Lacking of blood on the legs

Answer by Dr. Albana Greca, MD, MMedSc

Hello Isaac,

“Poor blood flow” can describe several conditions, so the first step is to determine whether the problem is arterial, venous, neurological or infectious.

Signs of Peripheral Artery Disease

Peripheral artery disease, or PAD, develops when narrowed arteries reduce blood flow to the legs and feet. Diabetes, smoking, high blood pressure, abnormal cholesterol and kidney disease increase the risk.

Possible signs include:

• Calf, thigh or buttock pain during walking that improves with rest


• One foot feeling colder than the other


• Pale, blue, reddish, shiny or thin skin


• Reduced hair growth or slow-growing toenails


• Weak or absent pulses in the feet


• Pain in the foot at rest, particularly at night


• Cuts, ulcers or toe wounds that heal slowly or do not heal

Diabetic nerve damage can hide typical PAD pain, so examination is important even when discomfort is mild. See diabetic foot ulcers and poor healing.

When It Is an Emergency

He needs urgent same-day assessment for a wound with spreading redness, warmth, swelling, pus, foul odor, fever, exposed tissue or bone, or difficult-to-control glucose. Neuropathy may hide serious pain.

Other Conditions Can Look Like Poor Circulation

• Diabetic neuropathy: Burning, tingling, numbness or loss of sensation, often starting in both feet.


• Venous disease: Swelling, aching, varicose veins and brown skin changes, often worse after standing.


• Deep-vein thrombosis: New swelling, warmth and pain, usually affecting one leg.


• Infection: Redness, warmth, tenderness, drainage or fever.


• Heart, kidney or liver disease: May cause swelling in both legs.

Numbness does not always mean poor arterial flow, and swelling does not always mean PAD. His clinician must examine the feet, pulses, skin and sensation. Learn more about diabetes-related nerve damage.

Which Tests May Be Needed?

Assessment may include blood pressure, leg and foot pulses, skin temperature and color, sensation testing, and inspection for wounds or infection.

An ankle-brachial index compares blood pressure at the ankle with pressure in the arm. However, arteries can become stiff and difficult to compress in diabetes, making the result appear falsely normal or high. In that situation, a toe-brachial index, toe pressure or Doppler waveform test may be more informative. Duplex ultrasound can show the location and severity of reduced blood flow.

Blood tests may include HbA1c, kidney function and cholesterol. Further imaging may be needed before a vascular procedure.

Can Blood Flow Improve?

The outlook depends on severity. Risk-factor treatment and structured walking can improve stable PAD, while severe narrowing may require angioplasty, a stent or bypass surgery.

Treatment may include:

• Stopping smoking completely


• Managing glucose, blood pressure and cholesterol


• A statin and antiplatelet medicine when prescribed for confirmed PAD


• A supervised or structured walking program after medical assessment


• Treatment of wounds, infection and pressure points


• A vascular procedure when the limb is threatened or symptoms remain disabling

Good glucose control supports healing and reduces complications, but it does not by itself reopen a blocked artery. Do not begin strenuous walking when there is rest pain, a foot ulcer, gangrene or suspected acute loss of circulation. Our guide to diabetes and exercise can help prepare questions for his doctor.

Do Not Start Compression Without Assessment

Compression stockings can help some vein-related swelling, but they may be unsafe when severe arterial disease is present. Do not use tight bandages or strong compression until a clinician has assessed arterial blood flow.

Also avoid vigorous massage of a painful or swollen leg until a blood clot and acute arterial problem have been excluded.

Daily Foot Protection

• Inspect both feet every day, including the soles and between the toes.


• Wash with lukewarm water and dry carefully, especially between the toes.


• Moisturize dry skin, but do not put cream between the toes.


• Wear clean socks and well-fitting closed shoes; never walk barefoot.


• Check shoes for stones, rough seams or foreign objects before wearing them.


• Do not cut corns or calluses or use chemical removers at home.


• Avoid heating pads, hot-water bottles and very hot foot baths.

Arrange regular comprehensive foot checks and seek early care for any blister, crack, cut or color change. See our diabetes skin and foot-care tips.

What Isaac Should Do Now

Arrange a prompt appointment with his diabetes clinician, primary doctor, podiatrist or vascular specialist. Bring his symptom history, medicines, smoking history, glucose readings and wound details. Emergency signs should not wait for a routine visit.

This educational answer does not replace examination of the legs and feet or individualized vascular treatment.