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      • Accessory Navicular Syndrome
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        • Ankle Sprain
        • Swollen Ankles
        • Tarsal Coalition
        • Tarsal Tunnel Syndrome
        • Weak Ankles
      • Arch Pain
      • Arch Supports
      • Bone Healing
      • Bone Infection
      • Bone Tumors in the Foot
      • Brachymetatarsia
      • Bunions (Hallux Abducto Valgus)
      • Bursitis
      • Calcaneal Apophysitis (Sever's Disease)
      • Calf Pain
      • Capsulitis of the Second Toe
      • Cavus Foot (High-Arched Foot)
      • Charcot Foot
      • Chronic Ankle Instability
      • Clubfoot
      • Cold Feet
      • Common Disorders of the Achilles Tendon
      • Drop Foot
      • DVT (Deep Vein Thrombosis)
      • Extra Bones
      • Fallen Arches
      • Fifth Metatarsal Fracture
      • Flatfoot
        • Flatfoot-Adult Acquired
        • Flatfoot-Flexible
        • Flatfoot-Pediatric
      • Foot Arthritis
      • Foot Drop
      • Fracture
        • Foot Fracture
        • Fracture-Ankle
        • Fracture-Foot
        • Fractures of the Calcaneus (Heel Bone Fractures)
        • Fractures of the Fifth Metatarsal
        • Fracture-Toe
        • Jones Fracture
        • Stress Fracture in the Foot
        • Toe and Metatarsal Fractures (Broken Toes)
      • Gangrene
      • Gout
      • Haglund's Deformity
      • Hallux Rigidus
      • Hammertoes
      • Heel Pain (Plantar Fasciitis)
      • High-Arched Foot
      • Intermetatarsal Neuroma
      • Intoeing
      • Joint Pain in the Foot
      • Joint Swelling in the Foot
      • Lisfranc Injuries
      • Os Trigonum Syndrome
      • Osteoarthritis of the Foot and Ankle
      • Osteomyelitis (Bone Infection)
      • Osteopenia
      • Osteoporosis
      • Peroneal Tendon Injuries
      • Pigeon-toes
      • Posterior Tibial Tendon Dysfunction (PTTD)
      • R.I.C.E Protocol
      • Restless Legs
      • Rheumatoid Arthritis in the Foot and Ankle
      • Sesamoid Injuries in the Foot
      • Shin Splints
      • Swollen Feet
      • Synovitis
      • Tailor's Bunion
      • Talar Dome Lesion
      • Tingly Feet
      • Tired Feet
      • Toe Walking
      • Turf Toe
      • Varicose Veins
      • Webbed Toes
    • Nails and Skin
      • Athlete's Foot
      • Black Toenails
      • Callus
      • Contact Dermatitis
      • Corns
      • Cracked Heels
      • Dermatitis
      • Dry Heels
      • Eczema of the Foot
      • Foot Bumps
      • Foot Lumps
      • Foot Odor
      • Foot Rash
      • Frostbite
      • Fungal Nails
      • Ganglion Cyst
      • Heel Fissures
      • Inflammation: Acute
      • Ingrown Toenails
      • Malignant Melanoma of the Foot
      • Plantar Fibroma
      • Plantar Wart (Verruca Plantaris)
      • Pump Bump (Hallux Rigidus)
      • Puncture Wounds
      • Rash
      • Raynauds Phenomenon
      • Skin Cancer of the Foot and Ankle
      • Smelly Feet
      • Sweaty Feet
      • Thick Toenails
      • Warts
      • White Toenails
      • Wounds/Ulcers
      • Wounds-Puncture
      • Yellow Toenails
    • Diabetic Health
      • Diabetic Complications and Amputation Prevention
      • Diabetic Foot Care Guidelines
      • Diabetic Peripheral Neuropathy
      • Diabetic Shoes
      • MRSA Infection of the Foot
      • Peripheral Arterial Disease (P.A.D.)
      • Soft Tissue Biopsy
    • Fitness and Your Feet
      • Baseball Injuries to the Foot and Ankle
      • Basketball Injuries to the Foot and Ankle
      • Field Hockey Injuries to the Foot and Ankle
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      • Rugby Injuries to the Foot and Ankle
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      • Softball Injuries to the Foot and Ankle
      • Tennis Injuries to the Foot and Ankle
      • Volleyball Injuries to the Foot and Ankle
    • Orthotics and Footwear
      • Custom Orthotic Devices
      • Orthotics
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    • Compartment Syndrome
    • Deep Vein Thrombosis (DVT)
    • Equinus
    • Instructions for Using Crutches
    • Staph Infections of the Foot
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Weill Cornell Medicine – Vascular & Endovascular Surgery, Section of Podiatry

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  • Peripheral Arterial Disease (P.A.D.)

What is Peripheral Arterial Disease?
Commonly referred to as “poor circulation,” Peripheral Arterial Disease (P.A.D.) is the restriction of blood flow in the arteries of the leg. When arteries become narrowed by plaque (the accumulation of cholesterol and other materials on the walls of the arteries), the oxygen-rich blood flowing through the arteries cannot reach the legs and feet.

