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Poor Circulation (PAD & Vein Problems)

Leg pain when you walk that eases with rest, cold or numb feet, or aching, swollen legs with bulging veins can all be signs of poor circulation. Peripheral artery disease (PAD) is common, often missed, and a warning sign for heart attack and stroke — and walking is one of its best treatments.

A suddenly cold, pale, painful or numb leg or arm — call 911. A sudden drop in blood flow to a leg (acute limb ischemia) is a medical emergency: call 911 or get help right away if you suddenly can’t feel or move your foot, if it is blue or paler and colder than the other foot, or if your leg or foot hurts or feels like “pins and needles” while you rest. Quick treatment may save the limb (NHLBI). A clot that suddenly blocks an artery can cause a cold, pale, numb, weak or painful arm or leg; go to the emergency room or call 911 (MedlinePlus).

Signs of a clot in a vein (DVT) or in the lungs (PE). Swelling, pain, warmth and redness in one leg or arm can mean a deep vein clot; see a doctor the same day. Sudden trouble breathing, chest pain that is worse with a deep breath, coughing up blood, or fainting can mean a clot in the lungs — seek help immediately (CDC) and call 911 (MedlinePlus). See our blood clots guide.

A bleeding varicose vein is an emergency — call 911 (NHLBI).

Sores that won’t heal or skin turning black — get care right away. Contact your provider right away if a wound does not heal, an area of skin turns blue or black, or a wound has a foul-smelling discharge; these can be signs of gangrene, which needs urgent treatment (MedlinePlus). An infected foot sore with fever and chills can spread to the bloodstream and needs hospital treatment right away (NHLBI). A red, hot, swollen leg with fever may be cellulitis — see our cellulitis guide.

Heart attack or stroke — call 911. Chest pain or discomfort, shortness of breath, or pain in the jaw, neck or back (CDC); sudden numbness or weakness of the face, arm or leg, especially on one side, or sudden trouble walking, seeing or speaking (CDC). People with PAD are at higher risk of both (NHLBI).

What is peripheral artery disease (PAD)?

PAD is a narrowing or blockage of the arteries that carry blood from the heart to the legs, mainly caused by a buildup of fatty plaque called atherosclerosis. It can affect any artery, but it is more common in the legs than the arms (CDC). With less blood flowing, the leg muscles can’t get enough oxygen when they work harder, such as when you walk; if PAD becomes severe, they may not get enough even at rest (MedlinePlus).

How common is it?

More than 8 million people in the United States ages 40 and older have PAD, according to the National Heart, Lung, and Blood Institute (NHLBI); the CDC puts the number at about 6.5 million (CDC). It becomes more common with age, and most people in the U.S. who have it are 65 or older (NHLBI).

Symptoms

  • Leg pain when walking that eases with rest (claudication): pain, aching, heaviness or cramping that comes on when walking or climbing stairs and goes away after rest. It is the most common PAD symptom and is often felt in the calf, but also in the buttocks, thigh or foot (NHLBI).
  • Many people have no typical symptoms: only about 1 in 4 people with PAD have these classic symptoms; more than half have other symptoms and about 1 in 5 report none at all (NHLBI). Up to 4 in 10 have no leg pain (CDC).
  • Other signs: one foot colder than the other; pale, discolored or blue skin; leg weakness or numbness; toenails and leg hair that stop growing (NHLBI); smooth, shiny skin, weak or missing pulses in the feet, and cold or numb toes (CDC).
  • Severe PAD: pain in the leg and foot even at rest (critical limb ischemia), and sores on the toes, feet or legs that heal slowly or not at all (NHLBI). Rest pain may be worse when the legs are raised and better when they hang over the side of the bed (MedlinePlus).

Who is at risk?

The main risk factors are smoking, high blood pressure, diabetes, high cholesterol and age over 60 (CDC). Smoking is the main risk factor of PAD (NHLBI). Others include chronic kidney disease, obesity, metabolic syndrome, a family history of PAD, heart disease or stroke, and having had preeclampsia or gestational diabetes in pregnancy. African American people have a higher risk of PAD and of its complications, and women are more likely than men to have PAD without symptoms (NHLBI). See our guides to blood pressure and cholesterol.

