Leg pain when walking is probably PAD
Q: I recently developed pain in my right leg, but only when I walk. If I slow down or stop, the pain goes away. Is it a circulation problem?
A: Your symptoms are most consistent with peripheral artery disease (PAD). PAD occurs when one or more of the arteries that carry blood to the leg muscles narrows, often because of a buildup of fatty plaque.
An estimated 10 million Americans have PAD, and it usually strikes after age 50. In addition to older age, risk factors include smoking, high cholesterol, high blood pressure, diabetes, and a history of heart disease or stroke.
Leg pain and fatigue are the most dominant PAD symptoms and usually occur with activity, but go away with rest.
Blood flow carries oxygen to tissues. When you walk, your leg muscles need more oxygen, but the blockages in the leg arteries won’t allow the blood flow to increase, so the muscles hurt from a lack of oxygen and buildup of lactic acid.
Plaque buildup doesn’t affect only the legs. If you have blockages in your leg arteries, you probably have blockages in the arteries leading to your heart and brain, which can raise your risk for a heart attack or stroke.
Other symptoms caused by poor blood flow to the legs include foot pain, foot sores that won’t heal, and impotence.
Diagnosis and treatment
Make an appointment with your doctor. Diagnosing PAD begins with a physical exam.
Your doctor feels the pulses in your legs and feet to identify any reduction in blood flow. He or she may order a noninvasive test called an ankle-brachial index to compare the blood pressure in your arms and legs.
Treatment begins with lifestyle changes. If you smoke, you need to stop immediately. In addition, you should eat a heart-healthy diet and keep walking, even if it hurts.
Walking increases blood flow in the smaller arteries of the legs and helps create new channels to move blood around the blockages.
It sounds like you are already on your way toward a good walking program. Begin with 5 to 10 minutes of walking. If you experience pain, stop and rest until the pain subsides, then begin walking again. Continue the cycle until the time period has elapsed.
Walk every other day at first, and then progress to more days and longer periods. As you improve, you should find that walking becomes easier and you have fewer stop-and-rest periods. You want to build up to walking for at least 30 minutes, five times a week.
Your doctor also may recommend daily low-dose aspirin to prevent blood clots, and a statin to lower your LDL (bad) cholesterol.
Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional information, visit health.harvard.edu.
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