Leg pain can warn of a serious condition: Why peripheral artery disease (PAD) needs more attention
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."
Leg pain when walking can be more than a sign of aging; it may signal a serious condition called peripheral artery disease (PAD). This condition occurs when plaque builds up in the arteries, reducing blood flow to the legs. PAD is more likely to affect those who smoke or have diabetes, and it disproportionately impacts individuals from lower-income backgrounds, rural or remote areas, and Indigenous communities. These groups often face challenges accessing preventive care, diagnosis, and vascular specialists.
Symptoms of PAD can vary, with many people experiencing discomfort, cramping, or fatigue in their leg muscles during walking, but finding relief with rest. This is known as claudication. However, some individuals may have few or no symptoms, which can lead to missed diagnoses. Commonly, people may attribute their symptoms to arthritis or aging, rather than recognizing them as potential signs of PAD.
The Canadian National Action Plan for Peripheral Artery Disease aims to improve recognition, diagnosis, and treatment of this overlooked disease. The plan emphasizes six key areas: awareness, earlier diagnosis, better treatment, Indigenous-led care, research, and advocacy. One significant issue highlighted is health literacy, as many patients may not understand that PAD is a cardiovascular disease and may interpret walking difficulties as a normal part of aging.
A simple test called the ankle-brachial index (ABI) can detect PAD by comparing blood pressure at the ankle with that in the arm. However, access to this test varies across Canada, particularly in primary care settings. Canadian guidelines recommend ABI testing for high-risk patients, but its use remains limited, leading to delayed diagnosis and treatment.
The action plan calls for increased awareness and education about PAD among medical professionals. Currently, Canadian medical students may receive only about 15 minutes of PAD-specific education during their training. Additionally, the plan highlights the need for equitable access to PAD care, particularly for lower-income populations, Indigenous communities, and those living in rural areas.
Structural barriers such as poverty, reduced access to preventive care, long distances to specialists, and systemic inequities contribute to the disproportionate burden of PAD in these groups.
To address these challenges, the action plan advocates for PAD strategies to be co-developed with Indigenous communities and under Indigenous leadership. This includes training community health workers and supporting Indigenous-led mobile clinics that can provide screening and care closer to home. Furthermore, building multidisciplinary PAD centers that integrate medical treatment, diagnostic testing, vascular procedures, and support services such as exercise, smoking cessation, and wound care is proposed.
These centers aim to provide comprehensive, evidence-based care to those in need, ultimately reducing complications like amputations and hospitalizations, and preserving mobility and quality of life.
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