The main symptom of peripheral arterial disease is intermittent claudication, which is a tight or squeezing pain in the calf, foot, thigh, or buttock that occurs during exercise such as walking. This pain usually occurs after a predictable amount of exercise and goes away after about 5 to 10 minutes of rest. Increasing your exercise intensity, such as walking uphill or at a more rapid pace than usual, may cause pain after a shorter amount of time than normal. If rest no longer relieves the pain, it may mean that peripheral arterial disease is getting worse.

People with intermittent claudication usually describe the pain as a deep aching that gradually gets worse until the person rests. Sometimes, the leg may also cramp or feel weak.

Your speed and whether you are walking uphill or downhill are all factors that affect how far you can walk before feeling pain. If you have severe arterial blockage and poor circulation, you will find walking long distances to be a greater challenge. The average person with blockage of one major arterial segment in a leg can walk 90 to 180 meters (a football field or two) before pain starts. As more blockages develop, the pain can appear earlier and earlier. In severe cases a person can only walk a few feet before needing to stop.

Pain at rest, without exercise, means that arterial blockage is advanced. If effective treatment is not started, tissue death and possible amputation usually follow quickly. The pain is often noticed at night and is relieved by hanging the leg off a bed or couch. The pain also may improve with walking because gravity helps blood to reach the foot. As PAD gets worse, the pain may interrupt sleep, cause a lack of appetite, and make the leg sensitive to the touch.