Why Peripheral Artery Disease Needs More Attention

By Matthew Ades, Anthony Sandre and Sonia Anand

Pain in your legs when you walk may seem like a normal part of getting older. But it can be a warning sign that the arteries carrying blood to your legs are becoming blocked: a condition called peripheral artery disease (PAD). 

If these blockages become severe, blood flow to the leg can suddenly be cut off, causing what is sometimes described as a “heart attack of the leg.”

The PAD burden is also not shared equally. People who smoke and have diabetes have the greatest risk of PAD, and it disproportionately affects those living on lower incomes, those in rural and remote communities, Indigenous Peoples and other under-served populations. 

That’s because these groups often face greater barriers to preventive care, diagnosis and vascular specialists, which — because of delayed care — results in worse outcomes, like amputation.

As physicians working in vascular medicine, we regularly care for people with PAD and see the consequences when the disease is recognized too late. Together with colleagues affiliated with the Canadian Society of Vascular Medicine and Prevention, we developed the Canadian National Action Plan for Peripheral Artery Disease, a road map for improving how we recognize, diagnose and treat this overlooked disease. 

The plan focuses on six areas: awareness, earlier diagnosis, better treatment and care pathways, Indigenous-led care, research and advocacy.

More Than Just Leg Pain 

PAD occurs when plaque builds up inside arteries and restricts blood flow, most commonly to the legs. It is part of the same disease process that causes heart attacks and many strokes.

One of its most common symptoms is discomfort, aching, cramping or fatigue in the leg muscles that occurs during walking and improves with rest. This is called claudication. But symptoms are not always typical, and some people have few or no symptoms.

This helps explain why PAD can go unnoticed. People may simply start walking less, avoid stairs and they or their front-line health-care professionals attribute their symptoms to arthritis or aging. The action plan identifies health literacy as an important issue: many patients do not realize PAD is a cardiovascular disease and may interpret their walking difficulties as a normal part of getting older.

That misunderstanding matters because PAD is not simply about leg pain. It is an important warning sign about a person’s overall cardiovascular health.

Why PAD Goes Undiagnosed

The lack of awareness of PAD extends beyond patients.

Despite its prevalence and clinical importance, PAD receives far less attention than heart disease and stroke. The action plan cites an estimate that Canadian medical students may receive only about 15 minutes of PAD-specific education during their training.

Diagnosis can also be challenging to access.

One of the simplest tests for PAD is measuring leg blood pressure using the ankle-brachial index, or ABI. It compares blood pressure measured at the ankle with blood pressure in the arm. A lower pressure in the leg can indicate narrowed arteries.

Yet access to this simple, non-invasive test varies widely across Canada, particularly in primary care. Canadian guidelines recommend ABI testing for appropriate high-risk patients, but its use remains limited.

The result is a disease that can remain undetected until it has progressed. A recent Canadian call to action highlighted that patients may not receive PAD care until late in their disease, when some already have limb-threatening complications.

Unequal Access to Diagnosis

Perhaps most concerning are the striking inequities in who develops PAD and who receives timely care.

Lower-income populations, Indigenous communities and people living in rural areas experience a disproportionate burden of PAD. Poverty, food insecurity, reduced access to preventive care, long distances to specialists and other structural barriers can all contribute.

For Indigenous people, these challenges are compounded by systemic inequities and the effects of colonial health systems. The action plan therefore calls for PAD strategies to be co-developed with Indigenous communities and under Indigenous leadership, including training community-health workers and supporting Indigenous-led mobile clinics that can bring screening and care closer to home.

Where someone lives or how much they earn should not determine whether vascular disease is recognized before they lose their mobility, or their limb.

A Roadmap for Change

The good news is that much of the harm associated with PAD is preventable. Once PAD is recognized, there are effective ways to reduce cardiovascular and limb complications. These include stopping smoking, controlling blood pressure, cholesterol and diabetes, taking appropriate low-cost medications and participating in regular walking exercise. For some people with more advanced disease, procedures to restore blood flow may also be necessary.

The challenge is getting evidence-based care to the people who need it most.

