If you have ever noticed aching, cramping, or tiredness in your legs when walking — only for it to ease when you stop — you may be experiencing something more than just ‘getting older.’ Peripheral artery disease (PAD) is one of the most common but least talked-about circulatory conditions affecting older adults, and in Ireland it touches the lives of far more people than many realise.
PAD occurs when fatty deposits (atherosclerosis) gradually narrow the arteries that supply blood to your legs and feet. The result is reduced blood flow, which can cause pain, slow wound healing, and — if left untreated — serious complications. The good news is that with early recognition and some straightforward lifestyle changes, PAD can be managed well, and its progression slowed significantly.
TL;DR
- Peripheral artery disease (PAD) affects roughly one in five people over 60 and is caused by narrowed arteries reducing blood flow to the legs
- The hallmark symptom is intermittent claudication — leg pain or cramping when walking that eases with rest
- Key risk factors include smoking, diabetes, high blood pressure, and high cholesterol — all manageable with the right support
- Diagnosis is straightforward with an ankle-brachial pressure index (ABPI) test, available through your GP or vascular clinic
- Walking programmes are the single most effective non-surgical treatment, and the Irish Heart Foundation offers free community supports
- PAD is a marker of wider cardiovascular risk — managing it protects your heart and brain as well as your legs
What Exactly Is Peripheral Artery Disease?
PAD is part of the same family of conditions as coronary heart disease and stroke. While those conditions involve narrowed arteries in the heart or brain, PAD affects the arteries in the legs — most commonly the femoral and popliteal arteries in the thighs and behind the knees.
The underlying process is atherosclerosis: a gradual build-up of fatty plaques inside the artery walls. Over time, these plaques narrow the artery, restricting the flow of oxygen-rich blood to the muscles and tissues of the legs and feet. Research from the Irish Longitudinal Study on Ageing (TILDA) highlights that cardiovascular risk factors — which drive PAD — remain highly prevalent among older adults in Ireland, with many cases going undiagnosed.
Recognising the Signs
The most characteristic symptom of PAD is intermittent claudication — a cramping, aching, or heavy feeling in the calves, thighs, or buttocks that comes on during walking and fades within a few minutes of rest. Many people dismiss this as simply being unfit or ‘getting on a bit,’ which is one reason PAD is so frequently missed.
Other signs to watch for include:
- One leg feeling noticeably colder than the other
- Colour changes in the feet or lower legs — pale, bluish, or reddish discolouration
- Slow-healing wounds or sores on the feet or lower legs
- Hair loss on the legs or feet
- Shiny, thin, or dry skin on the lower limbs
- Weak or absent pulse in the foot
- Numbness or tingling in the toes
In more advanced cases, pain may occur even at rest — particularly at night when lying flat. This is a sign that blood flow is critically reduced and warrants urgent medical attention.
Who Is at Risk?
PAD shares the same risk factors as other cardiovascular diseases. You are at higher risk if you:
- Smoke or have a history of smoking — this is the single biggest risk factor for PAD. Smoking damages artery walls and accelerates plaque build-up
- Have diabetes — people with diabetes are up to four times more likely to develop PAD. The HSE’s Chronic Disease Management (CDM) Programme includes regular foot and circulatory checks for those with diabetes
- Have high blood pressure — uncontrolled hypertension puts extra strain on artery walls
- Have high cholesterol — elevated LDL cholesterol fuels atherosclerosis
- Are over 50 — risk increases significantly with age, particularly after 60
- Have a family history of cardiovascular disease
If you have two or more of these risk factors, it is well worth raising PAD specifically with your GP — even if you have not yet noticed symptoms.
Getting Diagnosed
The good news is that PAD can be diagnosed quickly and painlessly. The key test is the ankle-brachial pressure index (ABPI), which compares the blood pressure in your ankle with that in your arm. A lower reading in the ankle suggests narrowing in the leg arteries. The test takes about 15 minutes, is non-invasive, and can be performed in your GP’s surgery or a vascular clinic.
If PAD is confirmed, your GP may refer you for further investigations such as a Doppler ultrasound scan to pinpoint where the narrowing is and how severe it is. In Ireland, vascular assessment services are available through HSE hospitals, and your GP can refer you through the standard pathway.
