Beyond Discomfort: Recognizing & Treating Vascular Leg Pain

PAD, also known as peripheral vascular disease, affects an estimated 18 million Americans, many of whom may be unaware of their condition (Nordanstig et al., 2023). PAD occurs when plaque buildup within the peripheral arteries restricts blood flow, often affecting the legs due to their higher demand for blood flow during movement. As Golledge (2022) states, “Approximately 6% of adults worldwide have atherosclerosis and thrombosis of the lower limb arteries (peripheral artery disease (PAD)).” Common symptoms include:

• Pain and cramping in the legs: Often the first sign, especially during activity (Bevan & White Solaru, 2020).
• Non-healing sores on the legs or feet: Restricted blood flow hampers the body’s ability to heal.
• Weak or absent pulse in feet or legs: Diminished blood circulation may reduce or eliminate detectable pulses in the extremities.
• Changes in skin texture or color: Shiny skin, hair loss, or unusual pallor can indicate vascular issues (Golledge, 2022).

If left untreated, PAD can progress to critical limb ischemia (CLI), leading to gangrene or even limb amputation. Early recognition and management, including lifestyle changes and, in some cases, revascularization (surgical restoration of blood flow), are crucial. The multidisciplinary approach recommended by Hinchliffe et al. (2020) suggests that “After a revascularization procedure in a patient with a diabetic foot ulcer, the patient should be treated by a multidisciplinary team as part of a comprehensive care plan.”

CVI, another common vascular issue, occurs when veins in the legs struggle to return blood to the heart. This condition can lead to pooling blood in the legs, which causes pain, swelling, and a sensation of heaviness. CVI affects around 40% of the U.S. population, though many remain unaware of their condition. This condition is often more prevalent in women with multiple pregnancies and individuals aged 50 and older. As Hinchliffe et al. (2020) note, “Patients with diabetes and PAD are at an elevated risk of other cardiovascular diseases, necessitating additional preventive strategies for cardiovascular health management.”

Symptoms of CVI often overlap with those of PAD and include:

• Pain and heaviness in the legs: Especially after long periods of standing.
• Swelling and discoloration: Pooling blood creates pressure on vein walls, leading to skin changes.
• Reduced mobility: The discomfort can restrict movement, leading to a sedentary lifestyle, which exacerbates vascular problems.

Managing PAD, CVI, and other vascular conditions begins with lifestyle modifications. Regular physical activity, a balanced diet, and smoking cessation can significantly impact vascular health (Soyoye et al., 2021). “Exercise, statins, antiplatelet therapy, and blood pressure control are essential in managing PAD in DM patients to improve outcomes and prevent complications” (Soyoye et al., 2021). Consulting a vascular specialist is advisable for anyone with persistent leg pain, especially if it’s accompanied by other symptoms like leg discoloration or non-healing sores.

Both PAD and CVI are progressive diseases with potentially serious complications, including heart attack, stroke, and limb loss. Golledge (2022) emphasizes that “PAD causes leg pain, impaired health-related quality of life, immobility, tissue loss, and a high risk of major adverse events.” With early diagnosis and proper management, patients can avoid the most severe outcomes.