Cholesterol can clog the heart's blood vessels, but it can also affect the legs, leading to peripheral arterial disease, or PAD.
Up to 12 million people in the U.S. have PAD, which is linked to a higher risk of heart disease, heart attack and stroke, says David Slovut, M.D., director of advanced interventional therapy at Montefiore Medical Center.
After five years, 20 percent of people with PAD will have had a nonfatal heart attack.
Here are 11 signs you could have PAD. The good news? It's treatable.
Pain In The Legs
An extremely common PAD symptom is claudication -- a type of leg pain or discomfort.
Because the arteries are clogged, they can't deliver enough blood to the legs to support exertion. Some people say their legs feel "heavy" or tired, or they report a burning pain, Dr. Slovut says.
The pain can be in any part of the leg, from the calf to the thigh or buttock, and it may be in one or both legs. It's also reproducible: The pain happens when walking a certain distance (like two blocks), it's relieved by rest, and then occurs again when walking the same distance.
Nighttime Cramps
While sleeping, people with PAD may get cramps or spasms, typically in the heel, forefoot or toes, says Darren Schneider, M.D., director of the Center for Vascular and Endovascular Surgery at New York-Presbyterian Hospital/Weill Cornell Medical Center.
The pain can often be relieved by dangling the foot off the bed or sitting in a chair, which allows gravity to assist in driving blood flow to the feet, Dr. Schneider says.
Skin And Nail Changes
PAD can cause changes in the toenails and the skin on the legs.
Because the legs aren't receiving normal blood flow or nourishment, you may notice that you are losing hair on the feet and legs, or that it's growing back more slowly if you shave it.
The skin on the legs may get shiny and tight, and toenails may thicken or grow more slowly. All of these are usually experienced together, Dr. Schneider says.
Unusual Skin Coloring
One of the things doctors look for is a change in the color of your legs. When raised, a leg may be white because of compromised blood flow.
Then, when the leg is dangled from the table, it can turn reddish or purplish in color, says Dr. Schneider, because the body has dilated the blood vessels to increase flow to the feet.
In some people with PAD, the feet or toes are pale or bluish when they're sitting, due to a lack of circulation.
Cold Feet
Feet or legs that feel cold, or are cool to the touch, may be an indicator that you have PAD. But it's not really the best indicator, says Dr. Schneider.
That's because this is a common problem and it can happen to anyone as he or she ages -- even someone without PAD.
Sores That Don't Heal
In people with more advanced PAD, a reduction in circulation can result in foot ulcers that don't heal.
Known as ischemic ulcers, these should be treated quickly, says Dr. Schneider.
The ulcers may be brown or black, and they're often painful (as opposed to diabetic foot ulcers, which may be painless due to diabetes-related nerve damage).
Erectile Dysfunction
Numbness Or Weakness
If your legs or feet feel numb or weak while you are resting, it could be a sign of PAD.
"Some patients will just say their legs get weak and feel like they will give out, and some get numbness in their feet," says Dr. Schneider. People who have symptoms when resting -- not just while walking or exercising -- usually have more severe PAD, he says.
Atrophy Of Calf Muscles
People with more advanced PAD may experience atrophy, or a reduction in the size of their calf muscle. On the microscopic level, a lack of adequate blood flow can lead to a decline in the number and size of muscle fibers.
In fact, those with severe PAD can lose more than half of their muscle fibers in an affected area, and the remaining muscle fibers tend to atrophy or shrink in size.
Tissue Death
About 80 percent of people with PAD never progress beyond having relatively mild symptoms, says Dr. Schneider, but a small minority of people can experience extreme symptoms.
In advanced stages, the disease can cause tissue death and even gangrene, which can be limb- and life-threatening, he says. PAD can even lead to amputation in some cases, but quitting smoking, eating healthy, taking medication and even having bypass or angioplasty can improve circulation in the leg.
No Symptoms At All
Most people with PAD have no symptoms. However, people at a greater risk for PAD may want to be tested, since the disease ups your chance of heart attack and stroke.
PAD is more likely to occur in smokers, people over 50 and those with diabetes. You're also more likely to get PAD if you have high cholesterol or blood pressure, or a strong family history of heart disease or stroke.
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