Symptom Details

Although pain at rest can happen anytime, it typically occurs at night during sleep. People may awaken to severe burning sensations in their lower legs or feet, which may become chronic and persistent. This pain may be temporarily relieved by hanging a foot or leg over the bed.

When a person experiences pain at rest, it can signify a severe blockage in the arteries of the lower extremities.2 The blockage happens when the arteries become narrowed and hardened due to excessive plaque build-up and can significantly reduce blood flow to the area.

Pain at rest can be a sign of advanced peripheral artery disease, also called critical limb ischemia (CLI).3 Over time, pain at rest can lead to more serious complications, such as tissue loss and leg ulcers. The skin can break down and develop non-healing wounds.1 Therefore, it is critical to take the step and see your doctor right away if you experience this symptom.

This is how pain at rest symptoms typically progress:1,2,3

Mild

  • Pain at rest, which comes and goes
  • Pain that occurs at night or while sitting
  • Weak pulse that may be hard to find in legs and feet

Moderate

  • Pain may progress in its severity
  • Possible loss of sensation in the legs
  • Weakness in the legs may occur
  • Pain may subside when standing
  • Elevation of the legs increases pain

Severe

  • Resting pain may become chronic and persistent and may interrupt normal resting routines
  • Leg ulcers, or non-healing wounds may develop due to restricted blood flow that causes further tissue damage
  • Gangrene, or black toe, can occur as the surrounding tissue dies

Causes

Pain at rest is a result of progressive and chronic blockage of the arteries to the legs and feet. When your body does not get the healthy blood flow it needs, pain may occur.

With a chronic lack of oxygen to the tissue, the skin can begin to break down and form leg ulcers, or other types of non-healing wounds. As the lack of blood flow progresses, the area may not heal and can lead to limb amputation or other complications.5

Risk Factors

Although PVD diseases range in symptoms and causes, they all carry certain risk factors.

For pain at rest, in addition to vascular conditions, other risk factors include:3

  • Certain medical conditions such as high cholesterol, high blood pressure and diabetes can increase the likelihood of developing arterial disease
  • Smoking, which can damage the arteries and their ability to transport blood
  • Obesity or being overweight can also put pressure on your legs and restrict healthy blood flow
  • Being older than 60 can increase the risk of developing pain at rest as blood vessels are more likely to become damaged over time
  • Inactive lifestyle and poor diet can be a factor

What to Look For

Pain at rest does not usually begin on its own. Instead, the condition may stem from untreated peripheral artery disease (PAD).

The Rutherford Classification is a common system that is widely used to diagnose and identify the severity of arterial disease. Here are how the symptoms progress:

Rutherford Classification

Stage 0

No symptoms

Stage 1

Some exercise pain after walking long distances

Stage 2

Exercise pain that occurs more frequently at shorter distances

Stage 3

Severe exercise pain that happens frequently after a short distance

Stage 4

Pain in the legs, calves, buttocks that occurs despite rest

Stage 5

Leg ulcers begin to develop

Stage 6

Severe non‑healing wounds can lead to gangrene or tissue loss

If you notice signs of advanced artery disease, it is important to see your doctor right away as the condition requires immediate care.4

Associated Symptoms

Exercise Pain

A common early symptom of PAD is exercise pain, or arterial claudication which produces cramping pain or discomfort in the legs, thighs, feet or buttocks.

Non-healing wounds

Poor blood circulation can lead to skin break down, open wounds, or ulcers, that require prompt medical attention. When the sores are open, they allow for bacteria and air to enter the wound, which can make the condition worse.

Gangrene

When blood flow to the toes is cut off, tissue can die and turn black. This is called gangrene and it can lead to tissue loss or amputation.

When to See a Doctor

Exercise pain may be a sign of a serious venous or arterial disease. Appropriate treatment of these conditions is important not only to prevent progression of disease.

If you notice intermittent pain in your legs during exercise, it is important to take the step to get help right away.

Talk to your doctor, or use our tool to locate a doctor to consult for a diagnosis.

Helpful Resources

PVD Doctor
Discussion Guide

Get helpful tips and advice on how to talk to your doctor about a PVD screening.

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Third-Party Resources

Find a Doctor

If you think you are experiencing pain at rest, it is important to get help. Talk to your doctor, or use our tool below to find a specialist near you.

