Peripheral arterial disease resulting in necrosis of multiple toes The signs and symptoms of peripheral artery disease are based on the part of the body that is affected. About 66% of patients affected by PAD either do not have symptoms or have atypical symptoms. The most common presenting symptom is intermittent claudication, which causes pain and severe cramping when walking or exercising. The pain is usually located in the calf muscles of the affected leg and relieved by rest. This occurs because during exercise the muscles of the leg need more oxygen. Normally, the arteries would be able to increase the amount of blood flow and therefore increase the amount of oxygen going to the exercised leg. However, in PAD, the artery is unable to respond appropriately to the increased demand for oxygen by the muscles, as a result, the leg muscles are overly saturated with lactic acid, resulting in pain of the muscle that only goes away with rest. Other symptoms may include * Pain, aches, and/or cramps in the buttocks, hip, or thigh * Muscle atrophy (muscle loss) of the affected limb * Hair loss of the affected limb * Skin that is smooth, shiny, or cool to the touch in the affected area * Decreased or absent pulse in feet * Cold and/or numbness in the toes * Sores/ulcers on the affected limb that do not heal In individuals with severe PAD, complications may arise, including critical limb ischemia and gangrene. Critical limb ischemia occurs when the obstruction to blood flow in the artery is compromised to the point where the blood is unable to maintain oxygenation of tissue at rest. This can lead to pain at rest, feeling of cold, or numbness in the affected foot and toes. Other complications of severe PAD include lower limb tissue loss, arterial insufficiency ulcers, erectile dysfunction, and gangrene. People with diabetes are affected by gangrene of the feet at a rate that is 30 times higher than the unaffected population. Many of these severe complications are irreversible.
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