How it is diagnosed

The ankle-brachial index (ABI) is usually the first test. It compares the blood pressure in your ankle with the pressure in your arm; a resting ABI below 0.90 suggests PAD. Your provider may also use an ABI after treadmill walking, a 6-minute walking test, Doppler ultrasound, blood tests, or CT, MR or catheter angiography (NHLBI). If you smoke or have high blood pressure or other risk factors, ask about testing even without symptoms (NHLBI). Nerve problems in the spine can cause leg pain that is mistaken for PAD; PAD pain usually comes with leg exercise and eases quickly with rest, without changing position (NHLBI).

Why PAD is a warning sign for your heart and brain

If you have PAD in your legs, you probably have plaque in other arteries too, including those of the heart and brain, which raises your risk of heart attack and stroke (NHLBI, NHLBI, CDC). Whatever the symptoms, everyone with PAD shares the same high risk of cardiovascular disease (NHLBI). Without treatment, PAD may also cause sores, infections and even the loss of a limb (NHLBI); see our amputation guide.

Vein problems: chronic venous insufficiency and varicose veins

Veins carry blood back to the heart, helped by one-way valves. In chronic venous insufficiency, weakened vein walls and damaged valves let blood pool in the legs, especially when you stand (MedlinePlus). It can also follow a past blood clot in the leg (MedlinePlus). Varicose veins are swollen, twisted veins just under the skin, usually in the legs, and they are very common (MedlinePlus).

Notice the difference: vein pain usually feels better with the legs raised, while the rest pain of severe PAD may feel worse (MedlinePlus, MedlinePlus). That’s one reason to get checked before relying on home remedies.

Other causes of cold or numb hands and feet

  • Raynaud’s phenomenon: blood vessels in the fingers and toes narrow, usually with cold or stress, so they turn white, then blue, cold and numb, then red as they warm up. The secondary form, linked to diseases such as lupus or scleroderma, tends to be more serious (NIAMS). A separate MBHA guide to Raynaud’s is on the way.
  • Nerve damage (peripheral neuropathy), often from diabetes, can make the feet, legs, hands or arms tingle, burn or feel numb, and can make it hard to sense pain or temperature (NIDDK).
  • An underactive thyroid can make you feel cold when others are comfortable (MedlinePlus).
  • Anemia can make you feel tired, cold and dizzy (MedlinePlus).

Because the causes are so different, persistent cold, numb or painful hands, feet or legs deserve a check with a health care provider rather than guesswork.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Supervised walking (exercise) therapy, quitting smoking, statins, antiplatelet medicines such as aspirin or clopidogrel, control of blood pressure and diabetes, cilostazol for walking pain, foot care, and angioplasty, stents or bypass for severe PAD. For vein problems: compression, leg elevation, movement and vein procedures. Medicare covers up to 36 sessions of supervised exercise therapy over 12 weeks for PAD with claudication, with a doctor’s referral. Medicines, procedures and compression stockings: cost estimate being researched. Supervised walking has high-quality evidence for walking farther with less pain. Medicines lower the risk of heart attack and stroke. PAD is lifelong, so care continues; most cases can be controlled without surgery.
Chiropractic No role in treating PAD or vein disease. Leg pain from a pinched nerve in the spine can be mistaken for PAD, so new leg pain with walking deserves a medical check. Not a treatment for poor circulation, so no cost is listed. We found no studies of chiropractic for PAD or venous insufficiency. Tell any chiropractor about PAD, blood thinners or a past clot.
Acupuncture No credible evidence that it improves circulation in PAD or vein disease. One small trial tested laser acupuncture for PAD leg pain. Not an established treatment for poor circulation, so no cost is listed. Too little research to recommend it. Never use it in place of walking therapy or medical care; tell the acupuncturist about foot sores, diabetes or blood thinners.
Herbal medicine Ginkgo for PAD leg pain has not shown a meaningful benefit. Horse chestnut seed extract has some evidence for short-term relief of chronic venous insufficiency. Cost estimate being researched. Ginkgo may raise bleeding risk with blood thinners and antiplatelet medicines. Raw horse chestnut is toxic. Check every supplement with your pharmacist.
Massage therapy Not a treatment for PAD or vein disease. Never massage a leg that might have a clot. Not a treatment for poor circulation, so no cost is listed. Leg massage can dislodge an unrecognized clot. If you have varicose veins, numb feet or foot sores, tell the therapist and ask for gentle work away from those areas.
MBHA Wellness Coach Building a walking routine, quitting smoking, daily foot checks, managing diabetes, blood pressure and cholesterol, a healthy weight, breaking up long sitting or standing, and raising the legs for vein symptoms. Cost estimate being researched. Quitlines (1-800-QUIT-NOW) are free. Supports — never replaces — your doctors. Steady habits ease symptoms and lower the risks that come with PAD.

