No Detectable Foot Pulse, But Pink Toes, With Peripheral Arterial Disease (PAD) Ironman Collaterals

No Detectable Foot Pulse
My toes (still have 10) are nice and pink, and there is excellent nail refill if I push on them. If I stop my training, especially running, my toe nails start to go blue, refill is slower. It’s not easy, but I’m still doing Ironman training with no detectable foot pulse in the right leg, using ultrasound.

About six years ago, four years after running the Boston Marathon, I noticed problems with running in longer races, including half Ironman. I would develop numb feet and mild pain in my calves, especially on the right side.

About five years ago, a routine ABI (Ankle Brachial Index) test confirmed I was developing peripheral arterial disease (PAD) in my right popliteal artery. My surgeon recommended against surgery, suggesting walking would help. Two weeks later, I ran a marathon, and foot pain and numbness issues killed my run. I only just finished the race, as the course was closing. This is an inevitable consequence of my genetic dyslipidemia (nasty blood fat profile).

I managed to continue Ironman, in spite of an abdominal aortic aneurysm, stented in 2010. This was achieved by modifying my training to protect an abdominal aortic aneurysm stent graft. The fact that I have both pathology and body-movement training helped a lot, when it came to working out what to do about Ironman with an AAA. And on I went, happily doing Ironman races.

Now I’m dealing with the PAD problem. The swim and bike are largely unaffected by PAD, which has been progressing slowly. Progression is in the nature of the arteriosclerosis beast.

The trick: build collaterals. Grow new blood vessels. The paper cited below provides an interesting window on current research, as work is done to encourage new growth around blocked arteries. Unfortunately, such therapies are not available to me, right now.

So I use exercise, lots of exercise, and it’s working.

No detectable foot pulse
Fig. 1. Schematic showing the various stages in new vessel formation (including angiogenesis, vasculogenesis and arteriogenesis). Ten individual steps are described in panels A to D showing endothelial cell (EC) proliferation and migration (angiogenesis) followed by extracellular matrix (ECM) remodelling and expansion of vascular smooth muscle (VSM) cells (arteriogenesis). From: Therapeutic Angiogenesis in Peripheral Arterial Disease: Can Biotechnology Produce an Effective Collateral Circulation?

A recent visit to my vascular surgeon, for routine assessment of the stability of my aortic stent graft, revealed the absence of a detectable pulse in my right foot, using ultrasound. This is the leg that gives me trouble, while running. Through logic, and trial and error, I’ve developed approaches to optimizing my ability to run with PAD, including, (a) low impact running style to reduce reverse pressure waves, (b) contracting my toes to encourage venous return and blood flow through my feet, (c) running with the whole body to minimize leg stress, (d) minimalist shoes so my feet are “massaged” as I run, to promote blood flow, and so they can talk to the road, (e) relaxed feet, calves and hips, as relaxed muscles have better blood perfusion, and (f) thick woolen socks to protect my feet.

These changes enabled me to just finish a recent half Ironman race. I noticed that my calf claudication and numb feet vanished five miles into the run, suggesting that it takes a while for collateral arteries/arterioles to open up. I was also horribly undertrained on the bike. I can fix that!

no detectable foot pulse
One tired old dude at the finish of the White Lake Half Ironman, 2022. But I managed to finish (1.2-mile swim, 56-mile bike, 13.1-mile run), missing the cutoff by about 10 minutes, largely due to being undertrained on the bike, plus my PAD running challenge. The race organizers kept the finish open, a they were delighted that the oldest competitor actually reached the finish line.

I’m now training for the 2022 Arizona Ironman (November). I have to be strong in the swim and bike legs, and somehow achieve a 15-minute mile pace or better on the run. I’ve had encouraging results, recently, as you can see from the image below.

no detectable foot pulse
This with no detectable pulse in my right foot, with. I’m running on collaterals! Getting closer to a 15-minute pace, though I’m aiming for 13.5. Go figure!

So the journey continues. Isn’t life fun?

Oh! Yes! I just turned 79, meaning a new age group next year, giving me a better chance for a Kona Slot.

-kev aka FitOldDog

no foot pulse
MRI scans through the thighs of three guys. Grey is muscle, white is fat, clear ring around the central white spot (bone marrow) is the femoral bone. Note the loss of both muscle and bone mass in the sedentary guy.


  1. Tracey Himmel says

    You are amazing! And happy birthday!

  2. Lynne Kerr says

    Kevin, congratulations on your persistence and achievements. Do you think that statins inhibit the development of collateral circulation ? I have stopped taking 10mg Atorvastatin for over 3 weeks and my running has noticeably improved. Muscle pain and fatigue has reduced and I’m much more alert especially in the mornings. I believe my cholesterol is within acceptable range and my diet is good. Only reason I am on statin is because of the collapse of my EIA. I have a stent in place to keep decent, but not full blood flow to my left leg.

Speak Your Mind


This site uses Akismet to reduce spam. Learn how your comment data is processed.

Disclaimer: As a veterinarian, I do not provide medical advice for human animals. If you undertake or modify an exercise program, consult your medical advisors before doing so. Undertaking activities pursued by the author does not mean that he endorses your undertaking such activities, which is clearly your decision and responsibility. Be careful and sensible, please.