 
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Robert Freedman

3311 Prescott Road | Alexandria, LA, 71301

Daniel Simon

347 Mount Pleasant Ave Suite 100 | West Orange, NJ, 7052

Daniel McDevitt

1035 Southcrest Dr, Suite 250 | Stockbridge, GA, 30281

Marvin Padnick

350 South 40th Street | Muskogee, OK, 74401

Patrick Mahon

87 McGregor Street | Manchester, NH, 3102

Jamie Strachan

1449 Old Waterbury Rd, Suite 101 | Southbury, CT, 6488

Aaron Aday

75 Francis St | Boston, MA, 02115

Russell Samson

600 North Cattlemen Rd | Sarasota, FL, 34232

Raghotham Patlola

5003 Hardy St, Ste 200 | Hattiesburg, MS, 39402

Bruce Brenner

200 S. Orange Ave | Livingston, NJ, 7052

Ernest Conti

3929 Mercy Drive | McHenry, IL, 60050

Sanjeev Trehan

6151 South Yale Ave Suite 1304 | Tulsa, OK, 74136

Tara Balint

2010 Health Campus Drive | Harrisonburg, VA, 22801

Stephen Bauer

1445 East Putman Ave, 1st Floor | Old Greenwich, CT, 6870

Deepak Nair

600 N Cattlemen Rd | Sarasota, FL, 34232

David Showalter

600 North Cattlemen Rd | Sarasota, Florida, 34232

Andrew Olinde

5131 O'Donovan Drive 301 | Baton Rouge, LA, 70808

Allison Barone

250 Engle Street | Englewood, NJ, 7631

Thomas Lutz

15 Tower Ct Suite 200 | Gurnee, IL, 60031

Mark Iafrati

800 Washington st | Boston, MA, 2111

Jerry Chen

2775 Laurel Street, Room 4203 | Vancouver, BC, V5Z1M9

Jonathan Bowman

495 Hawley Lane, Suite 2-A | Stratford, CT, 6614

Paul Vitulli

915 W Monroe St | Jacksonville, FL, 32004

Douglas Dorsay

600 North Cattlemen Rd | Sarasota, Florida, 34232

Carl Fastabend

501 Dr. Michael DeBakey Drive (3rd Floor) | Lake Charles, LA, 70601

Thomas Lee

131 Madison Avenue 2nd Floor | Morristown, NJ, 7960

Peter Swischuk

3109 Stirling rd. Suite 100 | Fort Lauderdale, FL, 33312

David Draughn, FACS, RVT, RPVI

15825 John J Delaney Dr | Charlotte, NC, 28277

Joe Viramontes

960 N 16th Street Suite 108 | Springfield, OR, 97477

Michael Sergi

75 Kings highway Cutoff, Suite 4B | Fairfield, CT, 6824

Manish Chauhan

2200 Park bend | Austin, TX, 78757

James Cunningham

8767 Perimeter Park Blvd | Jacksonville, FL, 32216

Nouri Al-Khaled

4400 W 95th Street, Suite 306 | Oak Lawn, IL, 60453

Cindy Sturt

200 S. Orange Ave | Livingston, NJ, 7039

Jesus Jimenez

2800 S Seacrest Dr. Suite 200 | Boyton Beach, FL, 33435

Andrei Pop

800 Biesterfield Road | Elk Grove Village, IL, 60007

Ediberto Soto-Cora

1139 Caper Rd | El Paso, TX, 79925

Kaveh Shahmohammadi

1449 Old Waterbury Rd, Suite 101 | Southbury, CT, 6488

Lori Pounds

7703 Floyd Curl Drive | SanAntonio, Texas, 78229

Alex Caballero

1879 Nightinglae Ln | Tavares , Florida, 32778

Thomas Levin

10837 South Cicero Avenue Suite 200 | Oak Lawn, IL, 60453

Leandro Perez

8188 Jog Rd. Suite 100 | Boyton Beach, FL, 33427

Jose Almeida

1501 S Miami Ave. | Miami Beach, FL, 33129

Saba Khan

800 Biesterfield Road | Elk Grove Village, IL, 60007

Jordan Knepper

5325 Elliot Drive, Suite 101 | Ypsilanti, MI, 48197

Jason Andre

12720 McManus Blvd, Suite 303 | Newport News, VA, 23602

Micheal Ayad

300A Faunce Corner Rd N | Darthmouth, MA, 02908

Yazan Khatib

Suite #160, FL, 32256

Santhosh Mathews

316 Manatee Ave W | Bradenton, FL, 34205

Patricio Rosa

601 N Flamingo Rd. Suite 408 | Pembroke Pines, FL, 33028

Akhilesh Sista

