Intermittent Claudication

by Dr. Jeffrey R. Carlson
The word claudication is derived from the Latin word “claudeo” meaning “to limp”. Pain that develops in the leg muscles when exercising or during other physical activity can be a condition called intermittent claudication. This pain normally occurs due to poor circulation of blood in the legs. You may only feel claudication as you exercise, but as time goes on you may begin to feel the pain while at rest.
What causes intermittent claudication?
Claudication is most often a symptom of peripheral artery disease, which is when the arteries that supply blood to the limbs are damaged. The arteries are damaged because of atherosclerosis, which narrows the arteries and clogs them up with fat and cholesterol. Atherosclerosis can develop in any of the arteries, but when it begins to affect the arms and legs it is called peripheral artery disease. Because the blood that is carrying the needed oxygen cannot flow through the artery with ease, you may feel pain in the legs as the muscles deplete the little oxygen that are receiving. Other causes of intermittent claudication can be from peripheral neuropathy, spinal stenosis, or deep venous thrombosis.
What are the risk factors?
• High blood pressure
• High cholesterol
• Sedentary lifestyle
• Older age (60+)
• Diabetes
• Smoking
• Obesity
• Family history of claudication
What are the symptoms?
One of the main symptoms of claudication is pain while exercising or moving around. This pain can feel like a burning sensation or weakness in the legs. The foot may become hairless, shiny and blotchy in appearance. If pain occurs while sleeping at night, this may be a sign that the condition is worsening.
How will I be diagnosed?
Many patients will let the pain from intermittent claudication go on, considering it just a consequence of older age. Pain in the legs could be caused by a variety of problems, so an accurate diagnosis is important. After discussing your medical history and doing a physical examination, there are a few other approaches that can be taken to correctly determine the cause of your pain. An ankle-brachial index (ABI) is a test that compares the blood pressure in the ankles with the blood pressure in the arms. Doppler ultrasound can monitor the blood flow by determining the velocity and direction of the blood cells through high-frequency sound waves. An angiogram can take images, like an x-ray, of a patient’s blood vessels and can determine if there is a blockage and the extent. An MRI (Magnetic Resonance Imaging) scan will show if the arteries are clogged and narrowed. It will also show if the patient has spinal stenosis, which is a narrowing of the spinal canal through which the spinal cord and/or specific nerves travel that carry messages to the legs. If the nerves are compressed, pain in the legs is the result.
What are my treatment options?
Treatment will be based on the condition of each patient. Most methods are conservative, and aim to manage the risk factors. Treatment of problems such as high cholesterol, blood sugar, and blood pressure can be managed through a healthy diet, regular exercise, and sometimes, medication. Medications will aid in widening the arteries, which should improve blood flow and reduce pain from claudication or decrease the viscosity, thickness and stickiness of the blood, which helps it flow better through the arteries and brings more oxygen to the muscles. For those patients who are smokers and experiencing the pain from claudication, a smoking cessation program will be recommended.
There are several surgical options available. Endovascular surgery, meaning inside the blood vessels, includes angioplasty and stenting of the arteries. An angioplasty procedure involves placing a balloon in the area that is blocked. Once the balloon is inflated, the artery will widen and increase the blood flow. Stenting is a procedure in which a wire coil is inserted to open up the blocked artery, and prevent scar tissue from reforming and decreasing the blood flow again. These will be handled by a vascular surgeon.
If the problem is caused due to spinal stenosis, I would recommend an epidural steroid injection first to see if the inflammation on the nerve can be decreased non-surgically. If that fails, surgical options would need to be explored. These could involve a laminectomy, where bone is removed to decompress the spinal cord and nerves. This is an outpatient procedure and patients do very well afterward, usually feeling immediate relief from the pain in their legs.
How can I prevent it?
Without spinal stenosis, there are steps you can take to reduce your chances of developing IC. Your primary care physician will be the best resource for your diagnosis and treatment. Because intermittent claudication can lead to other serious, life-threatening conditions, taking control of the risk factors involved is extremely important to a patient’s health. Maintaining a healthy weight and increasing physical activity, especially walking, are important factors in avoiding claudication. Eating foods that are low in saturated fat should be a modification to a patient’s diet. Those with high blood pressure or high blood sugar should be sure to follow appropriate precautions. Smoking can highly increase the chances for claudication, so all smoking should be stopped.
Spinal stenosis cannot be prevented, but maintaining an active lifestyle and a healthy weight will go a long way toward helping you manage your condition more easily should you ever need to be treated.