PAD is primarily caused by the build-up of fatty plaque or deposits in the walls of the arteries of the legs and feet. Biggest risk factor for PAD is smoking although in Asia diabetes seems to have a more potent effect. Men over 50 years old and post-menopausal women are likely to develop PAD and the likelihood increases if the patient is also obese, leads a sedentary lifestyle and has hypertension and chronic kidney disease.