Walking less? It could be a sign of a life-threatening condition
Painful muscle cramping in the legs or hips that begins during exertion and stops when you rest is the commonly known symptom for peripheral artery disease or PAD, a life-threatening condition affecting more than 8.5 million Americans.
The trouble is that only a small number of people living with PAD – as little as 10 percent according to a recent study by the American Heart Association – experience it. More often, patients talk about tired leg muscles, legs that feel “wooden,” sore hip or knee joints, or back pain.
A significant number – 40 percent according to the study - deny that pain occurs while walking or interferes with day-to-day activities without recognizing that they’ve changed their routines – shortening distances covered or other activities, blaming it on getting older or general tiredness.
Unfortunately, many PAD cases are misdiagnosed with back problems or arthritis, and some patients undergo invasive procedures that don’t address the actual problem.
As patients, it’s important to understand your risks and advocate for yourselves as you talk with your medical provider.
Understand your risks
PAD occurs when fatty deposits build up in the arteries that supply blood to the legs and feet, impeding proper circulation and oxygen that can damage limbs and placing you at risk for amputation if left untreated. The condition is also associated with heart disease and stroke.
Over the last decade, the number of people living with PAD increased by 30 percent and smokers are at the highest risk. Other risk factors include diabetes, high blood pressure, excessive weight and high cholesterol or being over the age of 65.
If you’ve been diagnosed with PAD, talk with your medical provider about your risk factors, and ways to lower them.
Ask about smoking cessation programs, especially those that combine medication with counseling. If you already quit, be aware that a history of smoking also increases risks.
If you have high blood pressure, high cholesterol or Type 2 diabetes, maintain any medication as prescribed and review with your doctor whether any changes may be needed. Ask whether you are a candidate for anti-platelet medication to cut the risk of heart attacks and strokes.
Military veterans, who have higher than average rates of high blood pressure, smoking and diabetes, also have higher than average rates of PAD.
Seek treatment and keep moving
Patients are often told to “just push through the pain.” In reality, that’s difficult to do. An “intermittent exercise” program in which a patient walks until the pain stops them, rests, then repeats the cycle is a good way to help improve your symptoms.
Your medical insurance may cover supervised exercise therapy sessions that encourage you to get active and walk on a treadmill at your own pace with a supervised mentor by your side.
Surgical approaches, in which the vessels are reopened with a stent, may also help in some cases, especially when paired with an exercise program.
Don’t ignore symptoms
If you haven’t been diagnosed with PAD, think about whether you’ve changed your routines. Did you stop going somewhere because the parking lot is too far away? Do you have to rest partway because you were overly tired or find yourself only walking where you know there are places to sit down?
Discomfort causes many people walk shorter distances or become more sedentary over time without realizing it, but they often forget to mention it during a clinic visit because they don’t have symptoms while they’re sitting down or feel like they are complaining about simply getting older.
Pain in your legs or buttocks while walking is not a normal sign of aging. It may be easily treated, but it’s not nothing. Patients who are “asymptomatic” – or don’t experience the “classic” symptoms are still at risk of having a heart attack or stroke, even if those symptoms aren’t severe.
Take your socks off at the doctor’s office during your visit, as they may be covering many of the warning signs of PAD, such as skin discoloration, wounds that are slow to heal and poor nail growth.
Ask your doctor for an ankle brachial index—a non-invasive, inexpensive test that measures whether the pulse in your ankle matches the one in your wrist and is a simple way to check if it could be PAD.
Dr. Diane Treat-Jacobson, PhD, RN, FAHA, is a professor and associate dean for research at the University of Minnesota School of Nursing and an American Heart Association volunteer.