The Canadian National Action Plan for Peripheral Artery Disease proposes practical changes. These include:

• Increasing public and professional awareness

• Expanding access to ankle-pressure testing

• Bringing screening into rural and remote communities

• Using virtual consultations to connect patients with vascular specialists

• Improving access to supervised exercise programs

• Creating co-ordinated PAD care pathways

The plan also calls for multidisciplinary PAD centres that bring together medical treatment, diagnostic testing, vascular procedures and services supporting exercise, smoking cessation, wound care and other needs, rather than forcing patients to navigate a fragmented system. This builds on previous Canadian calls for PAD centres of excellence and team-based vascular care.

The goals are straightforward: Raise awareness, diagnose PAD earlier, prevent avoidable amputations and hospitalizations, preserve mobility and quality of life and make high-quality vascular care more equitable across Canada.

PAD should not be a disease that’s discovered only after someone develops a non-healing wound, loses a limb or suffers a heart attack or stroke.

Leg pain with walking deserves attention. Recognizing PAD earlier provides an opportunity not only to protect a person’s legs and mobility, but also to protect their heart, brain and life.

Matthew Ades, MD, is an Assistant Professor in the Division of General Internal Medicine at McGill University. He also serves as Director of the Cardiovascular Prevention Centre at the Jewish General Hospital.

Anthony Sandre, MD, is an an Assistant Professor in the Division of General Internal Medicine at McMaster University.

Sonia Anand, MD, is Associate Vice-President of Global Health at McMaster University. 

This article originally appeared in The Conversation and is republished with permission. 

Managing Expectations Is Often Key to Chronic Pain Treatment

By Chris Seenan

In a 2026 study I conducted with colleagues on people with peripheral arterial disease, one participant described how leg pain had disrupted his golf for years. It forced him to stop mid-round, shake his leg and apologise to his playing partners while he waited for the pain to pass. He found it mortifying. 

Then he tried a small electrical device that delivered gentle pulses through pads stuck to his skin. He still had pain. But he could get round the course.

When we measured his walking on a treadmill, we found no improvement. He had not noticed. That was not the outcome that mattered to him. Before the study ended, he had already gone out and ordered his own device.

A different participant reached the opposite conclusion. The pain was still there when he used the device, he said. It had not done him any good. And he was right, in a narrow sense. The device had not eliminated his pain. 

What it had done was reduce its intensity and delay its onset, allowing him to walk measurably further. His expectation of complete relief meant that genuine, partial relief felt like failure. He concluded the treatment did not work.

The study did not tell a simple story of success or failure. For some participants, standard treadmill measures did not capture what had changed in daily life. For others, measurable improvements still failed to feel meaningful because they fell short of what the person had hoped for. 

The difference was not only the treatment, or the severity of their condition. It was what each person had been led to expect.

Recognising Relief

Both men were living with peripheral arterial disease, a condition caused by a build-up of fatty deposits inside the arteries that supply the legs. It affects an estimated 236 million people worldwide. 

Its hallmark symptom is a cramping pain in the calf during walking that eases with rest. Over time, it can shrink a person’s world, limiting independence and increasing the risk of serious cardiovascular problems.

The recommended first-line treatment is supervised exercise therapy: structured exercise sessions led by trained professionals. But in many countries, access to supervised exercise therapy remains patchy and under-resourced. That gap is fertile territory for the wellness market.

Transcutaneous electrical nerve stimulation (TENS) delivers small electrical impulses through electrode pads on the skin to interfere with pain signals travelling to the brain. There is evidence that it can help with some kinds of pain, and it is used in hospital pain management settings. It is not a wellness product. 

In our study, we explored what happened when people with peripheral arterial disease used TENS independently at home, outside the controlled conditions of a clinical trial.

The findings point to something standard clinical tests rarely capture. Expectation can shape whether useful relief is recognised as useful.

That finding matters well beyond this particular device or condition. The global wellness industry is worth over a trillion dollars and operates with minimal regulatory oversight. People living with painful long-term conditions are among its most heavily targeted consumers. 

Companies sell electrical stimulation devices, supplements and wearable gadgets to people in chronic pain, using influencer testimonials in place of evidence and social media algorithms to reach people who are frightened, frustrated or in pain.

