Poor circulation in the legs occurs due to reduced inflow or stagnant outflow -- or both, in some cases. Peripheral artery disease (PAD) involves reduced delivery of oxygen-rich arterial blood, usually due to artery narrowing caused by cholesterol-laden plaques in the blood vessel walls. In contrast, chronic venous insufficiency (CVI) involves diminished delivery of oxygen-depleted venous blood back to the heart due to damaged or improperly functioning veins. Both PAD and CVI commonly affect the legs. Symptoms of poor leg circulation vary, depending on whether the primary problem is PAD or CVI. In people with both conditions, these symptoms often overlap.
Discomfort is a leading symptom of both poor arterial and venous circulation in the legs. However, the aggravating and relieving circumstances differ with PAD and CVI. In people with PAD, leg pain -- typically cramping in the calf muscles -- is characteristically brought on by physical activity, such as walking. The pain usually decreases or goes away with rest, especially when sitting with the feet on the floor.
In contrast, people with CVI frequently experience leg discomfort -- often described as heaviness or a dull ache -- with prolonged standing or sitting without their legs elevated. These positions promote pooling of venous blood in the lower legs, largely due to gravity. While prolonged walking sometimes brings on CVI-related leg discomfort, this symptom does not occur as consistently as it does in people with PAD.
In people with PAD, the feet and legs frequently appear pale when lying down or sitting with the feet elevated. When the feet are on the floor, however, both the feet and lower legs often appear deep red. This sign is known medically as dependent rubor. People with CVI do not exhibit this sign, but the skin of the lower legs and ankles often develops a permanent reddish or brownish discoloration over time. Engorged superficial and varicose veins as well as spider veins are also typical signs of CVI.
Those with CVI typically experience swelling of the feet, ankles and lower legs -- something that usually does not occur with PAD. The skin often becomes thickened and leathery with CVI, but usually thins and takes on a shiny appearance with PAD. Itchiness of the lower legs commonly occurs with both conditions, but is typically more problematic with CVI. People with both PAD and CVI tend to develop persistent leg ulcers that often require months of intensive treatment before healing.
Other Signs and Symptoms
Several other signs and symptoms can potentially occur with poor leg circulation. Examples of additional signs and symptoms that might occur with PAD of the legs include:
-- nighttime pain relieved by hanging the feet over the edge of the bed
-- absent or weak pulses in the feet and lower legs
-- coolness and numbness or tingling of the feet and lower legs
-- thick, slow-growing toenails
-- thigh or buttock pain with walking
-- foot and toe pain at rest in those with severe disease
-- erectile dysfunction
Examples of additional signs and symptoms that might occur with CVI of the legs include:
-- decreased leg discomfort and swelling during the night
-- increasing swelling throughout the day
-- tingling or burning in the lower legs
-- oozing or weeping fluid from the skin
Other Considerations and Next Steps
Although poor leg circulation can cause a variety of signs and symptoms, many people remain largely asymptomatic until the condition reaches an advanced stage. Additionally, signs and symptoms can be easily overlooked or attributed to another cause since they develop gradually. Therefore, it's important to pay attention to your body.
See you doctor as soon as possible if you experience any signs or symptoms that might indicate PAD or CVI. An accurate diagnosis is essential as the treatment for these conditions differs. Ongoing medical care is necessary with circulatory problems in the legs, particularly if you are diagnosed with PAD because people with this condition are at substantially increased risk for heart disease and stroke. Seek immediate medical attention if you have a nonhealing ulcer on your foot or leg, or suddenly lose feeling or notice dark discoloration of one or more of your toes.
Reviewed and revised by: Tina M. St. John, M.D.