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On a warm November day, just before Thanksgiving, Jerald “J.B.” Starks put on his canvas shoes and light jacket and headed out the door to run errands.

But when the sunny morning turned into icy rain and snow that pelted the Chicago resident, he thought about running home to change. Yet, he pressed on with his to-do list.

The decision would forever change his life. 
 
Over the next couple of days, Starks’ feet ached. His toes changed colors and became inflamed. When the pain didn’t go away, he went to the emergency room, where he learned that he had frostbite that quickly turned into gangrene.

Several lab tests later revealed Starks had peripheral arterial disease, or PAD, which occurs when peripheral arteries that carry blood away from the heart to other parts of the body narrow. The most common type is lower-extremity PAD, in which blood flow is reduced to the legs and feet.

As a result, all five toes on Starks’ left foot were amputated. 
 
Starks is African American and has Type 2 diabetes, two factors that greatly increase risk for PAD. Starks’ mother also had PAD, putting him at greater risk.
 
“Even though I knew about PAD, I didn’t recognize the symptoms and didn’t realize it was hereditary,” Starks said. “I didn’t put two and two together.”
 
Peripheral arterial disease affects more than 8.5 million people in the U.S. each year, with smokers twice as likely to have it. Heart disease, high blood pressure and high cholesterol are other risk factors for PAD.

The most common symptoms are burning, aching, cramping, numbness, fatigue or discomfort in leg or hip muscles while walking. Pain usually goes away with rest and returns when one is active again. Symptoms can make it difficult to walk or engage in usual activities, severely diminishing quality of life. 
 
About 150,000 leg amputations are performed in the U.S. each year, according to the ľ¹ÏÖ±²¥. Most are for people with diabetes and PAD. But you can ask your doctor about other treatment options, and if necessary, get a second opinion as Starks did after his initial vascular surgeon suggested that he get his entire leg below the knee amputated.
 
After Starks switched doctors, he received a femoral bypass on his right leg. To treat PAD in his left leg, he took part in a therapeutic medical trial that focused on high-intensity walking, which is “essentially walking through the pain,” he said. 

At the start of the trial, he couldn’t walk more than 15 minutes at a time, but over time conditioned himself to walk up to two hours without a break. As a result, the circulation in his legs improved from 50% to 70% — a stunning increase. 
 
“It’s really phenomenal,” Starks said. “I didn’t make any changes to my treatment besides the high-intensity walking, but it has really improved my circulation.” 
 
Looking back, Starks wishes he had done several things differently, including not ignoring the persistent cramping in his calves, a sign that his lower leg muscles weren’t getting enough blood. He also said he should have realized the family connection with the disease.

Today, Starks urges anyone who experiences symptoms of PAD, especially continual leg pain, to immediately seek medical attention.
 
“Doctors are very good at identifying diabetes or kidney disease, but it seems to be more difficult to diagnose and treat PAD patients, and it may take a while to get a referral to the right cardiovascular surgeon,” Starks said. 
 
And he encourages those with peripheral arterial disease to try high-intensity walking and other therapies when possible, instead of rushing to surgery or amputation. 
 
“You just have to keep it moving,” he said.