When a product fails to deliver the transformation it promised, patients rarely conclude they were misled. They conclude that nothing can help them. In conditions where reduced physical activity carries real health consequences, that conclusion is not merely disappointing. It is dangerous.

Poor Communication Hinders Treatment 

This is where the study speaks to a much wider problem. Whether a person is using a clinical device, a wearable gadget or a supplement sold online, they are often asked to judge it against expectations they did not set for themselves. Even legitimate, clinically tested treatments can be undermined by poor communication about what to expect.

The golfer’s experience illustrates this clearly. He valued an outcome that no clinical trial had thought to measure: the ability to play a round of golf without humiliation. Once he understood the device could offer that, it worked for him. His fellow participant was never given the chance to find his equivalent.

A market built around selling hope is poorly equipped for that kind of honesty. But the same danger can appear even when the person giving advice has medical credentials.

Research shows that even medically qualified doctors who become prominent wellness influencers on social media are subject to many of the same pressures as their unqualified counterparts: to build a personal brand, produce content constantly, stand out from competitors and make advice sound more certain than it really is. 

Having a medical degree does not make someone’s Instagram post better at managing a patient’s expectations. It just makes it more convincing.

What actually helps requires something platforms cannot provide: time, a genuine clinical relationship and communication that is not contingent on making a sale. 

It requires asking a patient not just whether their pain has reduced, but what they were hoping to do that pain had been stopping them from doing. It requires explaining that partial relief is still relief and that the outcome worth measuring might not be the one on the form.

That kind of honesty does not feature in any influencer’s discount code, medical degree or otherwise. But for the person who just wants to get round the golf course, it might be the most important part of the treatment.

Chris Seenan, PhD, Senior Lecturer in Physiotherapy at the University of Stirling 

His research focuses on the lived experiences of people with long-term conditions, particularly Peripheral Arterial Disease (PAD), Diabetes, and Chronic Pain. 

This article originally appeared in The Conversation and is republished with permission.  

Restoring Blood Flow Reduces Pain in Patients with Peripheral Artery Disease

By Pat Anson, PNN Editor

Restoring blood flow to the legs significantly reduces pain and improves quality of life for people with peripheral artery disease (PAD), according to new research presented this week at the American Heart Association’s Scientific Sessions in Chicago.

Over 200 million people worldwide suffer from PAD -- a narrowing of peripheral arteries throughout the body that can cause severe leg pain, cramping and fatigue after a short walk or even just climbing a flight of stairs. In one out of ten people with PAD, the lack of blood flow can lead to chronic limb-threatening ischemia (CLTI), where people experience pain even when resting. Left untreated, tissue damage in the leg may result in amputation.

To restore blood flow, a common treatment for PAD is leg bypass surgery, in which a passage around the blocked arteries is created by using another vein from the leg of a patient. A less invasive approach is angioplasty, in which a balloon-tipped catheter is inserted into the blocked artery to widen it. A stent is then often placed to keep the artery open.

Few studies have compared the effectiveness of bypass surgery to angioplasty and stenting, which are known as “endovascular” procedures.

“The large body of high-quality evidence that guides treatment of heart disease and stroke does not exist for PAD, and until now, there has been almost no data to inform the care of CLTI patients,” says lead author Matthew Menard, MD, an associate professor of surgery at Harvard Medical School, and co-director of endovascular surgery at Brigham and Women’s Hospital.

In the first large-scale randomized controlled study of its kind, Menard and his colleagues enrolled 1,830 people with severe PAD at 150 centers in the U.S., Canada, Italy, Finland and New Zealand. Participants were surveyed at the beginning of the study about their quality of life and at several follow-up visits for 4 years after their surgery or procedure. The surveys asked about pain, PAD symptoms and severity, physical activity and mental health.

Pain levels were high and quality-of-life scores were low at the beginning of the study, reflecting the poor health and well-being of many patients with CLTI. But after surgery or an endovascular procedure, pain scores decreased significantly and quality-of-life scores improved for all participants.

