Client Health

Peripheral Artery Disease: What You Should Know

Peripheral Artery Disease (PAD) affects more than eight million Americans and can be an early sign of blocked arteries in the body that can lead to heart attacks. Find out how you can spot PAD in clients and how you should advise them.


Peripheral Artery Disease (PAD) is a condition in which the arteries that take oxygenated blood to the lower limbs become clogged with plaque and cholesterol and prevent the tissue in the lower limbs from receiving adequate amounts of blood. The symptoms of PAD typically begin with mild leg pain after walking, but as the condition worsens, the feet can become cold from lack of circulation and develop sores that do not heal. In the most extreme cases gangrene can set in and require amputation.

Although many people with PAD experience no symptoms, it is important to watch for early signs. If someone has PAD, they are also very likely to have arterial clogging elsewhere in the body, especially around the heart area, which can lead to heart attacks.

According to a 2008 report from the American Heart Association, PAD currently affects about eight million Americans. The disease becomes more common as we age, and African-Americans and diabetics have an increased risk of getting PAD.

What Exactly Causes PAD? Once there is significant blockage of a lower limb artery and circulation is decreased, a patient can be categorized with PAD. The act of an artery becoming clogged is called atherosclerosis. When the body has too much fat or lipid molecules in the blood stream, these lipid molecules can bond with an oxygen molecule found in an artery, because arteries carry oxygenated blood to the body. (This is why veins do not usually have blockage, because they carry de-oxygenated blood back to the heart.)
Once the lipid bonds with an oxygen and bumps into an arterial wall, it damages it and becomes stuck. The body then sends white blood cells (macrophages) to absorb the offending molecule. But once the white blood cells get there, they are not able to remove the lipid molecule, and they rupture, thus adding to the mess. The body then calls in more white blood cells that fail, and as more oxygenated lipids pass through, they add to the blockage as well.

The collective blockage is called plaque, and enough of it can cause heart attacks.

What Do You Do If You Think a Client Has PAD?
Dr. Johanna Youner, a podiatric physician and surgeon in New York City, says that nail techs can be a huge asset to help clients become aware of the symptoms of PAD. “Many patients do not wish to go to the doctor, and live in denial of their disease,” says Younger. “If a patient cannot feel her feet very well and does not go to the doctor, then the nail tech might be the only person who gets to see her feet. By simply examining the feet during the pedicure, the nail tech might notice a problem before the client does.”

Youner says that nail techs should look for abnormalities in the lower calf and feet, such as coldness, slight color irregularity (red or blue), a break in the skin that doesn’t seem to be healing right, and severely thickened nails.

If you suspect that a client might be suffering from PAD, Youner recommends your refer her to a podiatrist before she receives any pedicures, because any slight nick or cut can become infected and the body is less able to heal. “Sometimes a water-free pedicure may be a safe alternative for such a client,” she says.

But Youner adds that no matter what, if you think a client has PAD, tell her she needs to see a doctor since PAD is an early sign that arteries throughout the body might be clogged as well.

“The nail tech can be the first step to a person getting medical help. Many people are uncomfortable going to doctors and may feel more comfortable hearing advice from their nail tech,” says Youner.

It’s important for nail techs to remember that you aren’t “diagnosing” any medical conditions. But because you might be the only person seeing your client’s feet on a regular basis, it puts you in a good position to notice subtleties and changes so you can refer her to the doctor.

What Are Treatments for PAD? According to the Mayo Clinic, the number one thing recommended to sufferers of PAD is to quit smoking. Smokers have four times the risk of getting PAD, and smoking is a huge factor in atherosclerosis. For smokers who already have PAD, successful quitting is the most important thing to help reduce the progression of blockage.

Another key element is to begin an exercise routine. Proper exercise helps with circulation so oxygenated blood can start replenishing the tissue in the feet and lower legs, and help strengthen it to prevent cramping and pain. A healthy diet is also a huge component in treating PAD to reduce cholesterol in the blood stream that leads to blockage.

Because PAD affects the feet and lower limbs, proper foot care is also an important factor. PAD sufferers should wash and moisturize their feet daily to prevent lesions, wear well-fitting shoes and socks, and avoid walking bare foot. 


Why Does PAD Affect the Feet?
PAD is associated with the feet and legs simply because they are the furthest from the heart. Because so many things affect circulation — tobacco use, diabetes, and high blood pressure, to name a few — the feet manifest these problems first because the circulation path to get there is so long that there is more time for buildup.

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