The presence of P.A.D. may be an indication of more widespread arterial disease in the body that can affect the brain, causing stroke, or the heart, causing a heart attack.

Signs and Symptoms
Most people have no symptoms during the early stages of P.A.D. Often, by the time symptoms are noticed, the arteries are already significantly blocked.

Common symptoms of P.A.D. include:

  • Leg pain (cramping) that occurs while walking (intermittent claudication)
  • Leg pain (cramping) that occurs while lying down (rest pain)
  • Leg numbness or weakness
  • Cold legs or feet
  • Sores that won’t heal on toes, feet, or legs
  • A change in leg color
  • Loss of hair on the feet and legs
  • Changes in toenails—color and thickness

If any of these symptoms are present, it is important to discuss them with a foot and ankle surgeon. Left untreated, P.A.D. can lead to debilitating and limb-threatening consequences.

Risk Factors of P.A.D.
Because only half of those with P.A.D. actually experience symptoms, it is important that people with known risk factors be screened or tested for P.A.D.

The risk factors include:

  • Being over age 50
  • Smoking (currently or previously)
  • Diabetes
  • High blood pressure
  • High cholesterol
  • Personal or family history of P.A.D., heart disease, heart attack, or stroke
  • Sedentary lifestyle (infrequent or no exercise)

Diagnosis of P.A.D.
To diagnose P.A.D., the foot and ankle surgeon obtains a comprehensive medical history of the patient. The surgeon performs a lower extremity physical examination that includes evaluation of pulses, skin condition, and foot deformities to determine the patient’s risk for P.A.D. If risk factors are present, the foot and ankle surgeon may order further tests.

Several non-invasive tests are available to assess P.A.D. The ankle-brachial index (ABI) is a simple test in which blood pressure is measured and compared at the arm and ankle levels. An abnormal ABI is a reliable indicator of underlying P.A.D. and may prompt the foot and ankle surgeon to refer the patient to a vascular specialist for additional testing and treatment as necessary.

General Treatment of P.A.D.
Treatment for P.A.D. involves lifestyle changes, medication and, in some cases, surgery.

  • Lifestyle changes. These include smoking cessation, regular exercise, and eating a heart-healthy diet.
  • Medications. Medicines may be used to improve blood flow, help prevent blood clots, or to control blood pressure, cholesterol, and blood glucose levels.
  • Surgery. In some patients, small incision (endovascular) procedures or open (bypass) surgery of the leg are needed to improve blood flow.

P.A.D. and Foot Problems
Simple foot deformities (hammertoes, bunions, bony prominences) or dermatologic conditions such as ingrown or thickened fungal nails often become more serious concerns when P.A.D is present. Because the legs and feet of someone with P.A.D. do not have normal blood flow—and because blood is necessary for healing—seemingly small problems such as cuts, blisters, or sores can result in serious complications.

Having both diabetes and P.A.D. further increases the potential for foot complications. People with diabetes often have neuropathy (nerve damage that can cause numbness in the feet), so they don’t feel pain when foot problems occur. When neuropathy occurs in people with P.A.D., ulcers can develop over foot deformities and may never heal. For this reason, P.A.D. and diabetes are common causes of foot or leg amputations in the United States.

Once detected, P.A.D. may be corrected or at least improved. The foot and ankle surgeon can then correct the underlying foot deformity to prevent future problems should the circulation become seriously restricted again.

Avoiding P.A.D. Complications
Getting regular foot exams—as well as seeking immediate help when you notice changes in the feet—can keep small problems from worsening. P.A.D. requires ongoing attention.

To avoid complications, people with this disease should follow these precautions:

  • Wash your feet daily. Use warm (not hot) water and a mild soap. Dry your feet—including between the toes—gently and well.
  • Keep the skin soft. For dry skin, apply a thin coat of lotion that does not contain alcohol. Apply over the top and bottom of your feet, but not between the toes.
  • Trim toenails straight across and file the edges. Keep edges rounded to avoid ingrown toenails, which can cause infections.
  • Always wear shoes and socks. To avoid cuts and abrasions, never go barefoot—even indoors.
  • Choose the right shoes and socks. When buying new shoes, have an expert make sure they fit well. At first, wear them just for a few hours daily to help prevent blisters and examine the feet afterward to check for areas of irritation. Wear seamless socks to avoid getting sores.
  • Check your feet—every day. Check all over for sores, cuts, bruises, breaks in the skin, rashes, corns, calluses, blisters, red spots, swelling, ingrown toenails, toenail infections, or pain.
  • Call your foot and ankle surgeon. If you develop any of the above problems, seek professional help immediately. Do not try to take care of cuts, sores, or infections yourself.

