PAD is a progressive disease that involves the hardening and narrowing of the arteries. Arteries are strong, flexible blood vessels that expand to accept blood pumped into them with each beat of the heart. They deliver necessary oxygen and nutrients to the body. PAD can affect arteries of the neck or those that take blood to the kidneys, arms and legs.
Hardening and narrowing of the arteries is called atherosclerosis. This term comes from the Greek words ‘athro’ (meaning gruel or paste) and ‘sclerosis’ (meaning hardness). It involves deposits of fatty substances, cholesterol, cellular waste, calcium, and fibrin (a clotting material in the blood) on the inner lining of a blood vessel. Scientists believe it starts when this inner layer of the artery becomes damaged.
Atherosclerosis is a complex process that can affect your whole body. Remember, arteries are all over the body. According to the Canadian Cardiovascular Society, PAD is a sign of widespread atherosclerosis. It brings with it a higher risk of heart attack, stroke and cardiovascular death – three to six times that of someone without PAD. Approximately 30 per cent of people with PAD are thought to have triple vessel (serious) heart disease. If you do have PAD, take it seriously and work to reduce your risk factors.
If arteries in the leg become completely blocked, a part or the entire limb can become ischemic and die from lack of blood flow. Severe constant pain and a change in color and temperature of the leg or foot would suggest such a blockage. This is an emergency requiring an immediate trip to the emergency room. Possible surgery may be needed to save the leg or foot if blockage is severe. In cases where the leg or foot cannot be saved, it may have to be amputated (removed).
These tools can be used to help confirm PAD:
Exercise is an important part of health, especially if you have PAD. The Peripheral Arterial Disease Coalition and the Vascular Disease Foundation strongly encourage starting with a supervised exercise program.
Studies show that those who first attend a formal walking program before continuing on a maintenance program will get the best results. If you have PAD of the legs, walking is your best exercise. It helps prevent further artery blockage, and the muscles in your legs become more efficient in using oxygen.
Walking programs for PAD of the legs involves walking until a moderate amount of pain is felt, resting until the pain is gone, and then walking again. This can be done on a treadmill, track, outdoors or in a mall. The goal is to increase the time and distance you are able to walk without pain.
The Vascular Disease Foundation has developed a pain scale to help in knowing when to stop walking and rest.
Warm-up: 5 minutes of slow gentle walking.
Start: Start walking at a pace that will cause pain in 3 to 5 minutes. If you can walk longer than 5 minutes without pain, you need to walk faster, or if on a treadmill, you need to increase the incline.
Continue: Keep walking until the pain is a 3 to 4 on the pain scale.
Stop: Stop until the pain is gone. Pain scale score = 1.
Restart: Start walking again until your pain is 3 to 4 on the scale.
Repeat: Continue walking and resting for 50 minutes. Start slowly, perhaps only 15 minuutes then increase the time each week, until at 50 minutes.
You must take good care of your feet if you have PAD of the legs. PAD cuts down blood flow, which means less oxygen and nutrients are supplied to tissues. Oxygen and nutrients are very important for wound healing.
With normal everyday activities, feet take a lot of abuse. Injuries must be avoided. Simple problems, such as dry cracked skin, calluses, blisters or infected ingrown toenails, can become serious very quickly for someone with PAD. Infections are hard to heal and could lead to amputation. Caring for your feet is essential!
If your doctor approves, use a pumice stone on calluses. See a foot specialist about large calluses or corns, ulcers, infections, ingrown nails, blackened areas or embedded objects (such as a splinter under the skin).
Although PAD is a serious condition, it can be managed with exercise, by controlling other conditions and caring carefully for your feet. For more information, talk to your local health care provider.
Toes: when standing, the width of your thumb should fit between the tip of your longest toe and the end of your shoes.
Heels: the height of the heel should be less than two inches. Wearing heels greater than two inches puts 90 per cent of your body weight onto your forefoot. Your body weight should be half on your heel and half on your forefoot. Shoes with a low heel are best.
Material: the material should be soft and breathable, and adapt to the shape of your foot. There should be no pressure areas or rubbing – a seamless interior is best.
Lace up shoes help prevent the foot from slipping in the shoe. Velcro™ is also acceptable in many cases. Do not use slip-on shoes.
Support: the shoe should have a cushioned sole with good tread. The sole of the shoe should not bend more than two centimetres in any direction.
Time of day: buy your shoes at the end of the day. Your feet naturally swell during the day and will be at their largest by evening.
Use a shoe fitter: select a store that has experienced shoe fitters who can help you find a shoe to best fit the shape of your foot. They can recommend shoes that will provide your feet with the best protection. A store with a certified pedorthist, who has special training in fitting shoes for those with foot problems is best.