By Kym McNicholas, Global PAD Association
When we launched our “Collateral Nation” series, we made a bold declaration: walking is medicine. It remains the best medicine for maintaining circulation throughout your body’s vascular system—what I often call your “human superhighway.” But what happens when walking isn’t possible? What about our community members who face the double challenge of peripheral artery disease (PAD) and amputation?
This question became the centerpiece of our recent conversation with Dr. Kevin Morgan, a pathologist, PAD patient, and 82-year-old triathlete who has defied medical expectations despite blockages throughout his legs.
First, let’s understand why movement matters so profoundly for PAD patients. With every step you take, your body has the remarkable ability to grow what doctors call a “collateral network of vessels”—essentially your natural bypasses.
“Your body does have the ability to dilate this little network of vessels when you do have a blockage in your main artery, and they can literally grow like tree roots around the blockages,” I explained during our session.
These collaterals become lifelines when main arteries are compromised, redirecting blood flow through alternative pathways. The fascinating aspect is that this network doesn’t just develop in your legs—it grows throughout your body, including your heart, where doctors often call them “little lifesavers.”
When Amputation Complicates Exercise
The inspiration for this particular episode came from a community member’s question during a previous session. Allen, who joined us as a special guest, has faced the complex challenge of exercising with both a below-knee amputation on one leg and a transmetatarsal amputation (loss of toes) on the other.
“I was walking with claudication for almost three years,” Allen shared. “Being the man, you know, we have a tendency to blow things off.” By the time he sought help, both femoral arteries from his groin to knees were completely blocked.
For amputees like Allen, traditional PAD exercise recommendations that focus on toe movements or specific walking techniques aren’t always applicable. This leaves a critical information gap that Dr. Morgan is working to address.
“I’m creating right now a training plan for exercise to build collaterals for people with PAD, and I wanted to include people with amputation,” Dr. Morgan explained. “That gentleman calling in really got my attention focused on the difficulty.”
Unexpected Exercise Discoveries
One particularly fascinating insight emerged when Allen described his experience with different walking surfaces. While walking outdoors with his prosthetic, he needed to stop every eighth of a mile due to claudication pain. Yet surprisingly, when using a treadmill with an incline, he experienced significantly less pain.
Dr. Morgan theorized this might be related to impact stress: “I think the impact is much less. So the trick is to try to find a way to walk with low impact, which, of course, is more difficult in your case than ours.”
This observation opens up important considerations about how exercise surfaces and techniques might need modification for amputees with PAD. The traditional hard surface of roads and sidewalks might actually be exacerbating claudication symptoms compared to the more forgiving surface of a treadmill.
Alternative Exercise Approaches
Throughout our discussion, several practical exercise alternatives emerged:
- Pool-based exercises: Dr. Morgan recommended water exercises using a “pool boy” flotation device to enable upper-body workouts without leg strain. “You could actually get a really solid cardio workout by doing a freestyle with a pool boy,” he suggested.
- Low-impact movement techniques: Learning whole-body movement approaches based on Feldenkrais methods or chi walking could reduce impact stress during exercise.
- Focused resistance training: Allen mentioned his progress with leg presses (140 pounds) and kettlebell squats, showing that targeted strength training remains viable.
- Elliptical training: Dr. Morgan observed another amputee at his gym successfully using an elliptical trainer, which offers cardiovascular benefits with minimal impact.
- Seated exercises: For those in early recovery or with limited mobility, even exercises performed while seated can improve circulation.
The Critical Role of Mindset
Perhaps the most powerful element of our conversation wasn’t about specific exercises but about the mindset required to overcome these challenges. Allen’s perspective was particularly moving.
“Grit is just a state of mind that you have to say, ‘OK, this is what I’ve got and I’m going to move forward with it regardless,’” Allen reflected. “But I find a lot of amputees just sit there bound to a wheelchair, feeling sorry for themselves the rest of their lives. It’s really sad.”
Dr. Morgan agreed, sharing a powerful encounter he had with a paralyzed veteran named James who chose positivity despite losing all sensation below his sacrum after an RPG attack in Iraq. “After about a year, I decided I had a choice. I could be angry and die or I could get on with my life. And I chose life,” James had told him.
When Personal Determination Meets Healthcare Gaps
While the right mindset is crucial, even the most determined patients often find themselves navigating a healthcare system that isn’t designed to support their exercise journey. The grit that Allen and Dr. Morgan demonstrate shouldn’t have to compensate for systemic shortcomings in medical care.
Dr. Morgan shared his frustration about a woman who recently reached out through our support page: “Her doctor told her to suck it up until she was ready for surgery when things were bad enough. That actually pissed me off.”
This absence of comprehensive lifestyle guidance reflects a broader systemic issue. “Lifestyle changes like exercise for a diabetic, it gets pretty well gets lip service and that’s it. And then they’ll hand you a pill or they’ll ask you to have surgery,” Dr. Morgan observed.
The medical system often treats symptoms rather than empowering patients with the tools for self-management and improvement. As Dr. Morgan aptly noted, “The medical profession has turned into an illness injury, not a health industry.”
Moving Forward Together
What continues to inspire me about our PAD community is the relentless determination I witness daily. From Allen’s refusal to accept wheelchair dependence to Dr. Morgan competing in triathlons at 82 despite significant arterial blockages, these stories remind us that limitations often exist primarily in our minds.
As we continue our Collateral Nation series, we remain committed to exploring exercise solutions for everyone on the PAD spectrum—from those just beginning to experience symptoms to those managing multiple complications.
The human body’s capacity to adapt and grow new vascular pathways is nothing short of miraculous. Our goal is to help you activate that natural healing potential, regardless of your current limitations. Because whether you’re walking on two legs, one leg, or building strength through alternative methods, movement remains the key to improving circulation and quality of life with PAD.
Resources for Your Journey
Whether you’re managing PAD with all limbs intact or navigating the additional challenges of amputation, resources exist to support your journey:
- Join our PAD Support Group at padsupportgroup.org
- Connect with our Walking Support Group at walkingsupportgroup.com
- Check out Dr. Kevin Morgan’s insights at inspirationalselfhelpbooks.com or subscribe to his YouTube channel, Fiddle Dog
- Consider Dr. Morgan’s book “How to Fight the Crippling Pain of Peripheral Artery Disease”
- Call our Leg Saver hotline at 1-833-PAD-LEGS for personalized guidance
Let’s keep moving forward together.
This post reflects information shared during our Collateral Nation live session. While we strive to provide valuable insights, please consult your healthcare provider before beginning any new exercise program. The advice and views offered are for educational and informational purposes only. Do not act on any information provided without the explicit consent of your physician.