symptoms. PAD can be diagnosed with a simple test called an ankle-brachial index. This test measures blood flow by comparing blood pressure in your arms with blood pressure in your legs. Your doctor might also use ultrasound or angiography to diagnose PAD.

Treatment for PAD

Treatment depends on the severity of the blockage. You might need to change your lifestyle by quitting smoking, controlling cholesterol, lowering high blood pressure, or controlling diabetes. You may need to take medication to control cholesterol, blood pressure, and diabetes, or to thin your blood.

Exercise has been shown to decrease symptoms. But check with your doctor before starting on any new exercise regimen. The medication cilostazol can help increase walking distance. Aspirin and clopidogrel can help prevent blood clots. Sometimes people with PAD need surgery to bypass a blockage and create a new path for blood flow. Angioplasty, a procedure in which the blockage is flattened to make the artery opening wider, is another possible treatment.

You should check your feet and legs regularly for red spots that might indicate poorly fitting shoes. If you notice sores on you feet, call your doctor.

Wear shoes that are comfortable and that protect your feet from injury. Get professional care for foot problems, such as corns, bunions, or calluses.

Preventing PAD

Controlling the factors that can lead to atherosclerosis is important. If you smoke, your risk of getting PAD increases four times. Controlling high blood pressure, high cholesterol, and diabetes, if you have these conditions, will decrease your risk. Maintaining a healthy weight and getting regular exercise will improve your overall health.

Arthritis affects joints

Because PAD is such a serious and progressive disease, it's important to know the difference between pain caused by arthritis and symptoms that indicate blocked blood flow.

Leg pain caused by arthritis usually is tied to specific joints — either your knees or hips. When cartilage around a joint breaks down, you may feel pain, stiffness, and swelling. Arthritic joints may also be warm and have limited movement.

If joint pain lasts beyond 3 days, see a doctor. Also get medical attention for:

  • Severe, unexplained joint pain

  • A significantly swollen joint

  • A joint that's hot to the touch

  • Difficulty moving the joint

  • A fever with the joint pain

  • Unintentional weight loss