Claudication

Overview

Claudication is pain caused by too little blood flow to muscles during exercise. Most often this pain occurs in the legs after walking at a certain pace and for a certain amount of time — depending on the severity of the condition.

The condition is also called intermittent claudication because the pain usually isn't constant. It begins during exercise and ends with rest. As claudication worsens, however, the pain may occur during rest.

Claudication is technically a symptom of disease, most often peripheral artery disease, a narrowing of arteries in the limbs that restricts blood flow.

Treatments focus on lowering the risks of vascular disease, reducing pain, increasing mobility and preventing damage to tissues.

Claudication

Claudication is pain caused by too little blood flow to your legs or arms. This is usually a symptom of peripheral artery disease, in which the arteries that supply blood to your limbs are narrowed, usually because of atherosclerosis. Atherosclerosis occurs when arteries get thick and stiff due to a buildup of fatty deposits (plaques) on your artery walls.

Symptoms

Claudication refers to muscle pain due to lack of oxygen that's triggered by activity and relieved by rest. Symptoms include the following:

  • Pain, ache, discomfort or fatigue in muscles every time you use those muscles
  • Pain in the calves, thighs, buttocks, hips or feet
  • Less often, pain in shoulders, biceps and forearms
  • Pain that gets better soon after resting

The pain may become more severe over time. You may even start to have pain at rest.

Signs or symptoms of peripheral artery disease, usually in more-advanced stages, include:

  • Cool skin
  • Severe, constant pain that progresses to numbness
  • Skin discoloration
  • Wounds that don't heal

When to see a doctor

Talk to your doctor if you have pain in your legs or arms when you exercise. Claudication can lead to a cycle that results in worsening cardiovascular health. Pain may make exercise intolerable, and a lack of exercise results in poorer health.

Peripheral artery disease is a sign of poor cardiovascular health and an increased risk of heart attack and stroke.

Other conditions involving the blood, nerves, and bones can contribute to leg and arm pain during exercise. It's important to have a complete exam and appropriate tests to diagnose potential causes of pain.

Causes

Claudication is most often a symptom of peripheral artery disease. The peripheral arteries are the large vessels that deliver blood to the network of vessels in your legs and arms.

Peripheral artery disease is damage to an artery that restricts the flow of blood in an arm or leg (a limb). When you're at rest, the limited blood flow is generally still enough. When you're active, however, the muscles aren't getting enough oxygen and nutrients to work well and remain healthy.

Damage to peripheral arteries is usually caused by atherosclerosis. This is the buildup of cholesterol and other fats, blood cells, and other cellular debris into abnormal structures (plaques) on the lining of an artery.

Plaques cause a narrowing and stiffening of the artery, limiting the flow of blood. If the plaques rupture, a blood clot can form, further reducing blood flow.

Development of atherosclerosis

Atherosclerosis is a process in which blood, fats such as cholesterol and other substances build up on your artery walls. Eventually, deposits called plaques may form. The deposits may narrow or block your arteries. These plaques can also rupture, causing a blood clot.

Risk factors

The risk factors for peripheral artery disease and claudication include the following:

  • Smoking
  • High cholesterol
  • High blood pressure
  • Obesity (a body mass index, or BMI, over 30)
  • Diabetes
  • Chronic kidney disease
  • Age older than 70 years
  • Age older than 50 years if you also smoke or have diabetes
  • A family history of atherosclerosis, peripheral artery disease or claudication

Complications

Claudication is generally considered a warning of significant atherosclerosis in the circulatory system, indicating an increased risk of heart attack or stroke. Additional complications of peripheral artery disease due to atherosclerosis include:

  • Skin lesions that don't heal
  • Death of muscle and skin tissues (gangrene)
  • Amputation of a limb

Prevention

The best way to prevent claudication is to maintain a healthy lifestyle and control certain medical conditions. That means:

  • Quit smoking if you're a smoker
  • Exercise regularly
  • Eat a healthy, well-balanced diet
  • Maintain a healthy weight
  • If you have diabetes, keep your blood sugar in good control
  • Keep cholesterol and blood pressure within normal values

Diagnosis

Claudication may go undiagnosed because many people consider the pain to be an unwelcome but typical part of aging. Some people simply reduce their activity level to avoid the pain.

A diagnosis of claudication and peripheral artery disease is based on a review of your symptoms, a physical exam, evaluation of the skin on your affected limbs, and tests to check blood flow.

Some common tests used to diagnose claudication may include:

  • Pulse measurement in your palms or feet to assess blood flow to the entire limb
  • Ankle-brachial index, a comparison of blood pressure in your ankles with the blood pressure in your arms
  • Segmental blood pressure measurement, a series of blood pressure measurements at different areas on your arm or leg to help determine the amount and location of arterial damage
  • Exercise testing to determine the maximum distance you can walk or the maximum exertion without pain
  • Doppler ultrasound to see the flow of blood
  • Magnetic resonance imaging (MRI) or computerized tomography (CT) angiography to look for narrowed blood vessels

Treatment

The goals of treating claudication and peripheral artery disease are to reduce pain and manage the risk factors that contribute to vascular disease.

