Physio Network [Case Studies] Differentiating peripheral artery disease from sciatica: a case study with Tom Jesson
Jan 28, 2026
Tom Jesson, physiotherapist and writer focused on lumbar radicular pain, shares a real case where calf pain thought to be sciatica was actually peripheral artery disease. He explains how PAD can mimic musculoskeletal issues, key risk factors to ask about, useful objective tests like pulses and heel raises, and how to sharpen clinical reasoning to avoid dangerous misdiagnosis.
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Misdiagnosis Revealed Over Time
- Tom Jesson recounts misdiagnosing a man in his late 50s with sciatica when the real problem was peripheral arterial disease.
- The patient's exertional, predictable calf pain only became clear after MSK symptoms improved over weeks.
Exertional, Predictable Pain Flags PAD
- PAD pain is exertional and predictably relieved by rest, unlike most positional or variable MSK pain.
- Asking about predictable distances or times to pain onset reveals PAD more clearly than generic pain questions.
Prioritise Pulse Checks And Reproduce Symptoms
- Check pulses routinely and reproduce symptoms to differentiate vascular claudication from neural pain.
- If PAD is suspected, arrange an ankle-brachial pressure index (ABPI) test via GP or vascular clinic for confirmation.
