Avoiding Misdiagnosis: When Leg Pain After Exercise Lingers, Consider Peripheral Artery Disease

Many people experiencing leg pain after physical activity often assume it's related to common musculoskeletal issues like lumbar disc herniation. However, persistent calf pain and numbness after walking could be a sign of something more serious—peripheral artery disease (PAD) caused by lower limb atherosclerosis. This article highlights a real case where timely diagnosis and treatment at a vascular surgery clinic significantly improved the patient's quality of life.

Case Overview

Patient: Male, 58 years old
Diagnosis: Lower limb atherosclerosis
Hospital: Inner Mongolia Xing'an League People's Hospital
Visit Date: April 2022
Treatment: Percutaneous angioplasty with stent placement + medication (Aspirin and Atorvastatin)
Recovery: 10-day hospitalization with regular outpatient follow-ups
Outcome: Significant improvement in leg pain and mobility

Initial Consultation and Symptoms

This patient visited the clinic after being referred from the orthopedic department. He had been experiencing calf pain and numbness after walking approximately 300 meters for over two years. The discomfort eased after resting for a couple of minutes, only to return upon resuming activity. He also reported occasional coldness in the right foot. Initial lumbar CT scans at a local hospital showed signs of lumbar disc herniation, but physical therapy and massage provided no relief.

Upon physical examination, his right foot felt cooler than the left, and while femoral artery pulses were strong bilaterally, pulses in the right popliteal, dorsalis pedis, and posterior tibial arteries were absent. On the left side, the popliteal pulse was present but weak, and the dorsalis pedis artery was not palpable. These findings raised suspicion for peripheral artery disease.

Diagnostic Process

An ultrasound confirmed severe stenosis near occlusion in the right superficial femoral and popliteal arteries. Based on these results, the patient was diagnosed with lower limb atherosclerosis and scheduled for further evaluation and treatment.

Medical Intervention and Recovery

After hospital admission, the patient underwent computed tomography angiography (CTA) to map the affected arteries. Following a detailed explanation of the procedure and associated risks, the patient consented to a percutaneous angioplasty in a hybrid operating room.

Using a right femoral artery approach under local anesthesia, the surgical team successfully navigated the narrowed artery segment with guidewires and catheters. After balloon dilation, the artery regained normal morphology without dissection. A stent was not required due to favorable post-dilation results.

Postoperative Progress

Immediately after the procedure, the patient reported a noticeable warming of the right foot. By the second postoperative day, he was walking without pain. The puncture site healed well, and he was discharged on the third day with a prescription for Aspirin and Atorvastatin to prevent clot formation and manage cholesterol levels.

He was also advised to quit smoking, adopt a low-salt, low-fat diet, and engage in regular lower limb exercises to maintain vascular health. A follow-up ultrasound appointment was scheduled for three months later to monitor progress.

Key Takeaways and Preventive Care

Lower limb atherosclerosis is a prevalent condition that can mimic symptoms of spinal issues. This often leads to misdiagnosis and delayed treatment. Once diagnosed, however, the condition can be effectively managed with lifestyle changes and timely medical intervention.

Patients should prioritize quitting smoking, maintaining a balanced diet, and engaging in regular physical activity such as brisk walking, jogging, or cycling. For those with severe stenosis and a walking distance limited to under 200 meters, surgical intervention may be necessary to restore circulation.

Long-Term Management and Awareness

Peripheral artery disease is a progressive condition that can lead to serious complications like claudication, numbness, chronic pain, and even limb loss if left untreated. Controlling risk factors like hypertension, diabetes, and hyperlipidemia is essential.

Regular health screenings should include lower limb arterial ultrasound, especially for individuals over 50 or those with cardiovascular risk factors. Early detection and treatment can prevent disease progression and significantly improve long-term outcomes.