LEG PAIN, most especially when its recurring should be a cause for alarm. What many dismiss as simple fatigue or aging may, in fact, be an early sign of a vascular condition known as limb ischemia (LI) and an impending heart attack. LI can also lead not only to amputation but also to stroke, and death if ignored. LI is not simply a circulation problem. There is a fatal link between limb pain and cardiovascular disease.
During the
August 26, 2025 Philippine Heart Association (PHA) Usapang Puso sa Puso webinar, Dr. Paolo Joel Nocom, chair of PHA Council on Coronary Artery Disease, explained that “LI is not just a disease of the legsit is a reflection of your overall cardiovascular health.”
Nocom, cardiologist-vascular medicine specialist, who is also the head of Philippine Heart Center Section of Peripheral Artery Disease, Division of Vascular Medicine, added that “kapag may bara sa ugat ng paa, malaki ang posibilidad na may bara rin sa ugat ng puso o utak. Kaya’t ang simpleng pananakit o panlalamig ng binti ay maaaring senyales na nasa panganib ang iyong puso.
Severe, overlooked condition
Nocom said that LI has two kinds. Acute Limb Ischemia (ALI) occurs when blood flow to the arms or legs is suddenly cut off, putting tissues at risk of death within hours. Without urgent intervention, this can lead to permanent disability or even death.
Meanwhile, Critical Limb Ischemia (CLI) develops over time, often in people with diabetes, hypertension, or existing heart disease. CLI is marked by persistent pain, wounds that refuse to heal, and gangrene. Studies show that many patients with CLI face amputation and also suffer from high rates of heart attack and stroke within five years of diagnosis. CLI and surgical intervention will be tackled in the UPP Segment 2 on August 29, 2025, 10 AM via the PHA Facebook page. A team of thoracic and cardiovascular surgeons and wound specialists were tapped as resource persons.
Spot the early warning signs
Nocom urged the public that the symptoms of like: persistent leg pain often worse at night or even at rest, or a sudden severe pain in one limb that does not subside; coldness and paleness in the skin of the arms or legs, along with numbness, tingling, or weakness; the presence of non-healing wounds, ulcers, or darkened patches on the feet or toes, which may signal poor circulation, should be a cause for alarm.
For ALI, Nocom emphasized the importance of the 6Ps as a quick diagnostic guide: Pain (sudden, severe pain in the limb), Pallor (pale or bluish skin), Pulselessness (weak or absent pulse in the affected area), Paresthesia (tingling or pins and needles sensation), Paralysis (weakness or loss of movement), and Poikilothermia (coldness compared to the rest of the body).
LI is diagnosed through a combination of physical examination, medical history and diagnostic test such the ankle-brachial index, doppler ultrasound and angiography to visualize blood flow and identifiy blockages.
The legs have pulses
Bukod sa pulselessness o pagkawala ng pulso, kapag naramdaman mo ang isang sintomas, maaaring hindi iyan arterial disease, pero kung walang pulso ang binti, kumonsulta ka na agad dahil iyan ay emergency, Nocom added. (The absence of pulse in your leg should prod you to seek emergency consult.)
PHA Director III and Advocacy Committee Chair Dr. Iris Garcia reiterated: “Kumonnsulta na kayo agad sa doctor kapag walang puslo ang inyong binti dahil delikado iyan.”
The bad news is treatment for limb ischemia in the Philippines is limited. Treatment requires advanced procedures such as angioplasty, bypass surgery, or catheter-based interventions. In developed countries, these are increasingly common and accessible.
However, in the Philippines, such treatments are expensive and limited to specialized hospitals, according to Nocom. Access to vascular surgeons and interventional cardiologists is also scarce, especially outside Metro Manila.
Sa ating bansa, mahal ang gamutan at limitado ang mga espesyalista. Kapag huli nqa ang pagkonsulta, mas mataas ang tsansang umabot sa putol ng paa o ikamatay ng pasyente, Dr. Nocom said.
“Because treatment is not always within reach, prevention and early detection are critical, Nocom stressed.
Medications such as anticoagulants, antiplatelets and cholesterol-lowering drugs are prescribed.
Garcia added: “Kung ano ‘yung mga gamot natin sa diabetes, altapresyon, sa cholesterol, iyon din ang gamot na nakakatulong sa Peripheral Arterial Disease. Kung ano ang nagbabara sa puso, ganoon din sa utak, ganoon din sa binti, kaya ‘yung maintenance na mga gamot ay panatilihin nating inumin. Kung mayroon kang bara sa inyo binti, ang mga gamot na iyan ay maintenance na kaya kumonsulta sa manggagamot.”
Smoking: Top culprit in PAD
Nocom stressed that smoking is the top culprit in acquiring peripheral artery disease (PAD) which can lead to limb ischemia. Know and watch your numbers.
To put PAD at bay and manage limb ischemia, he said: quit smoking. Tobacco use greatly increases the risk of artery damage and poor circulation. Equally important is keeping blood sugar, blood pressure, and cholesterol under control, as these factors directly affect the health of both the heart and the blood vessels. A heart-healthy diet–rich in fruits, vegetables, whole grains, and lean proteins — also plays a major role in protecting vascular health.
He added that physical activity is another key step, as it improves circulation and strengthens the cardiovascular system. He stressed, however, that lifestyle changes must go hand in hand with timely medical attention.
