Peripheral Arterial Disease (PAD) in Singapore

Peripheral arterial disease (PAD) is narrowing or blockage of the arteries that supply the legs, usually caused by a build-up of plaque called atherosclerosis. Reduced blood flow can cause pain when walking, while more severe disease can affect the foot even at rest. Some people have few recognisable symptoms. Assessment helps establish whether an artery problem is present, how it affects daily life and whether the limb is at risk.

When does poor leg circulation need urgent help?

A suddenly painful, cold, pale or blue foot, especially with new numbness, weakness or difficulty moving it, is an emergency. This can indicate a sudden loss of blood supply, called acute limb ischaemia. In Singapore, call 995 for emergency ambulance help. Do not wait for a routine clinic appointment or try to walk through these symptoms.

New blackened tissue, or a foot wound with fever, rapidly spreading redness or signs of deep infection, needs urgent hospital assessment. If you have diabetes, a foot ulcer with poor circulation or gangrene needs immediate hospital assessment. Call 995 if you become seriously unwell, confused, faint or breathless. Foot pain at rest and other new or worsening wounds also need prompt medical assessment. Diabetes can reduce sensation, so a serious foot problem may not be very painful.

For a non-emergency circulation assessment or review of known PAD, contact the clinic. See the consultation records checklist for preparing medication details and any previous scans, procedure reports or wound-care records.

What symptoms and risk factors suggest PAD?

A typical symptom is claudication: aching, cramping or heaviness in the calf, thigh or buttock during walking that settles with rest. It may limit how far you can walk. Read more about leg pain when walking and claudication.

Watch the video: leg pain when walking (claudication) explained.

Other features include a colder foot, changes in skin colour and wounds that heal slowly. These symptoms can have other causes, including nerve, joint and vein problems; an online description cannot establish the diagnosis.

Smoking, diabetes, high cholesterol, high blood pressure, kidney disease and increasing age raise the likelihood of PAD. Atherosclerosis can also affect the heart and the carotid arteries supplying the brain. Treatment therefore addresses overall cardiovascular risk as well as the legs.

How is PAD assessed?

I assess your symptoms, walking limitations, medical history and medicines, then examine the legs, feet and pulses. Tell me about any wounds, previous vascular procedures or change in symptoms. Tests are selected to answer the clinical question rather than ordered automatically.

• Ankle–brachial index: compares blood pressure at the ankle and arm.

• Toe-pressure testing or exercise testing: may help when initial results do not explain the symptoms. Diabetes and kidney disease can make ankle pressures misleadingly high.

• Duplex ultrasound: shows blood flow and helps locate narrowing.

• CT or MR angiography: may provide more detailed anatomy when planning treatment. Catheter angiography is used selectively, sometimes during a procedure.

My guide to what happens at a PAD assessment explains how the findings fit together. Read about arterial duplex and leg-circulation assessment in our vascular lab.

How is peripheral arterial disease treated?

Medical treatment and walking support

Stopping smoking, managing diabetes and blood pressure, and cholesterol-lowering treatment help reduce future vascular risk. Antiplatelet or other antithrombotic medicines may be appropriate after considering bleeding risk and other conditions. Do not start or stop these medicines without medical advice.

For assessed, stable claudication, a structured walking programme can improve walking ability and daily function. The plan should suit your health and symptoms. See how walking fits into circulation care. Rest pain, deteriorating wounds or sudden changes require reassessment, not a harder exercise target.

Restoring blood flow when appropriate

Angioplasty, sometimes with a stent, can open a suitable narrowed artery from within. Bypass surgery creates another route around a blockage; some patients need a combination of approaches. A procedure may be considered for walking symptoms that remain substantially limiting despite appropriate medical treatment and structured exercise.

When poor circulation threatens the foot, timely specialist assessment considers whether restoring blood flow can support healing and preserve the limb. The choice depends on the arterial anatomy, wound or infection, overall health, available vein and your priorities. No single procedure suits every blockage, and further treatment may sometimes be needed.

Foot and wound care

Circulation is only one part of wound healing. Infection, pressure on the foot, reduced sensation and glucose control may also need attention alongside vascular treatment. Check your feet regularly and report new damage early. Read why a foot or leg wound may not heal.

Read about diabetic foot and vascular wound care, including circulation assessment, infection treatment and pressure relief.

Common questions about PAD

Does PAD always need surgery?

No. Many people are managed with medicines, risk-factor control and structured exercise. Limb-threatening disease and persistent limiting symptoms require a different discussion.

Can an artery procedure cure PAD?

A procedure can improve blood flow, but it does not remove the underlying tendency to atherosclerosis. Medicines, foot care and follow-up remain important after treatment.

Discuss a circulation assessment in Singapore

For non-emergency symptoms or review of known PAD, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Bring your medication list and relevant scan or procedure reports if available. Learn more about Dr Andrew Choong's vascular and endovascular practice.

Videos about leg circulation

Watch what an assessment for poor leg circulation involves and how walking can help circulation. For a foot or leg wound that is not healing, watch why the blood supply should be checked. Explore the leg circulation and wound-care video collection for related explanations from Dr Andrew Choong.

Dr Choong’s World Heart Day video explains the links between heart, brain and leg artery disease. Read the accompanying article for more about shared risk factors and warning symptoms.