Approach 1 of 6

Conventional medicine (AMA)

PAD treatment has two goals: to lower your risk of heart attack and stroke, and to help you walk, climb stairs and do daily activities more easily (NHLBI). PAD is a lifelong condition, so you will see a provider regularly (NHLBI).

1. Exercise therapy: the first step for leg pain

Physical activity often works well to relieve PAD symptoms and improve walking (NHLBI), and a supervised exercise program is recommended for people with leg pain from too little blood flow (CDC). A Cochrane review of 32 trials found high-quality evidence that exercise programs improve both pain-free and maximum walking distance in people with claudication who are fit to exercise (Cochrane review, 2017). Medicare covers supervised exercise therapy (SET) for symptomatic PAD; see “Walking therapy for PAD” below for how it works.

2. Quit smoking

Smoking is the main risk factor of PAD, and quitting can reduce your symptoms and your risk of complications; avoid secondhand smoke too (NHLBI). People who smoke or have diabetes have a much higher risk of complications, including losing a limb (NHLBI). Free coaching is available at 1-800-QUIT-NOW, and counseling and medicine together give you the best chance of quitting for good (CDC).

3. Medicines

We don’t list doses; your prescriber decides what is right for you.

4. Procedures and surgery

If lifestyle changes, exercise and medicines don’t work well enough, angioplasty (a balloon that flattens the plaque, sometimes with a mesh stent to keep the artery open) or bypass surgery (a new path for blood around the blockage) may be recommended (NHLBI). Surgery is considered when PAD is severe, causes pain at rest, or causes sores that won’t heal; most cases can be controlled without surgery (MedlinePlus).

5. Foot care

Foot sores and infections are a common PAD complication, and diabetes makes them more likely to lead to amputation (NHLBI). Check your feet every day, always wear socks and well-fitting shoes, don’t go barefoot, and see your provider rather than treating corns, calluses or ingrown nails yourself; with PAD and diabetes, have your feet examined twice a year (NHLBI). Get recommended flu and pneumococcal vaccines (NHLBI).

6. Treating vein problems

  • Self-care: avoid sitting or standing for long periods, exercise regularly, lose weight if needed, and care for any sores (MedlinePlus). When sitting, raise your feet; lying with your feet above your heart for a few minutes several times a day can also help (NHLBI).
  • Compression stockings gently squeeze the legs to move blood upward and help prevent swelling (MedlinePlus). They can ease pain, swelling and heaviness, but they only relieve symptoms, and they may cause discomfort, itching or skin irritation (NHLBI). They are not suitable if you have problems with blood flow in your arteries, so get checked first, and ask a doctor or pharmacist which type is right for you (NHS).
  • Procedures: heat ablation with laser or radiofrequency energy, sclerotherapy (injecting a liquid or foam to seal the vein), phlebectomy (removing small veins through tiny cuts) and, for larger veins, ligation and stripping. Most are minimally invasive, and most providers now recommend a procedure to correct the underlying backflow (reflux); new varicose veins can still form later (NHLBI, MedlinePlus).

What it costs

  • Supervised exercise therapy: Medicare covers up to 36 sessions over 12 weeks for people with claudication from symptomatic PAD. You need a face-to-face visit and referral from the doctor treating your PAD; sessions last 30–60 minutes in a hospital outpatient department or doctor’s office. Medicare contractors may cover another 36 sessions with a second referral (CMS national coverage determination 20.35).
  • Medicines, ABI and imaging tests, vein procedures and compression stockings: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating peripheral artery disease or vein disease. We found no studies testing it for either, and spinal adjustments can’t open a narrowed artery or repair vein valves.

Is it your back or your arteries?

