Peripheral Artery Disease (PAD)

Leg pain while walking

Peripheral Artery Disease (PAD) occurs when plaque builds up in the arteries of the legs, reducing blood flow to the muscles and tissues. This buildup — made of fatty deposits, cholesterol, calcium and other substances — narrows or blocks the arteries over time. Risk factors include smoking, high cholesterol, diabetes, high blood pressure and family history.

PAD is a progressive condition that requires ongoing monitoring and management. Some people may not have symptoms at first, but as the disease advances, it can cause:

Claudication – pain or cramping in the legs when walking
Critical limb ischemia – severely reduced blood flow, which can lead to non-healing wounds or ulcers; rest pain is also a symptom causing constant pain in the legs or feet while at rest

If left untreated, PAD can become dangerous and may put limbs at risk.

Diagnosis & Management

At Rex Vascular Specialists, we tailor treatment to each patient’s needs. Our goal is to manage PAD as conservatively as possible before considering surgery.

Treatment options may include:

Medications – such as antiplatelet agents, cholesterol-lowering medications, blood thinners or vasodilators
Exercise therapy – structured walking programs to improve circulation and reduce leg pain
Lifestyle changes – quitting tobacco, improving diet and managing blood pressure or cholesterol

Exercise Therapy

Research shows that structured walking programs can dramatically improve walking distance and reduce symptoms of claudication. Many patients see a 100- to 300-percent improvement within six weeks. Our specialists may recommend:

A structured program (such as vascular exercise therapy)
A home-based walking regimen tailored to your condition

Vascular Exercise Therapy Regimen

Research indicates that after just six weeks of being in a walking program, most participants have a 100- to 300-percent improvement in the distance they can walk before having leg pain. (This leg pain is known as intermittent claudication.)

According to the American Heart Association, exercise therapy is the best treatment for claudication.

American Heart Association recommendations:

Begin with a slow warm-up walk for five minutes.
Continue to walk at an increased pace. If pain begins, try to walk at least 30 to 40 yards more. Stop when the pain becomes severe. Record the number of continuous minutes you were able to walk.
Stop, remain standing and rest until the pain lessens. This is a key part to improving your circulation and reducing symptoms.
Resume walking until you must stop and rest. Continue this pattern until you have added up to 30 to 35 minutes of walking time. This does not include resting time.

Walk every day if you can, or a minimum of four days per week.

Week 2: Add five to 10 minutes over the course of that week; total 40 minutes.
Week 3: Add five to 10 minutes; total 50 minutes.
Week 4: Add five to 10 minutes; total 60 minutes.

Continue 60 minutes for five to seven days each week.

Once you have reached 60 minutes of walking time, increase your walking pace (how fast you go).

Progressive Walking Plan for Peripheral Artery Disease

Structured Walking Protocol for PAD Patients

Dr. Robert Mendes, vascular surgeon at Rex Vascular Specialists, recommends a progressive walking regimen to improve circulation and functional capacity in patients with peripheral artery disease (PAD).

Daily Walking Strategy:

Begin by walking until claudication pain starts. Stop, rest then resume walking once pain subsides.
Each day, aim to beat the previous day’s distance. Use visual markers (such as spray paint dots, chalk or a GPS) to track progress.
Push slightly beyond the prior endpoint to stimulate collateral vessel formation.

Guidelines:

Walk one to three times daily, five days per week.
Gradually increase total walking time to 30 to 50 minutes per session, including rest breaks.
Moderate-to-severe pain is acceptable if transient and improves with rest.

Safety:

Stop immediately for chest pain, dizziness or numbness.
Maintain proper footwear and monitor vascular health parameters.
Consult your vascular specialist for worsening symptoms or before intensifying the program if cardiac risk is present.

Consistent, incremental walking builds endurance and enhances lower extremity perfusion.

Advanced Treatment Options

The vascular surgeons at Rex Vascular Specialists are again leading the country in minimally invasive techniques for treating PAD. If PAD progresses or symptoms do not improve with medications and lifestyle changes, our vascular surgeons may recommend: