Peripheral arterial disease, also called PAD, happens when blood vessels in your legs are narrowed or blocked by fatty deposits. Blood flow to your feet and legs decreases, causing pain and circulation problems. When blood flow is reduced, your muscles can’t get enough oxygen.

If you have PAD, your risk for heart attack, stroke, and amputation goes up. About one-third of people with diabetes over the age of 50 have PAD. But many of them don’t know they have it.

If you have diabetes, you’re much more likely to have PAD. You’re also at high risk for a heart attack or a stroke. But you can cut your chances of having those problems by taking care of your health.

Just having diabetes puts you at risk. But your risk is even greater if you:

  • smoke

  • have high blood pressure

  • have abnormal cholesterol levels

  • already have heart disease

  • already had a heart attack or stroke

  • are overweight

  • aren’t physically active

  • are over age 50

  • have a family history of PAD, heart disease, heart attacks, or strokes

You can’t change some of these risk factors. But you can lower your risk for PAD by tackling some of the other risk factors, such as losing weight if you’re overweight.

Many people with PAD don’t have any warning signs. Some people may have mild leg pain when they walk (a condition called claudication), weakness, or trouble walking. But they might think these are just signs of getting older. Tell your health care provider if you have any of these signs of PAD:

  • pain in your legs that occurs while you walk but disappears after a few minutes of rest

  • tiredness or cramps in your legs

  • numbness, tingling, or coldness in your feet or the lower part of your legs

  • sores or infections on your feet or legs that heal slowly

  • dry, cracked skin on your feet

  • pain in your feet or toes, even when you’re resting

If you have warning signs of PAD, talk with your health care provider.

Your health care provider will check your pulses—the rate of blood flowing through your blood vessels—in your feet. Your provider will also look at your feet.

Another test is the ankle-brachial index (ABI). This test uses sound waves (ultrasound) to compare the blood pressure in your ankles to the blood pressure in your arms. If the blood pressure in your ankles is lower than the pressure in your arms, you may have PAD. The ABI also tells whether the amount of blood flow in your legs is reduced. Your health care provider should check your ABI if:

  • you’re over age 50 and have diabetes

  • you have warning signs of PAD (no matter how old you are)

  • you’re 50 or younger but have other risk factors, such as having diabetes for more than 10 years or being a smoker

If your results are normal, your health care provider should check your ABI every 5 years. These tests also can be used to diagnosis PAD:

  • In contrast angiography, the health care provider injects dye into your blood vessels and then takes X-rays to see whether your arteries are narrowed or blocked.

  • In an ultrasound test, sound waves produce pictures of your blood vessels on a viewing screen.

  • Magnetic resonance angiography (MRA) and computed tomography angiography (CTA) tests use special scans to see whether your blood vessels are blocked.

Exercise, such as walking, can be used both to treat PAD and to prevent it. Medicines may help relieve symptoms. Regular foot care helps prevent problems.

Some people need surgery for PAD.

  • In angioplasty, also called balloon angioplasty, a narrow tube with a balloon attached is inserted and threaded into an artery. Then the balloon is inflated, opening the narrowed artery. A wire tube, called a stent, may be left in place to help keep the artery open.

  • In an artery bypass graft, a healthy blood vessel is taken from another part of the body and attached to bypass (go around) a blocked artery.


  • If you smoke, talk with your health care provider about how to quit.

  • Aim for an A1C below 7%. The A1C test measures your average blood glucose (sugar) over the past 2–3 months.

  • Keep your blood pressure below 140/90 mmHg.

  • Ask your health care provider if you should take a statin or aspirin.

  • Make smart food choices.

  • Be physically active, aiming for at least 30 minutes of exercise, at least 5 days a week.

This hand-out was published in Clinical Diabetes, Vol. 39, issue 4, 2021, and was adapted from the American Diabetes Association’s Cardiometabolic Risk Toolkit handout “All About Peripheral Arterial Disease.” Visit the Association’s Patient Education Library at for hundreds of free, downloadable handouts in English and Spanish. Distribute these to your patients and share them with others on your health care team. Copyright American Diabetes Association, Inc., 2021.

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