PAD typically onsets with no noticeable symptoms. Over time, it can progress and begin causing limb pain and cramping, even when at rest. Early treatment can help to slow the progression and reduce your risk of complications.

PAD is a circulatory condition in which plaque buildup in the body narrows the arteries. Though either the arms or legs may be affected, it’s more common in the legs.

In the beginning, PAD doesn’t cause any symptoms. But as the blockage gets worse, you may start to experience increasingly severe limb cramping and pain.

In the early stages of PAD, lifestyle changes and medication can help to manage the condition. In some cases, early treatment may even reverse some plaque buildup. At all stages, monitoring the progression of PAD can also help to reduce your risk of cardiovascular complications, like heart attacks or stroke.

There are several ways to stage and classify PAD, such as the Rutherford and Fontain classifications. However, it’s easier to understand the progression of PAD by considering the four main ways it can present with varying levels of severity.

PAD has four distinct types of presentation. These aren’t clinically recognized stages of the disease, but your care team may use these categories to determine the best course of treatment.

Asymptomatic

Asymptomatic PAD is when there’s plaque buildup in the arteries but no noticeable symptoms. It may be detected with an imaging study or test conducted for another reason. When PAD is identified this early, lifestyle changes, such as quitting smoking or making adjustments to your diet, and medication can help.

Intermittent claudication (IC)

Intermittent claudication (IC) involves limb pain or cramping that generally begins when exercising and improves while resting. The pain is caused by narrowing arteries not sending enough oxygen-rich blood to your muscles.

It typically happens in the calves, thighs, or buttocks. Exercise programs and other lifestyle changes, as well as medications, can treat PAD at this stage.

Critical limb ischemia (CLI)

Critical limb ischemia (CLI) is characterized by more severe blockages in the arteries. Those with critical limb ischemia will experience discomfort or pain in the feet or toes, even while at rest.

Symptoms tend to worsen at night or with elevation. At this stage, a medical procedure is typically required to prevent permanent physical damage. Critical limb ischemia may also involve skin issues like ulcers, wounds, or gangrene.

According to a 2023 review, many peoples’ symptoms do not neatly fit into these categories. This seems to be particularly true for females, who are diagnosed with IC at a lower rate than males, but more likely to be diagnosed with CLI.

The review’s authors believe this may be due to biological factors like hormones and smaller vessel sizes. Because hormones may play a role in the progression of PAD, transgender individuals undergoing hormone therapy should discuss specific risk factors with a healthcare professional.

Acute limb ischemia (ALI) is the fourth presentation. While the three types of presentation discussed above provide a model for how PAD may progress over time, ALI occurs suddenly. It’s possible to develop ALI without a previous history of issues with your peripheral arteries.

ALI occurs when a sudden and severe decrease in blood flow to a limb puts it at risk of permanent neuromuscular damage or limb loss. It requires emergency treatment.

Symptoms of ALI include:

  • pale skin
  • slow pulse
  • cold skin
  • numbness or tingling in limbs
  • limb paralysis

According to a 2019 review, the rate of progression for PAD varies from person to person, making it difficult to predict.

Early intervention with lifestyle changes and medication can make a big difference in how the disease progresses. Be sure to mention any new sensations in your limbs to a healthcare professional, especially if you have an increased risk of developing PAD you’re over the age of 60 or have additional risk factors.

Other PAD risk factors include:

  • smoking
  • high blood pressure
  • diabetes
  • high cholesterol

Catching PAD in its earliest stages can improve health outcomes.

PAD symptoms aren’t always linear. Patients won’t necessarily progress through all the same stages or notice the condition in its earliest forms.

That said, the first symptom typically shows up in the claudication stage, which may involve:

  • leg cramping or pain that improves with rest
  • a feeling of leg heaviness
  • a colder body temperature
  • slower nail growth
  • altered skin color
  • hair loss in the legs

A variety of lifestyle changes and medications can help to stop or slow the progression of PAD.

These include:

If PAD advances beyond claudication, a procedure may be necessary to avoid permanent neuromuscular damage or limb amputation. These interventions may include:

Learn more about PAD treatments here.

Leg cramping or pain when exercising are among the earliest symptoms of PAD. If you notice these symptoms, talk with a healthcare professional as soon as possible.

When diagnosed early, PAD can be effectively managed with lifestyle changes and medication. Regular monitoring of the condition can also help to reduce your risk of cardiovascular complications.

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