What peripheral artery disease is

PAD and foot wounds are closely tied. Peripheral artery disease is a narrowing of the arteries that carry blood to the legs and feet, usually from a buildup of fatty plaque in the artery walls. It is more common with age, in people who smoke or used to smoke, and in people with diabetes, high blood pressure, high cholesterol or kidney disease.

Skin needs a steady supply of oxygen-rich blood to stay intact and to repair itself. When that supply is low, a small injury such as a blister or a nick from trimming a nail can turn into a wound that does not close.

Why foot wounds heal slowly with PAD

Repairing skin takes more blood flow than keeping healthy skin alive. With narrowed arteries, less oxygen and fewer nutrients reach the wound. The cells that fight infection have a harder time getting there, and so do antibiotics carried in the blood.

Wounds caused mainly by poor arterial flow are called arterial ulcers. Many people have a mix of causes, such as PAD with diabetic nerve damage or vein disease. See arterial and mixed wounds and our guide to venous and arterial ulcers.

Signs of poor circulation to mention

Tell your clinician about any of these:

  • Cramping or aching in the calf, thigh or buttock when you walk that eases with rest
  • Foot or toe pain at night that eases when you hang the foot over the side of the bed
  • A foot that feels cool, or one foot cooler than the other
  • Shiny, thin skin on the lower leg with little hair
  • A sore on a toe, heel or the edge of the foot that has not improved in a couple of weeks

How circulation is checked

A clinician starts by feeling the pulses in your feet and looking at skin color and temperature. If there is any doubt, tests can measure blood flow:

  1. Ankle-brachial index (ABI). Compares blood pressure at the ankle with blood pressure in the arm.
  2. Toe pressures. Often added for people with diabetes or kidney disease, whose stiff arteries can make the ankle reading look better than it is.
  3. Arterial ultrasound. Uses sound waves to show where flow is narrowed.

See circulation tests before compression for why testing comes first.

How the plan changes when blood flow is low

  • Vascular evaluation. A vascular specialist decides whether a procedure to improve blood flow could help the wound heal. Gateway can assist with vascular referral coordination.
  • A more cautious wound plan. The wound care clinician may hold off on removing tissue or on compression until blood flow is known. Do not put on compression stockings or wraps you have at home unless a clinician has said they are safe for you.
  • Attention to the causes. A primary care clinician works with you on tobacco use, blood sugar, blood pressure and cholesterol. See circulation and vascular health.

Ask whether walking is recommended for you. Walking is often encouraged for PAD, but with an open foot wound the answer depends on where the wound is.

Protecting your feet every day

  • Look at both feet daily, including the heels and between the toes.
  • Wear shoes or sturdy slippers, even indoors, and feel inside them for pebbles or rough seams first.
  • Skip heating pads, hot water bottles and hot soaks. Skin with poor circulation or reduced feeling burns easily.
  • Do not cut corns or calluses yourself. Ask who should trim your nails.
  • Choose shoes that do not rub. See choosing shoes with a foot wound.
  • If you smoke, ask your primary care clinician about help with quitting. See smoking and wound healing.

What Gateway coordinates

Gateway arranges wound care and primary care follow-up with partner clinicians across Greater St. Louis and the Metro East. When a treating clinician orders circulation testing or a vascular referral, we help with scheduling, records and transportation arrangements, and we keep your own physician informed. See limb preservation for how the pieces fit together.

Call 314-325-0126, or send a request for care with a name and phone number only.

When to get help fast

Call 911 if a foot or leg suddenly turns cold, pale or blue, or if you have sudden severe pain, numbness or weakness in the leg. A sudden blockage in an artery is an emergency.

Call the treating clinician’s office right away about a new black or dark area on a toe or foot, spreading redness, pus, a bad smell, fever, new pain at rest or a wound that is getting larger. Gateway is not an emergency service.

Common questions

Can a foot wound heal if I have PAD?

It depends largely on how much blood reaches the foot. Some wounds heal with careful wound care and protection. Others need a procedure to improve blood flow first. Testing shows which situation you are in, which is why clinicians want circulation measured early.

I have no leg pain when I walk. Could I still have PAD?

Yes. Many people with PAD have no typical symptoms, particularly if they walk very little or have nerve damage that dulls pain. A slow-healing sore on the foot or toes may be the first sign. If you have risk factors, ask whether your circulation should be tested.

Why does my foot hurt more at night in bed?

When you lie flat, gravity no longer helps pull blood down to the foot. If the arteries are badly narrowed, the foot may not get enough blood at rest, and that causes pain. Report this pattern promptly, since it can mean a serious drop in blood flow.

What kind of doctor treats PAD?

Primary care clinicians often find PAD and manage the conditions behind it. Vascular surgeons, and some cardiologists and radiologists with vascular training, perform the tests and procedures that restore blood flow. Ask your clinician which specialist they recommend for you.

Related pages

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.

Updated October 2026