Poor Circulation: Symptoms, Causes and Treatment

What poor circulation means

Arteries carry oxygen-rich blood from the heart to the tissues. Veins bring blood back. Circulation problems happen when:

• arteries narrow or block, so not enough blood reaches the tissues (arterial disease)
• veins struggle to return blood to the heart, so blood pools in the legs (venous disease)
• small vessels spasm and temporarily shut down (Raynaud's phenomenon)

Each type causes different symptoms. Telling them apart matters, because the treatments are very different, and some treatments for vein problems, such as compression stockings, can harm people with poor arterial supply.

Poor circulation symptoms

Signs of poor arterial circulation

• Claudication: cramping pain, aching or tiredness in the calf, thigh or buttock that comes on with walking a predictable distance and eases within minutes of rest
• cold feet or legs, often on one side more than the other
• numbness, tingling or weakness
• shiny, thin, hairless skin on the legs; slow toenail growth
• weak or absent pulses in the feet
• pale or bluish skin, especially when the leg is raised
• sores on the toes, heels or shins that heal slowly
• in severe cases, pain in the foot at rest, especially at night
• erectile dysfunction in men

Signs of poor venous circulation

• swollen ankles and legs, worse at the end of the day and better overnight
• heavy, aching, tired legs
• varicose veins
• itching, brown discoloration and thickened skin around the ankles
• leg ulcers near the inner ankle

Signs of Raynaud's phenomenon

• fingers or toes turn white, then blue, then red when they warm up
• triggered by cold or stress
• numbness, tingling and throbbing during attacks

Poor circulation causes

Peripheral artery disease

Peripheral artery disease (PAD) is the most important cause of poor circulation in the legs. Fatty deposits (atherosclerosis) narrow the leg arteries. Risk factors are smoking, diabetes, high blood pressure, high cholesterol, age over 65 and kidney disease. Many people have no symptoms. PAD means the arteries to the heart and brain are probably affected too, so it carries a higher risk of heart attack and stroke.

Diabetes

High blood sugar damages both large and small blood vessels and the nerves. People with diabetes may not feel the pain of claudication or a foot injury, so foot ulcers and infections can develop unnoticed. Daily foot checks are essential. See diabetic foot problems.

Chronic venous insufficiency and varicose veins

When the valves inside leg veins weaken, blood flows backward and pools. This venous insufficiency causes swelling, aching and skin changes. Varicose veins are a visible sign. Risk factors include age, pregnancy, obesity, standing jobs, family history and previous blood clots.

Blood clots

A deep vein thrombosis (DVT) blocks a deep vein, usually in the leg, causing sudden swelling, pain and warmth in one leg. It can travel to the lungs, so it needs prompt treatment. An arterial clot causes a sudden cold, painful limb.

Raynaud's phenomenon

Raynaud's phenomenon is an exaggerated spasm of small arteries in the fingers and toes in response to cold or stress. Primary Raynaud's is common, usually starts in young women and is harmless. Secondary Raynaud's is linked to autoimmune diseases such as scleroderma and lupus, vibrating tools or some medicines, and can cause sores.

Other causes

• Heart failure: a weak heart pump causes leg swelling and tiredness.
• Smoking: damages artery walls and causes vessels to constrict.
• Vasculitis: inflammation of blood vessels.
• Medicines: beta-blockers and some migraine and ADHD medicines can make hands and feet cold.
• Sitting or standing still for long periods.

Cold hands and feet without a circulation problem

Many healthy people, especially women and slim people, have cold hands and feet because their blood vessels constrict readily to conserve heat. An underactive thyroid and anemia can also make you feel cold. If your hands and feet warm up normally indoors, with no pain, sores or color changes, this is not a sign of disease.

How poor circulation is diagnosed

Your doctor will ask about your symptoms, when pain comes on, smoking, diabetes and heart history. They will look at the skin of your legs and feet, check pulses at the groin, knee, ankle and foot, and see how quickly color returns when pressing a toenail.

Common tests:

• Ankle-brachial index (ABI): compares blood pressure at the ankle with the arm. An ABI of 0.9 or less indicates PAD. It takes about 15 minutes and is painless.
• Doppler ultrasound: shows blood flow in arteries and veins and finds clots or faulty valves.
• Blood tests: cholesterol, blood sugar or HbA1c, kidney function, blood count, and autoimmune tests for secondary Raynaud's.
• CT or MR angiography: maps narrowed arteries before a procedure.

Poor circulation treatment

Lifestyle changes

• Stop smoking: the single most effective step for arterial disease.
• Walk: a supervised exercise program for PAD, walking until moderate pain, resting, then continuing, for 30 to 45 minutes 3 times a week, improves walking distance substantially over 3 months.
• Control risk factors: blood pressure, cholesterol and blood sugar.
• Lose excess weight to reduce strain on veins.
• Raise your legs above heart level for 20 to 30 minutes several times a day for vein swelling.
• Avoid sitting or standing still for long periods; flex your ankles regularly.
• Keep warm: gloves, warm socks and layered clothing for Raynaud's.

Medicines

• antiplatelet medicines such as low-dose aspirin or clopidogrel for PAD, as prescribed
• statins to lower cholesterol and stabilize artery plaques
• blood pressure medicines
• cilostazol to improve walking distance in some people with claudication
• anticoagulants for DVT
• calcium channel blockers for troublesome Raynaud's

Compression stockings

Graduated compression stockings help venous insufficiency and swelling. Do not wear them if you have significant arterial disease unless a doctor has checked your ABI first.

Procedures

• Angioplasty and stenting: a balloon opens narrowed arteries.
• Bypass surgery: reroutes blood around a blocked artery.
• Vein treatments: laser or radiofrequency ablation, foam injections, or surgery for varicose veins.

Caring for your feet

Poor circulation slows healing, so small injuries can turn into ulcers.

• Check your feet daily, including between the toes and the soles. Use a mirror if needed.
• Wash and dry your feet carefully, and moisturize except between the toes.
• Wear well-fitting shoes and never walk barefoot outdoors.
• Have nails cut straight across; see a podiatrist if you have diabetes or PAD.
• Do not use hot water bottles or heating pads on numb feet, which can burn without you noticing.

Frequently asked questions

What are the first signs of poor circulation?

Early signs include cold or numb feet, tingling, leg cramps or calf pain when walking that eases with rest, and slow-growing toenails or hair loss on the legs. Swollen ankles and aching legs at the end of the day suggest a vein problem.

What is the most common cause of poor circulation?

In the legs, peripheral artery disease from atherosclerosis is the most important cause, especially in people who smoke or have diabetes. Vein problems such as chronic venous insufficiency and varicose veins are also very common. In the fingers and toes, Raynaud's phenomenon is the commonest cause.

How can I improve poor circulation in my legs?

Stop smoking, walk regularly, keep to a healthy weight, and control blood pressure, cholesterol and blood sugar. Raise your legs to ease swelling from vein problems. Your doctor may also prescribe medicines or compression stockings, and some people need procedures to open arteries or treat veins.

Is poor circulation serious?

It can be. Peripheral artery disease raises the risk of heart attack and stroke, and severe disease can lead to ulcers and amputation. A blood clot can travel to the lungs. Cold hands and feet alone, with no other symptoms, are usually harmless.

How do doctors test for poor circulation?

The main test is the ankle-brachial index, which compares blood pressure in your ankle and arm. A Doppler ultrasound shows blood flow in arteries and veins. Blood tests check cholesterol, sugar and kidney function. CT or MR angiography maps blockages before treatment.