Exercise

Exercise reduces pain, increases exercise duration, improves vascular health in the affected limbs, and contributes to weight management and an overall improvement in your quality of life.

Recommended walking programs include:

  • Walking until you feel moderate pain
  • Resting to relieve pain
  • Walking again
  • Repeating the walk-rest-walk cycle for 30 to 45 minutes
  • Walking three or more days a week

Supervised exercise is recommended for beginning the treatment, but long-term exercise at home is important for ongoing disease management.

Medications to manage risk factors

Your doctor may prescribe one or more medications to control pain and manage risk factors for vascular disease. These include drugs to manage the following:

  • Pain. The drug cilostazol, which improves blood flow, may reduce pain during exercise and enable you to walk further.
  • High cholesterol. Statins are a class of drugs that help lower cholesterol, a key factor in the formation of plaques in arteries. Taking statins may improve the walking distance.
  • High blood pressure. Several different classes of drugs may be prescribed to lower blood pressure and reduce the risk of heart attack or stroke.
  • Other cardiovascular risks. Anti-platelet drugs, which help prevent the formation of blood clots, may reduce the risk of heart attack, stroke or clots blocking blood flow to limbs. These drugs include aspirin, clopidogrel (Plavix) and other classes of drugs.

Talk to your doctor about over-the-counter medications, supplements or other medications that you shouldn't take with your prescribed treatment.

Surgery

When peripheral artery disease is severe and other interventions do not work, surgery may be required. Options include:

  • Angioplasty. This is a procedure to improve blood flow by widening a damaged artery. A doctor guides a narrow tube through your blood vessels to deliver an inflatable balloon that expands the artery. Once the artery is widened, your doctor may place a small metal or plastic mesh tube (stent) in the artery to keep it open.
  • Vascular surgery. During this type of surgery, the doctor takes a healthy blood vessel from another part of your body to replace the vessel that's causing claudication. This allows blood to flow around the blocked or narrowed artery.

Lifestyle and home remedies

A healthy lifestyle is essential for improving treatment outcomes and lowering risks associated with claudication and peripheral artery disease. Recommended lifestyle changes include the following:

  • Smoking. If you smoke, quit. Smoking greatly increases the risk of complications of peripheral artery disease. Talk to your doctor if you need help quitting.
  • Exercise. Follow the exercise plan recommended by your doctor. Regular exercise is important for weight management and good heart health.
  • Eat a healthy diet. Eat plenty of low-starch vegetables, fruits and whole grains, and modest portions of lean meats, poultry, fish and low-fat dairy.
  • Foot care. Talk to your doctor about proper foot care. Know how to inspect your feet to ensure proper and prompt treatment of injuries. Wear socks and appropriate shoes to support and protect your feet.

Alternative medicine

Researchers have studied alternative treatments for claudication and peripheral artery including:

  • Ginkgo biloba
  • L-arginine
  • Vitamin E
  • B complex vitamins
  • Chelation therapy

To date, these studies have produced negative, inconclusive or contradictory results. Talk to your doctor before starting any type of alternative to make sure it's safe for you.

Coping and support

It can be concerning to learn that the reason you're having pain is that your blood vessels are narrowing. Learning all you can about what's causing your claudication can put you in control, and you'll know exactly what steps to take to ease your pain.

Some people also find it helpful to talk with other people who are going through the same thing that they are. In a support group, you may find encouragement, advice, and maybe even an exercise partner or two. Ask your doctor if there are any support groups in your area.

Preparing for an appointment

You're likely to start by seeing your family doctor. However, you may then be referred to a doctor trained in cardiovascular diseases (cardiologist) or a vascular surgeon.

To make the best of your appointment time, be prepared to answer the following questions:

  • When did you first begin having symptoms?
  • Do you have pain when you're walking or exercising, when you're at rest, or both?
  • On a scale of 1 to 10 (10 being the worst), how would you rate the pain?
  • Does anything seem to improve your symptoms, such as resting?
  • Do you need to sit down to get symptom relief, or does stopping and standing in one place relieve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Is the pain keeping you from regular exercise or normal daily activities?
  • Are you having any other symptoms?
  • Have you recently started or stopped taking any medications or supplements?
  • Do you have a personal history or family history of high blood pressure, high cholesterol, diabetes, heart disease or stroke?

What you can do

You'll also be asked about the medications you take, including over-the-counter medications and supplements. Before your appointment, write down each drug's name, dosage, reason for taking it, and the name of the prescribing doctor. Bring the list with you to your appointment.

Other strategies to help you use your appointment time well include the following:

  • Bring a friend along for support, to take notes and to ask questions of clarification.
  • During your appointment, ask your doctor about anything you don't understand.
  • Take notes or ask for a printed document outlining next steps for scheduling tests or additional appointments.

Last Updated Jan 11, 2020


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