Foot Care Tips for People With PAD, From Podiatrists

You’ve probably heard that “getting your steps in” can help you stay healthy. But for people with peripheral artery disease (PAD), walking even a few blocks might feel as challenging as a 10-mile run.

This common circulatory condition, which affects an estimated 8.5 million Americans, happens when the blood vessels that carry blood from the heart to the rest of your body become narrowed. This hampers blood flow to your limbs — your legs, in particular. That can have a serious impact on your

legs and feet.

“Your feet are at the end of the totem pole,” says Jeff Ross, MD, DPM, an associate professor of surgery at Baylor College of Medicine. “Blood circulation will be impaired to begin with as you go down from the core of the body to the legs to the ankles to the feet.”

PAD limits blood flow even further, causing cramping, fatigue, numbness, and burning or aching pain in the legs and feet, particularly while walking or doing other activities that use the leg muscles. Some people with PAD also have what’s known as rest pain.

“You’ve exercised and now you’ve sat or laid down, and you still have that pain,” Ross says. “The muscles are cramped because they aren’t getting enough circulation.”

PAD may also change how your legs and feet look.

Poor circulation causes your skin to lose elasticity, making it appear dull or shiny. PAD can also slow or prevent the growth of hair or nails, so you may notice you don’t have to shave your legs or clip your toenails as often. In serious cases, limited blood flow may make your legs feel cool to the touch, or the skin may change color due to a lack of oxygen.

Another major risk for people with PAD: infection. This is especially true if you also have type 2 diabetes, a condition that commonly goes hand in hand with PAD.

“The majority of patients who’ve had diabetes for any period of time develop some degree of peripheral neuropathy. This makes it hard for them to sense what normal pain would be,” says John N. Evans, DPM, chief of podiatry at Beaumont Hospital in Dearborn, MI.

At the same time, “if you don’t have adequate circulation, then your body can’t heal itself the way it should,” Evans says.

Good foot care is key to avoiding the most serious complications of PAD, which can even include amputation. Do these things to keep small problems from getting worse:

See a foot specialist every 3-6 months. A podiatrist can check for ulcers, ingrown toenails, abscesses, or skin issues that might cause a problem due to poor circulation. This is especially important if you have diabetes, Ross says.

Check your feet every day. Most of us only look at our feet if we feel there’s something wrong, like a blister or splinter. After all, your feet are about as far from your eyes as you can get, and — depending on your vision (or flexibility) — it can be hard to get a good look. For people with PAD, though, even minor problems can quickly turn into major ones.

“If you have a partner or someone around who can look at your feet for you, that’s great. If not, you can use a small mirror on the ground and sit with your foot near the mirror so you can see the reflection,” Evans says. “If you see something that’s not quite right, let your care specialist know that there’s something going on right away.”

Keep your feet clean and moisturized. Washing and drying your feet thoroughly every day can help prevent fungal infection. And smoothing on a lotion, gel, cream, or ointment that soothes, softens, and moisturizes will keep your skin hydrated and help prevent the skin from cracking or breaking. Just avoid moisturizers made with harsh ingredients like salicylic acid, Ross says.

Take good care of your nails. Cut your toenails straight across with the edges slightly rounded to avoid ingrown nails. If your nails are thick, deformed, or tend to rub or ingrow, don’t try to deal with it yourself.

“The risk is you’re going to cause more of a problem than if you had seen someone to take care of it,” Evans says.

The same goes for any other issues (like corns or calluses) that you might be tempted to self-treat. Although it may be tempting to head to a nail salon, particularly if it’s tough for you to reach your feet, getting a pedicure can be risky for people with PAD because of the risk of infection. Instead, see a trained medical specialist who can help you.

Always wear socks and shoes. Going sockless can lead to more rubbing, which can cause sores or blisters. Going barefoot (even indoors) can be dangerous because of the risk of cuts and infection.

Choose the right footwear. It’s critical to find a shoe that fits the structure and function of your feet, and even the most fancy, expensive footwear may be a terrible choice for you.

“I’m a big proponent of custom insoles or prescription orthotics, or even custom-made shoes,” Ross says.

A podiatrist can do a pressure analysis to predict where ulcers or sores may show up. “The right shoes can help you avoid breakdowns by taking the pressure off those areas,” Ross says.

Also, don’t wear the same pair of shoes 2 days in a row. Letting your footwear air out can help you avoid fungal infection.

Stay active. If your muscles cramp with every step, keeping up your golf game or walking around the neighborhood may seem like a tall order. But research shows that exercise can improve the symptoms of PAD and slow down the disease from getting worse. By becoming more active, you can maximize how well your arteries work, Evans notes.

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