Can Peripheral Artery Disease Be Reversed? What Restores Blood Flow and Saves the Foot

Peripheral artery disease (PAD) means plaque has narrowed the arteries that carry blood to your legs and feet.⁠^[1] Hearing “there’s no reversing it” can sound like there’s nothing to do. That isn’t the case. What matters is restoring enough blood flow to walk, heal and keep your foot, and that can often be done. For the warning signs and first tests, see our parent practice’s guide to poor circulation in the feet. This article is about what treatment can and can’t undo.

Can peripheral artery disease be reversed?

Not in the sense of making the plaque disappear. Treatment aims to ease symptoms, help you walk farther, lower the risk of heart attack and stroke, and lower the risk of losing a limb.⁠^[1]

• Walking does not reopen the artery. In a review of 32 trials, exercise programs added about 82 meters of pain-free walking and 120 meters of maximum walking, with benefits lasting up to two years. But the ankle-brachial index, the blood pressure ratio that measures the narrowing, did not improve.⁠^[2]
• Medicines slow it and protect you. Statins lower cholesterol and can slow plaque buildup.⁠^[1] In 51 studies of 138,060 people with PAD, mostly observational, statin use was linked with 30% fewer major limb events and 35% fewer amputations.⁠^[4]
• A procedure restores flow. Angioplasty opens a narrowed artery with a small balloon, sometimes leaving a mesh tube called a stent. Bypass surgery builds a new path around the blockage with one of your own veins or a man-made tube.⁠^[1] This is the step that improves blood flow to the foot itself.⁠^[3]

When does restoring blood flow make the biggest difference?

For leg pain with walking. In a Dutch trial of 212 people with walking pain, those who had an artery-opening procedure plus supervised exercise could walk 1,237 meters farther at one year than at the start, against 955 meters with exercise alone. Pain-free walking rose by 1,120 meters against 712, and quality of life improved more.⁠^[5]

For a foot wound. Here, restoring flow is often what decides whether the foot heals. The diabetic foot circulation guideline advises considering a procedure to restore flow for anyone with diabetes, PAD, a foot ulcer and signs of poor flow, such as missing pulses or a toe pressure under 60 mmHg.⁠^[3] With severe loss of flow, such as a toe pressure under 30 mmHg, it calls for an urgent vascular consultation, and it advises rechecking circulation when an ulcer hasn’t shrunk by about half in 4 weeks of good care.⁠^[3]

Which procedure. In BEST-CLI, a trial of people with limb-threatening PAD who had a good leg vein, bypass surgery led to fewer major limb events or deaths than a balloon or stent approach (42.6% vs 57.4% over a median of 2.7 years).⁠^[6] The guideline suggests bypass first in that situation when either is possible, and says the goal is a straight path of blood to at least one artery of the foot.⁠^[3]

Why foot surgery follows restored blood flow

Better flow lets a foot heal, but it doesn’t remove dead tissue, infected bone or the pressure point that caused the ulcer. That is the Foot and Ankle Surgeon’s part. When infection and poor flow occur together, the guideline calls for urgent input from a vascular specialist to time drainage of the infection and the procedure to restore flow.⁠^[3] After the procedure, blood flow to the foot should be rechecked with a test, and care should come from a team.⁠^[3]

Dr. Efe Ozturk is a Foot and Ankle Surgeon who is double board certified, including in wound care (FAPWH). We check circulation with noninvasive tests at our practice and refer you to a vascular specialist, who performs angioplasty or bypass. Then Dr. Ozturk drains infection, removes dead tissue and infected bone and, for the feet that need it, performs a toe or partial foot amputation that keeps as much of the foot as possible. See peripheral artery disease and foot wounds, restoring blood flow and limb salvage surgery.

How to treat peripheral artery disease: what works together

For people with diabetes and PAD, the guideline sets targets such as an LDL cholesterol under 70 mg/dL and an A1C under 8% for most, plus a single antiplatelet medicine; adding low-dose rivaroxaban to aspirin may be considered when bleeding risk is low.⁠^[3] After a leg artery procedure, that combination lowered a composite of limb loss, sudden limb artery blockage, heart attack, stroke and heart death from 19.9% to 17.3% over three years, with more major bleeding by one definition.⁠^[7] Quitting smoking can reduce symptoms and complications.⁠^[1] Your doctors decide these medicines with you.

What are the limits?

In the Dutch trial, the walking advantage of the procedure had faded by about five years, and the procedure group had more artery procedures in total (149 vs 65).⁠^[8] In BEST-CLI, people without a good vein did about as well with either approach.⁠^[6] Exercise trials found no clear effect on amputation.⁠^[2] Restoring flow carries risk: about 2 in 100 people with diabetes die within 30 days of either type of procedure, about 5 in 100 with end-stage kidney failure. The guideline rates the evidence on healing and amputation as low certainty and advises against a procedure when the chance of success is clearly poor.⁠^[3]

Common questions

Can peripheral artery disease go away?

Medicines can slow plaque buildup, and a procedure can open or bypass a blocked artery.⁠^[1] Many people walk farther and heal wounds once flow improves.⁠^[2,3]

How is peripheral artery disease diagnosed?

Usually with a pulse check, the ankle-brachial index and, with a foot wound, a toe pressure, which helps predict healing; a toe pressure of 30 mmHg or more raises the likelihood of healing.⁠^[3] See circulation tests for foot wounds.

Can walking open blocked arteries?

Walking programs improve how far you can walk, but trials found they didn’t change the ankle-brachial index.⁠^[2] They work alongside, not instead of, a procedure when a wound needs more flow.

Do I need a vascular surgeon or a foot surgeon?

With a foot wound, often both. The guideline advises care from a team, with a vascular specialist restoring flow and the foot treated alongside.⁠^[3] Our sister practice explains cold feet versus numb feet (external site) if you’re unsure whether circulation or nerves are the problem.

The bottom line

Peripheral artery disease isn’t reversed by lifestyle alone, but much of what it takes away can be improved: walking distance through exercise, and blood flow through a procedure. For a foot wound, restoring flow and then the right foot operation can save the limb. Don’t wait for a wound to stall before having your circulation checked.