2315 Broadway 4th floor | New York, NY, 10024

Kathleen Gibson

1135 116th Avenue NE, Suite 305 | Bellevue, WA, 98004

James Sampson

101 Bodin Circle 60 SGCS/SGCH | Travis AFB, CA, 94535

Brian Heeringa

880 Munson Ave, Suite A | Traverse City, MI, 49686

Ravi Chandra

1920 SW 20th Place | Ocala, Florida, 34471

Vaqar Ali

7011 AC Skinner Parkway | Jacksonville, FL, 32256

David Burkart

4801 College Blvd | Leawood, KS, 66214

Asad Sawar

3010 E. 138th Avenue Suite 12 | Tampa, FL, 33613

Andrew Barleben

9434 Medical Center Dr. | La Jolla, CA, 92037

Gennady Geskin

6637 State Route 30 | Jeannette, PA, 15644

William Grande

8200 east Belleview Ave Suite 600e | Greenwood Village, CO, 80111

Jeffrey Carr

1783 Troup Highway | Tyler, TX, 75701

Vincent Digiovanni

Riddle Health Center 3, 1098 W Baltimore Pike, Suite 3308 | Media, PA, 19063

Ido Weinberg

55 Fruit St | Boston, MA, 02114

Dale Buchbinder

1212 York Road | Lutherville, MD, 31093

Paul Gagne

85 Old Kings Highway North | Darien, CT, 6820

Vasco Marques

3010 E. 138th Avenue Suite 12 | Tampa, FL, 33613

Scott Koss

725 American Ave | Waukesha, WI, 53188

Janardhan Srinivasan

2232 Wilborn Avenue | South Boston, VA, 24592

Steve Lin

1401 Harrodsburg Rd Ste A300 | Lexington, KY, 40509

Kais Yehyawi

6375 W US 6 | Portage, IN, 46368

Diego Hernandez

43700 Woodward Avenue, Suite 207 | Bloomfield Hills, MI, 48302

Deepak Sudheendra

3400 Spruce Street | Philadelphia, PA, 19104

Fuad Rafidi

23101 Sherman Place | West Hills, CA, 91307

Thomas Kerr

19189 N Dale Mabry Hwy | Lutz, FL, 33548

Hesham Fakhri

3010 E. 138th Avenue Suite 12 | Tampa, FL, 33613

Aaron Hurd

630 13th Street Suite 250 | Augusta, GA, 30901

Sunil Rayan

9850 Genesee Ave | La Jolla, CA, 92037

David Lipski

6420 Dutchmans Pkwy Suite 180 | Louisville, KY, 40205

Rias Ali

4740 Mile Stretch Drive | Holiday, FL, 34690

Jed Peterson

10123 SE Market Street | Portland, OR, 97216

Constantino Pena

8900 North Kendall Drive | Miami, FL, 33176

Zahi Nassoura

2710 Alameda Ave | Burbank, CA, 91505

Nader Chadda

6633 Forest Ave Ste 302 | New Port Richey, FL, 34653

Richard Ofstein

8075 N Shadeland Ave Ste 200 | Indianapolis, IN, 46037

Robert Davies

1301 Sigman Road, NE Suite 130 | Conyers, GA, 30012

Elizabeth Brooke Spencer, MD, FSIR

8200 east Belleview ave Suite 600 E | Greenwood Village, CO, 80111

Mazen Abu-Fadel

825 NE 10th St #2500 | Oklahoma City, OK, 73104

David Frankel

10666 N. Torrey Pines Rd. | La Jolla, CA, 92037

Patricia Thorpe

333 W Thomas Rd, Suite 207A | Phoenix, AZ, 85013

Peder Horner

1746 Cole Boulevard | Lakewood, CO, 80401

Fuad Rafidi

2710 | Burbank, CA, 91505

Gene Tanquilut

20060 Governors Drive Suite 102 | Olympia Fields, IL, 60461

Kannan Natarajan

8433 Harcourt Rd. Suite 100 | Indianapolis, IN, 46260

Charles Ross

95 Collier Road NW Suite 5015 | Atlanta, GA, 30309

Windsor Ting

1468 Madison Avenue or 1190 Fifth Avenue | New York, NY, 10029

Dev Mangalat

705 Jesse Jewell Parkway 125 | Gainseville, GA, 30501

Arun Jagannathan

23120 South LaGrange Road | Frankfort, IL, 60423

Michael Flisak

3231 South Euclid Avenue, Suite 207A | Berwyn, IL, 60402

Shahin Pourrabbani

3680 Imperial Highway | Lynwood, CA, 90262

Joe Viramontes, MD

960 N 16th Street | Springfield, OR, 97477

Blaine Borders

