Pain at Rest

When peripheral vascular disease (PVD) progresses, it can lead to a variety of serious symptoms. One of these symptoms is pain at rest, which is a severe pain in the legs and feet that occurs while a person is resting.¹ Unlike exercise pain, which is brought on by mere activity, pain at rest can strike at any moment when lying down or when legs are elevated, which may produce burning or cramping discomfort.

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 Classification⁶

Stage 0	Stage 1	Stage 2	Stage 3	Stage 4	Stage 5	Stage 6
No symptoms	Some exercise pain after walking long distances	Exercise pain that occurs more frequently at shorter distances	Severe exercise pain that happens frequently after a short distance	Pain in the legs, calves, buttocks that occurs despite rest	Leg ulcers begin to develop	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.

Other PVD Symptoms

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.

Associated PVD Diseases

Deep Vein Thrombosis (DVT)

Critical Limb Ischemia (CLI)

All PVD Diseases

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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Patient Brochures

Peripheral Artery Disease (PAD) Brochure (815.0KB)

Critical Limb Ischemia (CLI) Brochure (387.0KB)

Third-Party Resources

A mobile app built by cardiologists, to simplify understanding of most cardiac and peripheral vascular conditions and treatments.

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.

This tool is not inclusive of all specialists. Consult with your insurance provider to find specialists that are covered within your network.

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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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