Peripheral artery disease (PAD), specifically atherosclerotic disease leading to peripheral artery obstruction, may be silent or present with a variety of symptoms and signs indicative of extremity ischemia. The clinical manifestations of arterial insufficiency (regardless of etiology) are due to a lack of blood flow to the musculature relative to its metabolism, which results in pain in the affected muscle groups. The presence of an extremity ulcer is one of the more obvious clinical signs that can be due to ischemia, but other manifestations, such as claudication and rest pain, should be actively sought out and differentiated from nonatherosclerotic and nonvascular conditions to ensure timely referral to a vascular specialist, when indicated. Ideally, a multidisciplinary approach involving the primary care provider, medical specialists, podiatrist, vascular specialist (interventionalist and/or surgeon), and plastic surgery provides optimal medical and surgical care. PAD is a treatable condition. When recognized early and appropriately managed, complications that can lead to limb loss can be minimized.