If you have leg cramps when you’re walking, you might assume they’re from age, dehydration, tight muscles or overuse. While those are possible causes, the pattern of the pain matters. If pain shows up when you’re walking and improves when you rest, it could point to blood flow problems.
Here’s more about the symptoms to watch for and when you should get care.
What is PAD?
PAD stands for peripheral artery disease. It’s a circulation problem that happens when arteries become narrow, so less blood flows through them. In your legs, these blocked arteries limit the amount of oxygen that reaches your muscles.
When your leg muscles don’t get enough oxygen when you’re walking or exercising, your muscles may cramp or hurt. This symptom is called claudication.
“It’s like a kinked garden hose,” said Tim Fuller, MD, a vascular surgeon with Banner Health. “When you are resting, your leg muscles don't need much oxygen, so the restricted blood flow is enough. But when you walk, those muscles demand more oxygen-rich blood. Because the arteries are narrowed with plaque, the blood can't keep up with the demand. You can feel cramping or aching until you stop and let the blood supply catch up.”
PAD isn’t just a leg problem. It’s linked with a higher risk for heart attack and stroke.
What PAD leg pain can feel like
With PAD symptoms, you may notice:
- Cramping
- Aching
- Tightness
- Heaviness
- Burning
- Fatigue or weakness
- Pain in the calf, thigh, hip or buttock
- Pain that appears when walking about the same distance at different times, for example, after walking two blocks
- Pain that improves after stopping and resting, usually within one to five minutes, and returns when you walk the same distance again
You may not notice PAD symptoms if you slow down, avoid hills or stop walking as much.
“Pain from PAD affects the muscles that are downstream from the blocked artery, not the joints,” said Devin Sponseller, DO, a vascular surgeon with Banner Health. Pain is most common in the calf but you might have pain in your thigh, buttock or foot.
With more severe PAD, you may have:
- Pain in your foot or toes when you’re resting or lying flat that gets better when you dangle your feet over the side of the bed or stand up
- Nonhealing wounds on your feet or toes
- Cold, pale or bluish feet
How PAD pain is different from a regular cramp or other leg pain
A regular cramp, joint pain or muscle strain may:
- Happen after new or intense exercise
- Start right when you stand up
- Feel sore to the touch
- Improve with more walking, stretching, massage, hydration or time
- Last more than 10 minutes after you stop activity
- Feel like it’s in a joint, not a muscle
- Feel like burning, tingling or shooting down the leg
- Feel better when you sit or bend forward
- Be linked to a specific injury or workout
You may still need medical care for these symptoms but they are less likely to be signs of PAD.
PAD is more likely to:
- Cause leg pain when walking, climbing stairs or exercising
- Improve after you rest for a few minutes
- Come back when you start moving again
- Happen in the same leg or muscle area
- Occur at a predictable walking distance
Other signs of poor circulation in your legs
You may also have circulation problems in your legs if you have:
- One foot or leg that feels colder than the other
- Pale, bluish or discolored skin
- Slow-healing cuts or sores on your foot or toes
- Less hair growth on your legs or feet
- Toenail changes or slow nail growth
- A weak pulse in your foot
- Numbness, weakness or heaviness in your feet or legs
- Foot pain at rest (especially at night) which you should have checked right away
Who is more likely to develop PAD?
Your chance of developing PAD risk is higher if you have any of these risk factors:
- A history of smoking
- Diabetes
- High blood pressure
- High cholesterol
- Older age
- Kidney disease
- Family history of vascular disease, heart disease or stroke
- Personal history of heart disease or stroke
How doctors check for PAD
When you see a provider for PAD, they will want to find out whether your leg pain is from blood flow, nerves, joints, muscles or another cause. They may:
- Ask about your medical history and symptoms
- Check your pulse in your feet
- Examine your feet and skin
- Compare the blood pressure in your arm and ankle, called the ankle-brachial index (ABI test)
- Order an ultrasound or other imaging if more detail is needed
- Order CT angiogram (CTA) or magnetic resonance angiogram (MRA) if they need to plan surgery or another intervention
When to ask your doctor about PAD
Talk to your provider about:
- Leg pain, cramping or heaviness that starts when you’re walking and improves when you rest
- Pain that comes back when you start activity again
- Avoiding walking, stairs or exercise because of your leg symptoms
- Risk factors like smoking, diabetes, high blood pressure or high cholesterol
- Cold feet, skin color changes, weak pulses or slow-healing sores
While PAD can happen at any age, it’s important to get care if you’re over age 50 and have diabetes or a history of smoking or over age 65 regardless of other risk factors.
Get emergency care for:
- Sudden severe leg pain
- A cold, pale, blue or black leg or foot
- Sudden weakness or numbness in a leg
- Foot or toe pain when you’re at rest, especially if it wakes you up at night
- Wounds on your feet or toes that aren’t healing
- A new inability to move or feel the foot
- Chest pain, stroke symptoms or trouble breathing
The bottom line
If you get leg cramps when you’re walking, don’t chalk it up to sore muscles or aging. Pain, cramping, heaviness or fatigue in your calf, thigh or buttock could be a sign of PAD.
Because PAD is related to circulation and blood vessel health, it is worth discussing it with a provider, especially if you have diabetes, a history of smoking, high blood pressure, high cholesterol or slow-healing foot wounds.
A Banner Health provider can check your circulation and help you understand whether PAD or another condition may be causing your symptoms.
FAQs about leg pain from poor circulation and PAD
Can PAD feel like leg cramps?
Yes. PAD can cause cramping, aching, heaviness or fatigue in the calf, thigh or buttock during walking or stair climbing.
Why do my calves hurt when I walk but stop when I rest?
Calf pain that starts when walking and improves with rest may mean the muscles are not getting enough blood flow during activity. PAD is one possible cause.
Is PAD leg pain always in the calf?
No. PAD pain may happen in the calf, thigh, hip, buttock or foot, depending on which arteries are affected.
How do doctors test for PAD?
A common test is an ankle-brachial index (ABI). It compares blood pressure in your arm and ankle to check blood flow to the legs.
Should I keep walking if I have PAD symptoms?
Do not ignore symptoms. Talk to your provider first. Many PAD treatment plans include a walking program but it should be guided by your health and diagnosis.
When is leg pain an emergency?
Seek emergency care for sudden severe leg pain, a cold or blue foot, sudden weakness or numbness, loss of movement or feeling, chest pain or stroke symptoms.