102 Thomas Rd. Suite 205 | West Monroe, LA, 71291

Pat Neville

4600 Memorial Dr. Suite 240 | Belleville, IL, 62226

Charles Wyble

61 Witcher Street, Suite 2100 | Marietta, GA, 30060

David Gillespie

363 Highland Ave | Fall River, MA, 2720

Polly Kokinos

2255 S. Bascom Avenue #200 | Campbell, CA, 95008

Howard Roth

23120 South LaGrange Road | Frankfort, IL, 60423

Anthony Avino, MD, FACS

4750 Water Avenue, Suite 500 | Savannah, GA, 31410

Murat Sor

3833 Fairfax Drive | Arlingston, VA, 22205

Mahesh Raju

3825 highland ave | downers Grove, IL, 60515

Kenneth Wright

19189 N Dale Mabry Hwy | Lutz, FL, 33548

Rick Coats

4600 Memorial Dr # 240 | Belleville, IL, 62260

Sendhil Subramanian

7130 Mt. Zion Blvd, Suite #10 | Jonesboro, GA, 30236

Richard Pin

363 Highland Ave | Fall River, MA, 2720

James McPherson

4644 Lincoln Blvd. Suite 500 | Marina del Rey, CA, 90292

Ben Marson

85 Old Kings Highway N, 1st Floor | Darien, CT, 6820

E. Jerry Cohn Jr., MD, FACS

4750 Water Avenue, Suite 500 | Savannah, GA, 31410

George Hemstreet

100 Rice Mine Road Loop | Tuscaloosa, AL, 35406

Harold Tabaie

18905 Sherman Way | Reseda, CA, 91335

Alberto Gonzalez

19189 N Dale Mabry Hwy | Lutz, FL, 33548

Ayaz Malik

1035 Bellevue Ave #500 | St. Louis, MO, 63117

Isabel Newton

200 W Arbor Dr. | San Diego, CA, 92103

Michael Ayad

363 Highland Avenue | Fall River, MA, 2720

Jozsef Lukacs

24800 S.E. Stark St. | Gresham, OR, 97030

Timothy Manoni

85 Old Kings Highway N, 1st Floor | Darien, CT, 6820

Larry Horesh, MD

4750 Water Avenue, Suite 500 | Savannah, GA, 31410

Amiel Moshfegh

11411 Brookshire Ave | Downey, CA, 90241

Lev Pukin M.D

2560 Ocean Ave | Brooklyn, NY, 11229

Parag Patel

6633 Forest Ave #300 | New Port Richey, FL, 34653

Hoang Nguyen

2 Good Samaritan Way Suite 220 | Mt. Vernon, IL, 62864

(Charles) Daniel Procter

725 Jesse Jewell Parkway #125 | Gainesville, GA, 30501

Michael Naumann

7777 Alvarado Road, Suite 108 | La Mesa, CA, 91942

Stephen Lalka

1001 Blythe Blvd., Suite 300 | Charlotte, NC, 28203

Taras Kucher

495 Hawley Lane, Suite 2-A | Stratford, CT, 6614

Junyang Lou

520 Medical Center Drive | Medford, OR, 97504

Michael Lepore

600 North Cattlemen Rd | Sarasota, FL, 34232

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1.“Critical Limb Ischemia.Vascular Cures. VascularCures.org. n.d.

2.“Symptoms and Causes of Peripheral Artery Disease.” Mayo Clinic. Mayo Foundation for Medical Education and Research. Dec. 24, 2015.

3.“Critical limb ischemia.” UC Davis Vascular Center. n.d.

4.“What is Peripheral Artery Disease?” National Institutes of Health. U.S. Department of Health and Human Services. June 22, 2016.

5.Varu et al. “Critical limb schema.Journal for Vascular Surgery. Volume 51, Issue 1, Pages 230–241. Jan. 2010.

6.Hardman et al. “Overview of Classification Systems in Peripheral Artery Disease.Semin Intervent Radiol. 2014 Dec; 31(4): 378–388.

Disclaimer

The opinions and clinical experiences presented herein are for informational purposes only. Individual results may vary depending on a variety of patient specific attributes and related factors. Dr. Raghu Kolluri has been compensated by Philips for his services in preparing and providing this material for Philips further use and distribution.

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