Intermittent Claudication

The word claudication is derived from the Latin word “claudeo” meaning “to limp”. Pain that develops in the leg muscles when exercising or while 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?

Peripheral artery disease is the number one cause of Claudication, meaning there is damage to arteries that supply blood to the limbs. The arteries are damaged because of atherosclerosis, which narrows the arteries and clogs them up with fat and cholesterol. Any artery can show Atherosclerosis, 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. A variety of problems could cause pain in the legs, 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 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 are 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 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 is 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 with a healthy diet, regular exercise, and sometimes medication. Medications will widen the arteries, improving blood flow and reducing pain from claudication or decreasing the viscosity, thickness, and stickiness, of the blood. Doing so helps the blood flow better through the arteries and bring more oxygen to the muscles. For those patients who are smokers and experiencing the pain from claudication, a smoking cessation program may be recommended.

Surgery

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. A vascular surgeon will handle these procedures when necessary.

If the problem is due to spinal stenosis, an epidural steroid injection would first be tried to see if the inflammation of the nerve can be decreased non-surgically. If that fails, surgical options would need to be explored. These could involve a laminectomy, where the bone is removed to decompress the spinal cord and nerves. Laminectomy 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?

Your primary care physician will be the best resource for your diagnosis and treatment. The best prevention begins with an accurate diagnosis. Intermittent claudication can lead to other serious, life-threatening conditions, so 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 of 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.

There is no way to prevent Spinal stenosis, but maintaining an active lifestyle and a healthy weight will go a long way toward helping you recover more easily should you ever need to be treated.