Some 10 million Americans are affected by peripheral artery disease (PAD), which causes leg pain (especially when walking), numbness, and tingling in the feet or lower legs. Sores on the legs or feet that heal very slowly are also associated with this condition.

In PAD, the blood vessels in the legs become blocked or narrowed by fatty deposits, and there is decreased blood flow to the lower extremities. Having PAD automatically puts an individual at a heightened risk for both stroke and heart attack.

If you have diabetes, you need to be particularly attuned to the symptoms of PAD, since the disorder is much more common in individuals with the disease. In fact, 1 in 3 people with diabetes who are over the age of 50 have PAD. The disorder is four times as common among women with diabetes compared to women who don't have diabetes.

The Link Between Diabetes and PAD

"There is something about the impact of high blood sugar on the cells in the walls of the blood vessels that leads to atherosclerosis," says Nicholas Morrissey, MD, vascular surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center in New York City. "We know that if you control your blood sugar, you are less likely to develop PAD."

Although the exact mechanism of how diabetes affects development and progression of PAD is unknown, one of the theories suggests that the presence of high glucose levels and high concentration of glucose byproducts may trigger the cascade of inflammatory reactions, which can further cause progression of atherosclerosis.

There is a genetic component, says Maja Zaric, MD, an interventional cardiologist specializing in venous issues of the lower extremities at Lenox Hill Hospital in New York City. Patients who already have diabetes tend to have a higher incidence of PAD if they also have a family history of PAD, Zaric says.

Besides diabetes, risk factors for developing PAD are smoking, being overweight, a sedentary lifestyle, high blood pressure, and high cholesterol.

What's more, the longer you have diabetes, the greater the chances for PAD, says Zaric.

Getting a PAD Diagnosis

Many people don't experience symptoms, so it's important for anyone with diabetes over the age of 50 be tested for PAD.

To diagnose PAD, your doctor will perform an ankle brachial test (ABI), which measures the blood pressure in your ankle and compares it to the blood pressure in your arm. If the blood pressure in your lower leg is lower than in your arm, you may have PAD. Angiograms, ultrasound, and MRI also help detect PAD.

If you're diagnosed with PAD:

  • Stop smoking.
  • If it hurts to walk, ask your doctor about aspirin therapy.
  • Control your blood pressure and blood cholesterol by taking appropriate medications.
  • Get moving. Physical activity (check with your doctor first) is highly recommended if you want to prevent PAD from progressing. Easy walking regimens, treadmill exercise programs, and leg exercises can improve the symptoms of PAD.

Nicholas J. Morrissey, MD, and Maja Zaric, MD,  reviewed this article.




"About peripheral artery disease." American Heart Association.

"Understand your risk for PAD." American Heart Association.

"Prevention and treatment of PAD." American Heart Association.