“Improvement in health-related quality-of-life measures regardless of the type of procedure is very encouraging and highlights the importance of timely restoration of blood flow to the leg and foot,” said Menard.

Menard noted there were some differences initially between the two study groups favoring endovascular procedures, possibly reflecting the longer recovery time for a surgical bypass. But the differences were not “clinically meaningful” and leveled out over time.

“The quality-of-life data are a nice complement to the clinical results and suggest that both revascularization strategies may effectively improve a patient’s quality of life. So, while there is still much work to be done, and quality-of-life measures have not always been the focus in past PAD research, this is an important step forward,” he said.

PAD patients who don’t have bypass surgery or endovascular procedures may want to continue walking despite the pain and discomfort, according to a recent study. Researchers at Northwestern University’s Feinberg School of Medicine found that elderly PAD patients who exercised 5 days a week walked at a faster pace and performed better on physical performance tests than non-walkers.

Between 8 and 10 million people in the United States have PAD. The condition disproportionately affects African-Americans, Native Americans and those with low socioeconomic status.

‘No Pain, No Gain’ Approach Helps People With Peripheral Artery Disease

By Pat Anson, PNN Editor

“No pain, no gain” is a phrase that caught on in the 1980’s when fitness videos promoting aerobic exercise became popular. Most doctors today will say that’s bad advice, because physical pain during exercise could be a sign of a serious injury or health problem. Pain is your body’s way of warning you that something is wrong.  

But it turns out that pain and discomfort while walking for exercise may actually be a good thing for people with peripheral artery disease – PAD for short – a condition that occurs when arteries become narrow or clogged, reducing the flow of blood and oxygen throughout the body.

In a new study published in the Journal of the American Heart Association, researchers reported that people with PAD who experienced cramping, soreness, fatigue and other ischemic leg symptoms while walking may actually benefit from the pain.

“We were surprised by the results because walking for exercise at a pace that induces pain in the legs among people with PAD has been thought to be associated with damage to leg muscles,” said senior author Mary McDermott, MD, an Internal Medicine and Geriatric Professor at Northwestern University’s Feinberg School of Medicine. “Based on these results, clinicians should advise patients to walk for exercise at a pace that induces leg discomfort, instead of at a comfortable pace without pain.”

McDermott and her colleagues followed 264 mostly elderly people with PAD for 12 months, randomly assigning them to one of three groups. The first group walked at home at a comfortable pace; the second group walked at a faster pace that induced ischemic leg symptoms; and the third group did not walk for exercise.

Participants who walked were asked to exercise 5 days per week for up to 50 minutes, while wearing an ActiGraph, a device that monitored the intensity and duration of their walking.

After six months, researchers found that people who walked at a pace that induced ischemic leg symptoms walked significantly faster in daily life than those who did not exercise or walked at a comfortable pace without leg symptoms. They also performed better on a physical performance test that assessed their speed, strength and balance. The findings were similar after 12 months.

“This finding is consistent with ‘no pain, no gain’ with regard to walking exercise in PAD,” McDermott said in a press release. “Exercise that induces leg pain is beneficial, though difficult.

“We now are working to identify interventions that can make the higher intensity exercise easier -- and still beneficial -- for people with PAD.”

Between 8 and 10 million people in the United States have PAD. The condition disproportionately affects African-Americans, Native Americans and those with low socioeconomic status.

Previous research found that walking for exercise improves walking ability and walking distance for people with PAD. What remained unclear, until now, were the potential effects of walking at a pace that induced symptoms such as leg pain.

The American Heart Association and 24 other organizations recently launched the PAD National Action Plan, a guide to assist in the prevention of PAD complications, reduce cardiovascular risk, and improve quality of life for those living with the disease.

“PAD is a lifelong medical condition, but people with PAD can lead active and long lives,” said Joshua Beckman, MD, professor of medicine at Vanderbilt University. “If you notice walking is becoming more difficult, keeping up with others is hard, or you have pain when you walk, talk with a doctor and describe when it happens and how it feels.” 

A recent study found that walking for exercise is also beneficial for people with osteoarthritis, who experienced 40% less knee pain than non-walkers.