Peripheral Artery Disease may progress silently for years without symptoms (asymptomatic), at least for its early stages.

Some people may have moderate or even advanced Peripheral Arterial Disease and still experience no symptoms, either because they have lost the pain sensation (e.g. diabetics with peripheral neuropathy), or because the disease has been progressing slowly allowing the body to build up sufficient collateral circulation.

Some others may not experience symptoms just because they are not walking enough to trigger a higher blood supply demand that will eventually lead to pain.

The typical first symptom of Peripheral Artery Disease is a tight, aching or squeezing pain or cramp in the calf, thigh or buttock when walking a certain distance.

The pain goes away when you stop walking and comes back as soon as you resume walking, again at a similar distance.

As the disease progresses and over the course of years, this walking distance will keep shortening.

This symptom is called intermittent claudication.

Other symptoms may include:

• Weak or tired legs
• Difficulty walking or balancing
• Brittle, thin, or shiny skin on the legs and feet
• Loss of hair on feet
• Sores that are slow to heal
• Thickened, opaque toenails (may have a fungal infection)
• Erectile dysfunction

At the advanced stages leg or foot pain will be present even when not walking (rest pain).

This is the stage of critical limb ischemia (ischemia = greek "stop of blood'), signaling a threatened limb (risk of gangrene and amputation).


Ischemic Foot 286552778

Gangrenous Toes 211917265


Critical limb ischemia is a surgical emergency and may also manifest as:

• Cold and numb feet or toes
• Pain (described as burning or aching) in the legs while lying flat that is relieved when sitting
• Pale color when legs are raised up
• Redness when legs are in a hanging down position (dependent rubor)
• Reddish-blue discoloration of the extremities