Under the CDM Programme, adults with conditions like diabetes and cardiovascular disease are entitled to structured GP reviews — this is an ideal setting to discuss any leg symptoms and request an ABPI check.
Managing PAD: What Really Works
Walking — the Best Medicine
It may sound counterintuitive when walking causes pain, but supervised exercise — particularly walking programmes — is the most effective non-surgical treatment for PAD. Research consistently shows that regular, structured walking improves symptoms, increases the distance you can walk pain-free, and helps your body develop alternative blood supply routes (collateral circulation).
The recommended approach is to walk until you feel moderate discomfort, rest until it passes, and then continue. Aim for 30–45 minutes at least three times a week. Over weeks and months, most people notice a real improvement in how far they can walk comfortably.
The Irish Heart Foundation runs free community-based walking groups and cardiac rehabilitation programmes across Ireland. These are excellent, supportive environments to build up your walking capacity under guidance. Your GP can also refer you to hospital-based cardiac or vascular rehabilitation.
Medications
Your GP or specialist may prescribe:
- Antiplatelet medication (such as low-dose aspirin or clopidogrel) to reduce the risk of blood clots
- Statins to lower cholesterol and stabilise existing plaques
- Blood pressure medication to protect artery walls
- Diabetes management — tighter blood sugar control slows PAD progression
These medications also reduce your overall risk of heart attack and stroke, making them doubly important.
Stopping Smoking
If you smoke, quitting is the single most impactful thing you can do for your PAD — and your overall health. The HSE offers free support through QUIT.ie and the HSE Quit Team (Freephone 1800 201 203), including nicotine replacement therapy and one-to-one coaching. Even after years of smoking, stopping makes a measurable difference to circulation within weeks.
Foot Care
Reduced blood flow means your feet are more vulnerable to injury and slower to heal. Good foot care is essential:
- Check your feet daily for cuts, blisters, or colour changes
- Keep feet clean and moisturised (but not between the toes)
- Wear well-fitting shoes and avoid going barefoot
- See a podiatrist regularly — HSE community podiatry services are available for those with diabetes or circulatory problems
- Never ignore a wound that is slow to heal — seek medical advice promptly
When More Treatment Is Needed
For more severe PAD, your vascular specialist may recommend:
- Angioplasty and stenting — a minimally invasive procedure to widen the narrowed artery using a balloon catheter, sometimes with a stent to keep it open
- Bypass surgery — creating a new route for blood flow around the blocked section, using either a vein graft or synthetic tube
These procedures are available through HSE vascular surgery departments. Waiting times can vary, and in some cases the National Treatment Purchase Fund (NTPF) may offer faster access.
PAD as a Wider Warning Sign
It is important to understand that PAD is not just a leg problem. If atherosclerosis has narrowed the arteries in your legs, it is very likely present elsewhere in your body too. People with PAD have a significantly higher risk of heart attack and stroke. This is why managing PAD is really about managing your whole cardiovascular health — and why your GP will want to address blood pressure, cholesterol, blood sugar, and smoking as part of your care plan.
At Críonna Health, we believe that understanding conditions like PAD — and knowing what supports are available in Ireland — empowers people to take control of their health as they age. Small, consistent steps make a genuine difference.
Practical Steps You Can Take Today
- Talk to your GP if you experience leg pain when walking — ask about an ABPI test
- Walk regularly, even if you need to start with short distances. Consistency matters more than intensity
- If you smoke, call QUIT.ie (Freephone 1800 201 203) — support is free and confidential
- Check your feet daily and see a podiatrist if you notice any concerns
- Attend your CDM reviews — use these appointments to discuss circulation and leg health
- Join a walking group — the Irish Heart Foundation, parkrun, and Get Ireland Walking all offer free local options
Useful Irish Resources
- Irish Heart Foundation — irishheart.ie — information, walking groups, and cardiac rehabilitation
- HSE QUIT Team — 1800 201 203 / quit.ie — free stop-smoking support
- HSE CDM Programme — structured GP reviews for cardiovascular and diabetes patients
- Diabetes Ireland — diabetes.ie — foot care resources and local supports
- ALONE — 0818 222 024 — support for older adults living alone, including health check-ins
📷 Photo by Arek Adeoye (@areksan) on Unsplash