  • Bone/Joint/Tendon
    • Accessory Navicular Syndrome
    • Achilles Tendon Rupture
    • Ankle
      • Ankle Arthritis
      • Ankle Fractures
      • Ankle Pain
      • Ankle Sprain
      • Swollen Ankles
      • Tarsal Coalition
      • Tarsal Tunnel Syndrome
      • Weak Ankles
    • Arch Pain
    • Arch Supports
    • Bone Healing
    • Bone Infection
    • Bone Tumors in the Foot
    • Brachymetatarsia
    • Bunions (Hallux Abducto Valgus)
    • Bursitis
    • Calcaneal Apophysitis (Sever's Disease)
    • Calf Pain
    • Capsulitis of the Second Toe
    • Cavus Foot (High-Arched Foot)
    • Charcot Foot
    • Chronic Ankle Instability
    • Clubfoot
    • Cold Feet
    • Common Disorders of the Achilles Tendon
    • Drop Foot
    • DVT (Deep Vein Thrombosis)
    • Extra Bones
    • Fallen Arches
    • Fifth Metatarsal Fracture
    • Flatfoot
      • Flatfoot-Adult Acquired
      • Flatfoot-Flexible
      • Flatfoot-Pediatric
    • Foot Arthritis
    • Foot Drop
    • Fracture
      • Foot Fracture
      • Fracture-Ankle
      • Fracture-Foot
      • Fractures of the Calcaneus (Heel Bone Fractures)
      • Fractures of the Fifth Metatarsal
      • Fracture-Toe
      • Jones Fracture
      • Stress Fracture in the Foot
      • Toe and Metatarsal Fractures (Broken Toes)
    • Gangrene
    • Gout
    • Haglund's Deformity
    • Hallux Rigidus
    • Hammertoes
    • Heel Pain (Plantar Fasciitis)
    • High-Arched Foot
    • Intermetatarsal Neuroma
    • Intoeing
    • Joint Pain in the Foot
    • Joint Swelling in the Foot
    • Lisfranc Injuries
    • Os Trigonum Syndrome
    • Osteoarthritis of the Foot and Ankle
    • Osteomyelitis (Bone Infection)
    • Osteopenia
    • Osteoporosis
    • Peroneal Tendon Injuries
    • Pigeon-toes
    • Posterior Tibial Tendon Dysfunction (PTTD)
    • R.I.C.E Protocol
    • Restless Legs
    • Rheumatoid Arthritis in the Foot and Ankle
    • Sesamoid Injuries in the Foot
    • Shin Splints
    • Swollen Feet
    • Synovitis
    • Tailor's Bunion
    • Talar Dome Lesion
    • Tingly Feet
    • Tired Feet
    • Toe Walking
    • Turf Toe
    • Varicose Veins
    • Webbed Toes
  • Nails and Skin
    • Athlete's Foot
    • Black Toenails
    • Callus
    • Contact Dermatitis
    • Corns
    • Cracked Heels
    • Dermatitis
    • Dry Heels
    • Eczema of the Foot
    • Foot Bumps
    • Foot Lumps
    • Foot Odor
    • Foot Rash
    • Frostbite
    • Fungal Nails
    • Ganglion Cyst
    • Heel Fissures
    • Inflammation: Acute
    • Ingrown Toenails
    • Malignant Melanoma of the Foot
    • Plantar Fibroma
    • Plantar Wart (Verruca Plantaris)
    • Pump Bump (Hallux Rigidus)
    • Puncture Wounds
    • Rash
    • Raynauds Phenomenon
    • Skin Cancer of the Foot and Ankle
    • Smelly Feet
    • Sweaty Feet
    • Thick Toenails
    • Warts
    • White Toenails
    • Wounds/Ulcers
    • Wounds-Puncture
    • Yellow Toenails
  • Diabetic Health
    • Diabetic Complications and Amputation Prevention
    • Diabetic Foot Care Guidelines
    • Diabetic Peripheral Neuropathy
    • Diabetic Shoes
    • MRSA Infection of the Foot
    • Peripheral Arterial Disease (P.A.D.)
    • Soft Tissue Biopsy
  • Fitness and Your Feet
    • Baseball Injuries to the Foot and Ankle
    • Basketball Injuries to the Foot and Ankle
    • Field Hockey Injuries to the Foot and Ankle
    • Football Injuries to the Foot and Ankle
    • Golf Injuries to the Foot and Ankle
    • Lacrosse Injuries to the Foot and Ankle
    • Rugby Injuries to the Foot and Ankle
    • Running and Track Injuries to the Foot and Ankle
    • Soccer Injuries to the Foot and Ankle
    • Softball Injuries to the Foot and Ankle
    • Tennis Injuries to the Foot and Ankle
    • Volleyball Injuries to the Foot and Ankle
  • Orthotics and Footwear
    • Custom Orthotic Devices
    • Orthotics
    • Shoe Inserts
  • Compartment Syndrome
  • Deep Vein Thrombosis (DVT)
  • Equinus
  • Instructions for Using Crutches
  • Staph Infections of the Foot

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