Leg pain while walking is often blamed on ageing, muscle fatigue or joint problems, but vascular specialists are warning that it can be an early sign of Peripheral Arterial Disease (PAD) — a condition that can eventually threaten both mobility and limb viability if left untreated.
Speaking ahead of National Vascular Day, Dr P. C. Gupta, Clinical Director and Head of Vascular & Endovascular Surgery, Vascular IR and Podiatric Surgery at CARE Hospitals, Banjara Hills, urged greater awareness of vascular disease and its warning signs.
For India’s prosthetics and orthotics community, the message is especially relevant. CPOs may ultimately become involved after limb loss, but there is a growing opportunity to contribute much earlier through risk recognition, diabetic foot care, pressure management, orthotic intervention and appropriate referral.
India’s diabetic and vascular burden is substantial
The report states that more than 10 crore Indians are living with diabetes, while an estimated 5 crore people have PAD affecting circulation in the legs. It also cites nearly one lakh limb losses every year due to diabetic foot complications, while stressing that many such amputations may be preventable with timely diagnosis and vascular treatment.
For clinicians working in P&O, that is a major public-health challenge.
The progression toward amputation often begins long before a prosthetist sees the patient. Diabetes may cause neuropathy, reducing sensation, while PAD limits blood flow and impairs healing. A small wound or pressure point can therefore worsen without causing enough pain to prompt early treatment.
Once infection, tissue loss or critical ischaemia develops, the options for limb preservation become much narrower.
The leg may warn before the heart
One of the key messages from Dr Gupta is that leg symptoms can be an important cardiovascular warning sign.
PAD is caused by narrowing or blockage of the arteries supplying the limbs. The report notes that blocked arteries in the legs are also associated with increased risk of heart attack and stroke.
Typical warning signs include:
- pain or cramping while walking;
- persistent swelling;
- coldness or numbness in the feet;
- colour changes in the legs or feet;
- varicose veins;
- ulcers or wounds that do not heal.
Patients with diabetes, high blood pressure, high cholesterol, a history of smoking or those aged over 50 are among those at greater risk.
For CPOs and podiatry-related professionals, these symptoms should never simply be treated as a footwear or orthotic issue without considering whether vascular referral is required.
A simple Doppler test can identify compromised circulation
The report highlights Doppler ultrasound as a simple, non-invasive test that can help evaluate blood flow and identify arterial narrowing or blockage at an earlier stage.
That is significant because treatment outcomes are often much better when vascular disease is identified before a foot wound becomes severely compromised.
The challenge is that PAD may initially resemble other conditions.
Dr Gupta noted that vascular disease is frequently mistaken for orthopaedic, neurological or age-related problems, delaying referral to vascular specialists.
This is where interdisciplinary awareness matters.
An orthotist may see a patient because of walking difficulty, foot pain or a pressure lesion. A physiotherapist may see them because of reduced walking endurance. A prosthetist may be treating the opposite limb following an earlier amputation.
None of these professionals diagnose PAD independently, but all can play a role in recognising when further vascular investigation is appropriate.
Why this matters for orthotists
For orthotists, diabetic foot and vascular disease increasingly sit within the same limb-preservation pathway.
Appropriate intervention may include:
- pressure-relieving insoles;
- extra-depth diabetic footwear;
- custom foot orthoses;
- ulcer offloading devices;
- Charcot management;
- postoperative footwear;
- plantar-pressure assessment.
But mechanical offloading cannot compensate for severely impaired blood supply.
If a patient has significant ischaemia, the first priority may be vascular assessment and revascularisation rather than simply modifying footwear.
This is an important distinction for P&O practice.
A high-quality insole can redistribute pressure, but it cannot restore arterial flow. The strongest outcomes come when vascular treatment, wound care, diabetes management and orthotic intervention are coordinated rather than provided in isolation.
Prevention must happen before the prosthetic clinic
For prosthetists, diabetic and vascular amputations represent a growing share of lower-limb rehabilitation workload.
Yet the most desirable clinical outcome is often avoiding amputation entirely.
This changes the way P&O professionals should think about their role.
Rather than viewing diabetic foot disease purely as something that eventually creates demand for prostheses, the profession can contribute to earlier stages of care through education, footwear assessment, pressure reduction and timely referral.
A CPO working with an existing amputee should also consider the risk to the contralateral foot.
Protecting the remaining limb through appropriate footwear, regular inspection and multidisciplinary review can be just as important as optimising the prosthesis.
National Vascular Day puts screening into focus
As part of its National Vascular Day programme, CARE Hospitals in Banjara Hills offered a free vascular health check including Doppler testing and specialist consultation on August 6, 2026.
The broader message is that vascular health should be treated in the same way as blood pressure, diabetes and cardiac screening — something to assess before severe symptoms develop.
For Bharat CPO readers, that message is highly relevant.
The country will continue to need strong prosthetic rehabilitation services for people who experience limb loss. But reducing preventable diabetic and vascular amputations will require greater focus on the stage before surgery becomes inevitable.
CPOs, orthotists, podiatrists, vascular surgeons, diabetologists and wound-care teams all have a role in that process.
Sometimes the most valuable intervention is not fitting a prosthesis after limb loss, but recognising the warning signs early enough that the patient never needs one.
- News Patrolling – Your Legs Could Be Warning You Before Your Heart Does
- CARE Hospitals
- Vascular Society of India
- International Diabetes Federation
- Rehabilitation Council of India