Leg pain is a common reason people see a chiropractor, and a nerve squeezed where it leaves the spine can cause pain that spreads from the hip or buttock down the leg and may be confused with PAD. PAD pain usually comes on with leg exercise and is relieved quickly by rest without changing position, while nerve pain is often set off by standing up or changing position (NHLBI). If you have leg pain with walking and risk factors such as smoking, diabetes or high blood pressure, ask a medical provider about an ankle-brachial index test (NHLBI). For back-related leg pain, see our back pain guide.

Staying safe

Tell your chiropractor if you have PAD, take a blood thinner or antiplatelet medicine, or have had a blood clot. A leg with possible signs of a clot — swelling, pain, warmth or redness — needs a medical check the same day, not an adjustment (CDC).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

We found no credible evidence that acupuncture improves blood flow or walking in PAD, or treats venous insufficiency or varicose veins.

What the research says

One small 2022 trial gave 30 older men with PAD either their usual medicines alone or medicines plus laser applied to acupuncture points, twice a week for five weeks. The laser group reported fewer claudication symptoms than the control group and walked farther in six minutes than at the start, and the authors called it “promising” (randomized trial, Hong Kong Physiotherapy Journal, 2022). A single trial this small is not enough to recommend it, and it did not use needles. Walking therapy has far stronger evidence (Cochrane review, 2017).

Staying safe

Acupuncture needles must be sterile and single-use, and complications have come from nonsterile needles and improper technique (NCCIH). Sores on feet with poor circulation heal slowly and are more likely to get infected (MedlinePlus), so as a precaution MBHA suggests avoiding needles in a foot or leg with sores, poor circulation or numbness, and telling the acupuncturist if you take a blood thinner or antiplatelet medicine.

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement has been shown to clear blocked arteries. The evidence differs for arteries and veins, and safety matters most, because many people with PAD take antiplatelet medicines.

Ginkgo for PAD leg pain

  • A Cochrane review of 14 trials (739 people) found no evidence that ginkgo has a clinically significant benefit for people with PAD; in the placebo-controlled trials, any gain in walking distance was small and may have been inflated by unpublished negative trials (Cochrane review, 2013).
  • NCCIH says there’s no conclusive evidence that ginkgo is helpful for any health condition, and that it is not helpful for preventing heart disease (NCCIH).
  • Bleeding: ginkgo may increase bleeding risk in people taking anticoagulants such as warfarin (NCCIH, NCCIH). Memorial Sloan Kettering notes that ginkgo may prolong bleeding time with anticoagulants and antiplatelet medicines, and lists a study of ginkgo taken with cilostazol and clopidogrel (Memorial Sloan Kettering).

Horse chestnut seed extract for vein problems

  • A 2012 review of 17 studies suggested horse chestnut seed extract can improve symptoms of chronic venous insufficiency, and one study suggested it may work as well as compression stockings; the reviewers called for larger, more rigorous trials (NCCIH). A Cochrane review found less leg pain and swelling than with placebo and called it an effective, safe short-term treatment, with the same caveats (Cochrane review, 2012).
  • Raw horse chestnut is poisonous. The raw seeds, bark, flowers and leaves are unsafe to take by mouth. Standardized seed extracts with the toxic part removed have been used safely in studies for up to 12 weeks, but may cause dizziness, stomach upset, headache or itching; little is known about use in pregnancy or breastfeeding (NCCIH).
  • Horse chestnut products that contain aesculin may increase bleeding risk if you take warfarin, aspirin or other blood thinners (Memorial Sloan Kettering).
  • An extract eases symptoms; it doesn’t replace a medical check for leg swelling, which can also be a sign of a clot (CDC).

Before you take any supplement, show it to your pharmacist or prescriber, especially if you take aspirin, clopidogrel, cilostazol or a blood thinner. Some herbs and medicines interact in harmful ways (NCCIH). Never stop a prescribed medicine to make room for a supplement. We don’t list doses.

Approach 5 of 6

Massage therapy

Massage does not treat PAD, chronic venous insufficiency or varicose veins, and we found no good studies showing it improves circulation in these conditions. Some people still enjoy it for relaxation; the key is doing it safely.

Never massage a leg that might have a clot. In a published case, a leg massage dislodged an unrecognized deep vein clot and caused a life-threatening pulmonary embolism; the authors concluded that leg massage should not be done in people with DVT (case report, BMC Pregnancy and Childbirth, 2020). NCCIH lists a blood clot among the rare serious problems reported with massage (NCCIH). Swelling, pain, warmth or redness in one leg means a same-day medical check first (CDC).

