Peripheral arterial disease (PAD) is a common atherosclerotic disease approximately affecting 8.5 million Americans above age 40 and is associated with significant functional impairment, morbidity and mortality from both cardiovascular and non-cardiovascular causes. PAD has increasing prevalence in females contrary to previous findings. Compared to men, women with PAD are more asymptomatic or have atypical symptoms. Women with PAD have increased quality of life impairment, increased risk of depression and increased cardiovascular mortality. The intent of this review is to provide an update on gender differences in PAD that can help in timely diagnosis and appropriate management through intensive cardiovascular risk factor modification, exercise program and guideline directed therapy to improve cardiovascular outcomes. •Peripheral arterial disease (PAD) is a significant healthcare burden affecting 8–10 million Americans.•PAD confers equal morbidity and mortality as well as economic costs to coronary artery disease and stroke.•Significant gender differences exist in epidemiology, clinical assessment, treatment and outcomes for PAD patients.•Women suffer from functional impairment, morbidity and mortality from PAD at higher rates as compared to men.•Timely diagnosis, treatment and cardiovascular risk modification in women will reduce significant morbidity and mortality from cardiovascular as well as non-cardiovascular causes.