Peripheral Vascular Disease (PVD) Lower Extremities: Part I

Signs and Symptoms

            Peripheral vascular disease (PVD) can have  devastating effects on one’s feet.  It is a condition that typically has a slow onset that many people do not recognize until it is too late.  Without proper blood flow, tissues in our most distal part of our bodies, such as our feet, lose valuable nutrition and become easily damaged.  This happens because the small arteries in our feet and legs become smaller and smaller, oftentimes due to smoking, diabetes, hypertension, and hyperlipidemia, but this can happen without an underlying reason, as well.  A sudden shower of tiny clots due to an underlying heart murmur can also lead to sudden symptoms of tissue changes in our feet. 

The signs and symptoms of PVD can vary from person to person, but there are key parameters a person can watch for to improve one’s chances of early diagnosis and treatment.

Skin Changes

When PAD is present, the skin on the feet becomes shiny and very pale.  Hair growth becomes scant or disappears from the digits.  Nails become thick and brittle.  The temperature of the skin decreases.  The person may complain that their feet are always cold.  The skin loses its suppleness. 

In very progressed PAD, gangrenous changes may be present that begin with a mottled appearance, followed by darkening at the furthest parts of the toes and spreading to other areas.


People suffering from PAD often relate severe pain in their feet and legs that is present all of the time, but is particularly severe when they elevate their legs to sleep.  Many patients suffering from PAD relate that they sleep with their legs dangling down from an easy chair or that they have reduced pain when they dangle their legs. 

Non-healing wounds

The most devastating effects of PAD become evident when some trauma to this frail tissue results in a wound that just doesn’t heal.  In fact, despite efforts to reduce pressure, apply topical ointments, and to keep the wound clean, the wound continues to become deeper, instead of showing signs of healing.  As the wound persists, the risk of infection in the area increases.  Once an infection becomes evident, delivery of antibiotics to these parts of the body becomes a very difficult task, as blood flow to these tissues is very poor.  Furthermore, surgical amputation of the infected tissue does not always result in closure of the wound at the level of the foot.  When PAD is very severe, blood flow may not be present below the knee and the surgical wound itself may not heal.  This leads to amputations at the level of the knee, and sometimes, even higher.

Other Symptoms

            People suffering from an underlying disease of the arteries may have none of the above symptoms.  Instead, they may have very subtle changes in their activity level or behavior.  Because of poor circulation to the legs and feet, they may reduce their activity to fewer and fewer steps, walk slower, or rest more often.  They may not be able to walk very far distances without having to rest.  They may also complain of numbness, cramping, or tightness in their legs or feet.

Recognizing the symptoms of PAD early can help to save limbs and lives.  Even when a wound is not present, it is very important to look at your feet and monitor the skin and nails for any changes.  It is important to maintain soft, supple skin that can withstand the daily abrasions in shoes and other routine traumatic events.  Maintaining good circulation of the feet with local massage, daily exercise, and good hygiene can reduce the chances of developing the devastating changes that can happen in PAD.  Most important of all, it is important to stop smoking, control glucose levels in diabetes, maintain good blood pressure control, avoid elevations in cholesterol, and follow your doctor’s recommendations on leading a healthy and active lifestyle.