Peripheral artery disease and acute limb ischaemia: limb checks, positioning and foot care

What it is

In peripheral artery disease, narrowed arteries reduce blood flow to the legs. The person has pain on walking that eases with rest, and later pain at rest, cool pale or bluish skin, hair loss, thick nails and slow-healing wounds on the toes or feet. The nurse compares pulses, colour, warmth, capillary refill and sensation in both legs and calls at once if a limb suddenly becomes cold, pale, numb or loses its pulse, because the limb may be at risk. Pain is often worse with the legs raised and better with them hanging down, so the legs are not elevated. Teaching covers walking, no tobacco, risk-factor control and foot care.

What it requires

• Comparing both limbs: pulses, colour, temperature, capillary refill, sensation, movement, hair and skin.
• Recognising acute ischaemia and escalating at once.
• Positioning and protection of the ischaemic limb.
• Foot care and wound prevention, especially in diabetes.
• Teaching about walking, tobacco, blood pressure, glucose and lipids.

How it is applied (and why)

1. Palpate the pulses of both feet and use a Doppler if absent; mark them — a pulse that disappears is a key change.
2. Compare colour, warmth, capillary refill, sensation and movement on both sides — finds low blood flow.
3. Ask about pain on walking, at rest or at night, and what relieves it — rest pain means more severe disease.
4. Do not raise the leg; let it hang down if that eases the pain — gravity helps arterial flow.
5. Moisturise the skin and look for dry or cracked skin, blisters, cuts and redness — small injuries heal poorly.
6. Inspect the whole foot, between the toes and the heels, every day — wounds may not hurt when nerves are damaged.
7. Teach a walking programme agreed with the doctor: walk to moderate pain, rest, repeat — walking improves blood flow.
8. Teach stopping tobacco and control of pressure, glucose and lipids — they slow the narrowing.

In nursing practice

• Call at once for a leg or foot that is suddenly cold, pale, blue or numb, or a pulse that is lost.
• Call for rest pain that does not go away, or for new sores or sores that do not heal.
• Call for signs of infection: red, hot or swollen skin, fever, sweats or feeling unwell.
• Call for chest pain or breathlessness together with leg pain.
• Report after vascular procedures any change in pulse, colour or warmth below the treated area.

Common mistakes

• Raising an ischaemic leg on pillows as if it were a venous problem.
• Treating a foot problem without reporting it.
• Checking only one leg, so there is no comparison.
• Missing a foot wound because the patient feels no pain.
• Applying compression to a leg without checking its arterial circulation.

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Elsewhere in DurgiPedia

• Peripheral pulses and the ankle–brachial index
• Acute limb ischemia and chronic arterial insufficiency
• Capillary refill time

Connections

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Peripheral artery disease - legs: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Peripheral artery disease of the legs - self-care: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); Nursing Skills, 9.3 Cardiovascular Assessment (Open RN (Chippewa Valley Technical College), LibreTexts, 2021).

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