Leg pain and circulation · St. Louis

Leg symptoms and circulation

Poor circulation in the legs comes from peripheral artery disease: plaque narrows the arteries and blood flow falls, usually to the legs first. The classic sign is intermittent claudication. The ankle-brachial index, paired with pulse volume waveforms and the toe-brachial index, measures it in minutes.

Cramping that comes on when you walk and stops when you stand still is one of the few symptoms in medicine with a straightforward objective test behind it.

What is claudication?

Peripheral artery disease is the narrowing of arteries by atherosclerotic plaque along the vessel lining. As plaque accumulates the artery narrows, stiffens and loses function. Blood flow falls, usually to the legs first, and if the process continues far enough it can cause tissue loss.

The classic symptom is intermittent claudication: a cramping, aching or tired feeling in the calves, thighs or buttocks that appears at a fairly predictable walking distance and goes away within a few minutes of stopping. It is reproducible, which is what distinguishes it from most other causes of leg pain.

What are the warning signs of clogged arteries in the legs?

What you notice	What it may indicate
Cramping on walking that stops with rest	Claudication from reduced arterial flow
A shorter walking distance than a year ago	Progression, often unnoticed because people adapt
One foot colder than the other	Asymmetric arterial disease
Pain in the foot at night, relieved by hanging it out of bed	More advanced ischemia — this needs prompt assessment
A sore or ulcer on the foot that will not heal	Impaired perfusion, often with neuropathy — needs prompt assessment
Burning or tingling rather than cramping	More likely nerve than artery — see neuropathy symptoms

Why do so many people have PAD and not know it?

Peripheral artery disease is frequently silent, and the reason is behavioral: people reduce how far they walk without noticing they are doing it. Prevalence rises steeply with age — from roughly 5% of adults in their late forties to roughly 18% by the late eighties in the wealthier countries surveyed. Smoking carried the strongest association, followed by diabetes, hypertension and high cholesterol.

How is peripheral artery disease diagnosed?

The ankle-brachial index compares systolic pressure at the ankle with the arm. It is non-invasive, takes minutes, and is the standard first measurement. Because a calcified artery can make that index falsely reassuring, it is paired with the pulse volume waveform and the toe-brachial index, neither of which depends on the vessel being compressible.

Is my leg pain coming from nerves or arteries?

Artery disease and autonomic nerve damage are both frequent complications of diabetes, kidney disease, hepatitis, thyroid failure and aging, and their symptoms imitate each other closely. Distinguishing between them matters, because the treatments are quite different. Measuring both in the same appointment is the reliable way to tell them apart.

If you are a clinician: the same subject written for the person ordering the test is at the full test description.

Frequently asked questions

How far should I be able to walk?

What matters is the change, not the absolute distance — a reproducible drop in walking distance is the useful signal. Claudication explained.

My index was normal. Does that settle it?

Not if the arteries are calcified, which is common in diabetes and kidney disease. Why a normal index can mislead.

Is it varicose veins?

Vein problems and artery problems produce different patterns — veins tend to ache after standing still, arteries after walking. The measurement separates them. What the vascular study measures.

Can walking make it better?

Supervised walking is one of the best-established treatments for claudication, which is another reason to have an objective baseline first. Tracking change over time.

What is often the first symptom of peripheral artery disease?

Intermittent claudication. It is a cramping, aching or tired feeling in the calves, thighs or buttocks that comes on at a fairly predictable walking distance and goes away within a few minutes of stopping. Because it repeats the same way each time, it stands apart from most other causes of leg pain and has a straightforward objective test behind it.

What causes peripheral artery disease?

Plaque builds up along the lining of the arteries. As it accumulates, the artery narrows, stiffens and loses function, and blood flow falls, usually to the legs first. Smoking carries the strongest association, followed by diabetes, high blood pressure and high cholesterol. The chance of having it also rises steeply with age.

What are the symptoms of mild artery narrowing in the legs?

Often there are none you would notice. People with early disease tend to walk less without realizing they are doing it, so the problem stays hidden. Clues include a walking distance that is shorter than a year ago, cramping on walking that stops with rest, and one foot that feels colder than the other. The ankle-brachial index checks it in minutes.

References

• Fowkes FGR, Rudan D, Rudan I, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382(9901):1329–1340. doi:10.1016/S0140-6736(13)61249-0
• Aboyans V, Criqui MH, Abraham P, et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation. 2012;126(24):2890–2909. doi:10.1161/CIR.0b013e318276fbcb

Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, medical director of Measura. Last reviewed August 20, 2026.