Intermittent Claudication

What is Intermittent Claudication

Intermittent claudication is pain in one or both legs that occurs when walking or exercising and goes away when resting. Intermittent claudication is a symptom of peripheral arterial disease (PAD).

This condition is commonly treated with rest, medicine, and healthy lifestyle changes. If medical management does not improve symptoms, surgery can be done to restore blood flow (revascularization) to the affected leg.

What is claudication?

Claudication is derived from the Latin verb claudicare , which means “to limp.” Claudication describes exercise-induced leg pain secondary to peripheral arterial disease (PAD). Patients with claudication typically complain of a burning or aching sensation in the thigh or calf, which starts after walking a predictable distance and remits with rest. With advanced disease, there may be progression to rest pain, skin ulceration, and tissue loss.

What are the causes?

This condition is caused by buildup of fatty material (plaque) within the major arteries in the body (atherosclerosis). Plaque makes arteries stiff and narrow, which prevents enough blood from reaching the leg muscles. Pain occurs when you walk or exercise because your muscles need (but cannot get) more blood when you are moving and exercising.

What increases the risk?

The following factors may make you more likely to develop this condition:

• A family history of atherosclerosis.
• A personal history of stroke or heart disease.
• Older age.
• Being inactive (sedentary lifestyle).
• Being overweight.
• Smoking cigarettes.
• Having another health condition such as:
  • Diabetes.
  • High blood pressure.
  • High cholesterol.

What are the symptoms?

Symptoms of this condition may first develop in the lower leg, and then they may spread to the thigh, hip, buttock, or the back of the lower leg (calf) over time. Symptoms may include:

• Aches or pains.
• Cramps.
• A feeling of tightness, weakness, or heaviness.
• A wound on the lower leg or foot that heals poorly or does not heal.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Your medical history.
• Tests, such as:
  • Blood tests.
  • Arterial duplex ultrasound. This test uses images of blood vessels and surrounding organs to evaluate blood flow within arteries.
  • Angiogram. In this procedure, dye is injected into arteries and then X-rays are taken.
  • Magnetic resonance angiogram (MRA). In this procedure, strong magnets and radio waves are used instead of X-rays to create images of blood vessels and blood flow.
  • CT angiogram (CTA). In this procedure, a large X-ray machine called a CT scanner takes detailed pictures of blood vessels that have been injected with dye.
  • Ankle–brachial index (ABI) test. This procedure measures blood pressure in the leg during exercise and at rest.
  • Exercise test. For this test, you will walk on a treadmill while tests are done (such as the ABI test) to evaluate how this condition affects your ability to walk or exercise.

How is this treated?

Treatment for this condition may involve treatment for the underlying cause, such as treatment for high blood pressure, high cholesterol, or diabetes. Treatment may include:

• Lifestyle changes such as:
  • Starting a supervised or home-based exercise program.
  • Losing weight.
  • Quitting smoking.
• Medicines to help restore blood flow through your legs.
• Blood vessel surgery (angioplasty) to restore blood flow around the blocked vessel. This is also known as endovascular therapy (EVT). This is only done if your intermittent claudication is caused by severe peripheral artery disease, a condition in which blood flow is severely or totally restricted by the narrowing of the arteries.

Follow these instructions at home:

Lifestyle

• Maintain a healthy weight.
• Eat a diet that is low in saturated fats and calories. Consider working with a diet and nutrition specialist (dietitian) to help you make healthy food choices.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• If your health care provider recommended an exercise program for you, follow it as directed. Your exercise program may involve:
  • Walking 3 or more times a week.
  • Walking until you have certain symptoms of intermittent claudication.
  • Resting until symptoms go away.
  • Gradually increasing your walking time to about 50 minutes a day.

General instructions

• Work with your health care provider to manage any other health conditions you may have, including diabetes, high blood pressure, or high cholesterol.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your pain does not go away with rest.
• You have sores on your legs that do not heal or have a bad smell or pus coming from them.
• Your condition gets worse or does not get better with treatment.

Get help right away if:

• You have chest pain.
• You have difficulty breathing.
• You develop arm weakness.
• You have trouble speaking.
• Your face begins to droop.
• Your foot or leg is cold or it changes color.
• Your foot or leg becomes numb.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• Intermittent claudication is pain in one or both legs that occurs when walking or exercising and goes away when resting.
• This condition is caused by buildup of fatty material (plaque) within the major arteries in the body (atherosclerosis). Plaque makes arteries stiff and narrow, which prevents enough blood from reaching the leg muscles.
• Intermittent claudication can be treated with medicine and lifestyle changes. If medical treatment fails, surgery can be done to help return blood flow to the affected area.
• Make sure you work with your health care provider to manage any other health conditions you may have, including diabetes, high blood pressure, or high cholesterol.