Biomet Biologics

Symptoms and Diagnosis


While many people have mild or no symptoms, if left untreated, PAD can lead to critical limb ischemia (CLI), a serious form of the disease4-5.

PAD symptoms include:

  • Increased pain during exercise in the legs, thigh or buttocks (also called intermittent claudication)4,5
  • Ulcers or sores on the feet or toes that are slow to heal3-5
  • Numbness in the legs or feet when not moving3,6
  • Gangrene31
  • Limbs and/or feet that are colder to the touch than other limbs3,31
  • Decreased or complete lack of pulse in the legs or feet1,32
  • Shiny skin, or thick and slower growth of toenails1,32

Stages of PAD

There are different stages as PAD progresses from having little-to-no symptoms through potential amputation, if left untreated.

Stages include33:

  • Asymptomatic (no symptoms)
  • Intermittent Claudication (IC)
  • Critical Limb Ischemia (CLI)
Stages of PAD33
Clinical Description Asymptomatic Intermittent Claudication Critical Limb Ischemia
Symptoms no symptoms, decreased leg pulse might be found in clinic ranging from mild to severe leg pain upon exertion Rest Pain:
leg pain without exertion (while at rest)
Tissue Loss:
ranging from minor to major ulcers or gangrene


A physician may perform any of the following methods of diagnosis:

Physical Exam

During an assessment for PAD a doctor will look for decreased blood pressure or pulses in the legs,1,5,31 high blood pressure5, heart abnormalities5, color changes in the legs or feet1,5, loss of hair in the legs or feet1, and ulcers5 (infections or sores that won't heal)1,2,5.

Ankle Brachial Index (ABI)

An ABI test is an easily done exam that compares the blood pressure in the feet to the blood pressure in the arms2,5,31. This test helps diagnosis PAD patients by determining if there is narrowing of the arteries31.

Doppler Ultrasound

An ultrasound is a test allowing for a visualization of arteries as well as measurements based on sound waves 2,5,31. Ultimately, the doctor is determining blood circulation and if blockages in the arteries exist2,5,31.


An angiography test injects a dye into the patient's blood vessels in the affected area. X-rays are then taken to evaluate blood circulation and if blockages exist in the arteries.1-2,31.

Blood Tests

Blood tests can be done to look for related factors such as high cholesterol or diabetes1

Patients with No or Poor Options

In severe cases, patients with CLI who are not candidates for revascularization may require amputation. Amputation may be necessary for a variety of reasons, including necrosis of the weight-bearing portions of the foot, uncorrectable flexion contracture, weakness or loss of movement of the extremity, unmanageable rest pain, severe infection, or very limited life expectancy due to other comorbid conditions39.