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Wed, Feb. 26

Don't ignore leg pain - it could be peripheral artery disease

Think aches and pains are an expected part of aging? Many older adults chalk up sore calves, legs, thighs and hips to aging. For one of every 20 Americans over age 50, however, these aches and pains are caused by peripheral artery disease (PAD).

"If you're over 50 and have pain anywhere from your hips to your toes," said interventional radiologist Matthew Dicker, M.D., "you should be checked for peripheral artery disease."

PAD can affect a person's ability to walk and increase your risk for heart attack and stroke, according to the National Heart, Lung and Blood Institute. It's caused by plaque buildup on the inside walls of the arteries that carry blood from the heart and then to the head, internal organs and limbs. According to Dr. Dicker, PAD has three stages:

• Stage 1: The first signs of PAD are fatigue as well as heaviness or cramping in the leg muscles (calf, thigh or buttocks) during activity such as walking or climbing stairs. In this stage, pain or discomfort-called claudication-disappears once the activity is stopped and while resting.

• Stage 2: As PAD progresses, people can experience leg pain that awakens them from their sleep. At this stage, sitting up on the side of the bed-which allows for easier blood flow-stops the pain.

• Stage 3: At this stage, the lack of blood flow to the legs can be so severe that a sore on the foot may not heal. This can lead to a dangerous infection or worse.

Other signs of PAD include:

• Coldness in the lower leg or foot;

• A thickening of the skin on the legs, giving them a wooden-like appearance;

• A weak pulse or no pulse at all in the legs or feet;

• Poor nail growth or discoloration of the feet; and

• Hair loss or slower hair growth beneath the knees.

Smoking sharply increases the risk of developing PAD. On average, smokers who develop PAD experience symptoms 10 years earlier than nonsmokers diagnosed with PAD. Additionally, people with diabetes, heart disease, high blood pressure (hypertension), high cholesterol or kidney disease are at greater risk for PAD.

How is PAD diagnosed and treated? Dr. Dicker notes most physicians begin by compiling a thorough medical history to learn the patient's symptoms, family history and other signs of PAD. Following this, Dr. Dicker recommends the patient undergo an exam to detect blockages in the arteries and measure blood flow.

"This test does not include needles or radiation," Dr. Dicker said. "It involves applying a blood pressure cuff to the ankle and the arm and recording the flow of blood."

The test measures blood pressure at the ankle and the arm while the patient is at rest. The patient then walks on the treadmill for five minutes and the test is repeated. The test arms the physician with what is called the ankle-brachial index (ABI). A normal ABI means the patient's blood pressure is the same at the ankle as the arm and means there is no significant narrowing or blood flow blockage. A slight drop in the ABI with exercise usually indicates PAD.

Once PAD is diagnosed, a physician may recommend angioplasty and stenting to open the narrowed or blocked arteries to restore blood flow. An atherectomy is another procedure physicians use to shave plaque from the blocked arteries.

"The trend is toward these outpatient procedures, which allow the patient both a good outcome and rapid recovery," said Dr. Dicker.

Prevention is always the best medicine. Here are some steps to reduce the risk of PAD:

• Quit smoking;

• Eat a heart-healthy diet that includes plenty of fruit, green vegetables, and whole grains, and is low in saturated fat and cholesterol;

• Get regular physical activity (at least 30 minutes a day most days of the week);

• Maintain a healthy weight; and

• Know your blood pressure and cholesterol numbers (work with your doctor to get them to healthy levels).

Leading a healthy lifestyle has many benefits, including preventing plaque build-up in the arteries. If you think you have PAD, contact your physician immediately to get evaluated and get back on the path to health.

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