Diabetes Self-Management Articles

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Diabetic Leg Pain and Peripheral Arterial Disease

by Joyce Malaskovitz, PhD, RN, CDE, and Susan Rush Michael, DNSc, RN, CDE

Another sign of PAD is that sores on the legs or feet heal slowly (longer than 8 to 12 weeks) or don’t heal at all. Feet may feel cold because of decreased blood flow. When this happens, you may notice that one foot or leg seems colder than the other, although sometimes both are cold. Cold feet can be a subtle sign; if you have a spouse, he or she may notice them more than you do, particularly when you sleep at night.

Other things you may notice if you have PAD include color changes in your feet (paleness or blueness), poor nail growth, and decreased hair growth on your toes or legs.

It is also possible to have PAD with no symptoms. In people with diabetes, PAD often affects smaller blood vessels below the knee, which makes it less likely to cause pain and other symptoms. In fact, almost 50% of people with diabetes who have PAD experience no symptoms at all. This is in part because many people with diabetes have neuropathy and decreased sensation in their legs. For other people, symptoms may be so subtle or develop so gradually that they do not seem worth reporting to a health-care provider. Symptoms that are commonly ignored include walking more slowly, an inability to walk long distances due to pain, and a feeling of heaviness or fatigue in the legs.

Even if you do not have symptoms, or if the symptoms you have do not interfere with your daily activities, having diabetes alone is reason enough to be concerned about PAD. Like other vascular diseases (diseases of the heart and blood vessels), it can be “silent” until it causes a severe problem such as a blood clot that results in lasting damage.

Screening
The American Diabetes Association recommends that if you are over 50 and have diabetes, you should be screened for PAD even if you have no symptoms. If you are under the age of 50 and have risk factors such as smoking, high blood pressure, high cholesterol, or having had diabetes for more than 10 years, you should be screened, as well.

How does one go about getting screened? First, see your health-care provider. A doctor will most likely ask you a series of questions to evaluate your risk and also look at your feet to see if you have physical signs of PAD (cold feet, decreased hair growth on the toes, ulcers that are slow to heal, or a weak pulse in the feet). Once your doctor determines that you are at risk for PAD, he may perform a test (or refer you to someone else to do the test) called an ankle–brachial index (ABI). The ABI test is painless and noninvasive, and it takes about 20–30 minutes to perform. You will be asked to lie down for about 10 minutes so that the effect of gravity is the same on your arms and legs; this is necessary to get accurate results. Then the doctor or nurse will measure the blood pressure in your arms and in two places on each foot with a handheld device called a Doppler probe. The Doppler probe uses sound waves to detect blood flow. Only the systolic blood pressure (the “top number”) will be recorded for each site. The blood pressure in your ankles will be compared to the blood pressure in your arms. If it is lower in the ankles than in the arms, you may have PAD.

The ABI is a screening test, so it cannot tell you where a blockage or narrowing of the arteries is located. To determine the location and extent of a blockage, you will most likely be referred to a peripheral vascular specialist for further testing. These tests can include an ultrasound, magnetic resonance imaging (MRI), or an angiogram (an x-ray test to look at blood flow).

Once you know whether you have PAD, treatment will depend on the location and extent of the blockage. The goal of the treatment will be to improve your quality of life and to prevent a heart attack, stroke, or amputation.

Treatment options
There are generally three treatment options for PAD. These include lifestyle changes (discussed in the next section on risk factors), drug treatment, and surgery.

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