Staying safe

  • Varicose veins: a bleeding varicose vein is an emergency (NHLBI), and the NHS advises trying not to injure your legs to help prevent bleeding (NHS). As a precaution, MBHA suggests asking for gentle pressure and no direct work over bulging or tender veins.
  • Numb feet or foot sores: nerve damage can lower your ability to feel pain, heat or cold (CDC), and sores heal slowly when circulation is poor (MedlinePlus). MBHA suggests telling the therapist, and asking them to avoid sores and skip heat on numb areas.
  • Medicines: tell the therapist if you take a blood thinner or antiplatelet medicine, since bleeding is a possible side effect (NHLBI).
  • Don’t use massage to put off seeing a health care provider about a medical problem (NCCIH).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Much of what helps poor circulation happens between appointments. An MBHA Wellness Coach can help you build these habits — alongside, never instead of, your doctors.

Walk, rest, repeat

Regular physical activity can improve circulation in your legs (NHLBI). With PAD, walk to the point of pain, rest, and walk again; over time circulation may improve as new small blood vessels form. Talk to your provider before starting (MedlinePlus). A coach can help you log your walks and stay motivated — see “Walking therapy for PAD” below.

Quit smoking

Smoking narrows the arteries and makes clots more likely (MedlinePlus), reduces blood flow to the feet (CDC), and damages veins (NHLBI). Call 1-800-QUIT-NOW for free coaching; counseling plus medicine gives the best chance of quitting (CDC).

Daily foot checks

Manage the numbers

Follow your provider’s plan for diabetes, high blood pressure and high cholesterol (NHLBI); keep your blood sugar in your target range (CDC). Choose heart-healthy foods such as the DASH eating plan, and if you have overweight, losing just 3% to 5% of your weight can help with PAD risk factors (NHLBI). See our blood pressure and cholesterol guides.

For vein symptoms

Coping and support

Living with PAD can bring fear, anxiety or depression. A support group, family and friends, or a counselor can help (NHLBI). Make sure the people close to you know the emergency signs at the top of this page.

Another approach

Walking therapy for PAD

For leg pain from PAD, walking is not something to avoid — done the right way, it is treatment. Exercise programs bring important gains in both pain-free and maximum walking distance; they don’t change the ABI number, and no effect on amputation or survival has been shown (Cochrane review, 2017).

Supervised programs

  • Programs usually meet at least 3 times a week for 3 to 9 months, most often with treadmill walking; some use upper-body exercise, and some are part of cardiac rehabilitation (NHLBI).
  • A Cochrane review of 21 trials found that supervised exercise improved treadmill walking distance more than home-based programs or simple walking advice; after three months, supervised groups walked about 120 and 210 meters farther, respectively (Cochrane review, 2018).
  • CMS says SET has been shown to be significantly more effective than unsupervised exercise and to perform at least as well as more invasive treatments to restore blood flow (CMS).

Medicare coverage

Medicare covers up to 36 SET sessions over 12 weeks for people with claudication from symptomatic PAD. Sessions last 30–60 minutes, take place in a hospital outpatient setting or doctor’s office, and are supervised by a physician, physician assistant or nurse practitioner trained in basic and advanced life support. You need a face-to-face visit with the doctor treating your PAD for the referral, and that visit should include advice on lowering your heart and PAD risks. It isn’t covered if you have an absolute reason not to exercise. Medicare contractors may cover 36 more sessions with a second referral (CMS).

Home-based programs

Your provider may instead recommend a coached home program, similar to a supervised one and usually walking outdoors. Sessions last 30 to 50 minutes, with the goal of working up to at least 30 minutes of continuous walking. These programs include health coaching or activity monitors, and some include phone check-ins with a coach (NHLBI).

When to stop and call

Call your provider between visits if leg pain doesn’t go away after a few minutes of rest or other PAD symptoms get worse (NHLBI), and get help for chest pain or shortness of breath with leg pain (MedlinePlus). Call 911 for the emergency signs at the top of this page.

Member stories

Living with Poor Circulation (PAD & Vein Problems)? Share your experience

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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