Blocked blood flow in arteries can cause painful walking

Many people who find walking painful believe it’s a natural effect of aging, or that it’s related to arthritis. In fact what they may have is peripheral arterial disease (PAD) — a condition caused by blocked blood flow in the leg arteries.

PAD commonly affects men and women over 50, especially those who already have heart disease, diabetes, high cholesterol, high blood pressure and are smokers, says Dr. R. Eugene Zierler, UW professor of vascular surgery.

He points out that pain from PAD is more consistent than that of arthritis. “People with mild PAD will feel fine when they’re sitting still, but when they walk they’ll get a crampy pain in their calf muscles, thighs or buttocks, which will be painful enough to stop walking,” says Zierler. A few minutes of rest is usually enough to relieve the pain, so they can go on.

However, if blockage becomes more severe and blood flow decreases, patients may find that they also have “rest pain” in their toes and feet. This pain is relieved when the foot is kept lower than the rest of the body. But since this isn’t always possible, it’s likely that rest pain will disrupt their sleep. In the worst cases, PAD can lead to ulceration or gangrene, though only a small minority reach this stage, says Zierler.

Although many elderly and sedentary people don’t feel the need to walk much, they should try to walk as much as possible in order to stimulate the circulation and help the leg to use the blood supply more efficiently, he adds.

Medication can also help, but the effects are not dramatic. “One drug, pentoxifylline, works like a very mild blood thinner, and some clinical trials show patients can walk further, but it doesn’t open the blockage,” says Zierler.

Only 1 to 2 percent of PAD sufferers reach the “rest pain” stage, but those who do should seek medical attention. A doctor can assess the severity of blockage through non-invasive tests.

If a patient opts for direct intervention on the artery, he or she will first have an arteriogram, an X-ray in which dye is injected into the artery. If the blockage is limited to a short segment, the patient can have a balloon angioplasty supplemented by a stent (a wire tube to hold the artery open). This procedure works better in larger arteries.

However, longer blocked passages require bypass grafting, which can be risky, especially for those with heart or kidney problems. In the future, catheter-based intervention will be an alternative to open surgery, says Zierler. Dacron grafts, guided by X-rays, will be inserted with catheters and held in place with stents.

Although solutions are highly individualized, Zierler stresses that anyone suffering from PAD can benefit by not smoking, losing weight if necessary, and starting an exercise program. ¶

Ellen Liang