What is claudication?
Claudication refers to pain in the thigh, calf, and/or buttocks that occurs when walking and may cause you to limp. It may be a symptom of peripheral arterial disease (PAD).
At first, the pain of claudication occurs with a predictable amount of walking and disappears at rest. As the disease gets worse, the distance you can walk before pain develops may decrease. In time, you may no longer be able to walk because the pain is unbearable.
Because claudication is associated with disease conditions that also increase the risk for heart attack or stroke, you also need assessment and possible treatment of artery disease in other areas of the body.
What causes claudication?
Peripheral arterial disease is very common especially in people over the age of 50. PAD is caused by a narrowing or blockage of arteries in the legs or in the aorta, which may cause decreased blood flow to the muscles of the calf, thigh, or buttocks. This decreased blood flow may cause the pain that leads to claudication.
The blockage is usually a result of atherosclerosis. This is the build-up of plaque, which is a deposit of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of an artery. This is the same process that can affect heart arteries and lead to chest pain or heart attack.
Blockages in the leg are most common in the thigh and behind the knee but may also occur at other sites in the body including the aorta, groin, or abdomen. You can have more than one blockage.
Who is at risk for claudication?
Risk factors for claudication are the same as those for atherosclerosis, and include:
- Sedentary lifestyle
- High cholesterol
- High blood pressure
- Family history of atherosclerosis or claudication
- Older age (55 for men, 60 for women)
Knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and seeing your doctor.
What are the symptoms related to claudication?
Claudication itself is a symptom of a narrowing or blockage of an artery.
Typical characteristics of claudication include:
- Pain, a burning feeling, or a tired sensation in the legs and buttocks while walking
- Shiny, hairless, blotchy foot skin that may get sores
- Paleness in the limb when elevated and reddened when lowered
- Cold feet
- Impotence in men
- Leg pain that occurs at night when in bed
- Pain that occurs at rest may be a sign of increasing severity of arterial disease in the leg(s)
The symptoms related to claudication may look like other medical conditions or problems. Always consult your doctor for a diagnosis.
How is claudication diagnosed?
Diagnosis focuses on identifying narrowing of arteries in the lower extremities. In addition to a complete medical history and physical exam, other tests for claudication may include:
Ankle-brachial index (ABI). For this test,blood pressure is taken in the arms and in the legs and the two measurements are compared. ABI is done with a regular blood pressure cuff and a Doppler ultrasound device.
Auscultation. In this test, the doctor listens to the arteries of the belly (abdomen) or legs with a stethoscope to determine if a bruit (a "whooshing" sound) is present. A bruit indicates the blood flow is limited in the area.
Doppler ultrasound. For this test,a Doppler probe within the ultrasound transducer evaluates the speed and direction of blood flow in the vessel by bouncing high-frequency sound waves off of red blood cells. The transducer picks up the reflected waves and sends them to an amplifier, which makes the ultrasonic sound waves audible. Absence or faintness of these sounds may indicate an obstruction to the blood flow.
Angiogram (also called an arteriogram). This is an X-ray image of the blood vessels. It may be done to help determine the presence and extent of blockage. The procedure involves inserting a thin, flexible tube into an artery in the leg and injecting a contrast dye into the artery. The contrast dye makes the arteries and veins visible on the X-ray.
What is the treatment for claudication?
Specific treatment will be determined by your doctor based on:
- Your age, overall health, and medical history
- Extent of the disease
- The location of the blockage
- Your signs and symptoms
- Your tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
Claudication is usually treated first with lifestyle changes to modify the risk factors for peripheral arterial disease. Medication and surgery may be needed in some cases. Treatment may include:
- Smoking cessation
- Exercise, preferably a walking program
- Diet low in saturated fats
- Treatment of related medical problems, such as high cholesterol, high blood pressure, and/or high blood sugar levels. Treatment for these problems includes diet and exercise. In some cases, medication(s) may be prescribed.
- Prevention of blood clots with antiplatelet medication, such as aspirin or other medications
- Medications, such as pentoxifylline or cilostazol, that may improve walking distances in some cases
For severe cases, such as when blood flow has been completely or almost completely blocked a procedure or surgery may be needed. This may include:
- Angioplasty. This is the use of a catheter to create a larger opening in the vessel to increase blood flow. Often, a tiny coil called a stent is expanded inside the blocked artery to open the blocked area. The stent is left in place.
- Surgery may be needed to open the blocked artery.
In very few cases, when all other treatments have not been effective, the limb may need to be amputated. People who smoke or who have diabetes are at increased risk amputation.
Can claudication be prevented?
Atherosclerosis that causes claudication in the legs can also affect the blood vessels of the heart and brain. For this reason, it is important to aggressively modify your risk factors for atherosclerosis to prevent claudication as well as heart attack and stroke.
Preventative measures may include:
- Treating high blood pressure
- Lowering low-density lipoprotein (LDL) as directed by your doctor
- Lowering triglycerides (fats in the blood)
- Raising high-density lipoproteins (HDL) as directed by your doctor
- Maintaining normal weight
- Increasing physical activity, especially walking
- Controlling blood sugar levels if you have diabetes
- Smoking cessation and avoiding all forms of tobacco or nicotine
When should I call my health care provider?If your symptoms get worse or you get new symptoms, call your health care provider.
- Claudication is pain in the muscles of the legs when walking. Poor blood circulation to the muscles causes the pain with exertion. Rest relieves the pain.
- Prevention and treatment are aimed at improving blood flow to the peripheral arteries.
- Preventing high blood pressure, high cholesterol, controlling diabetes, stopping smoking and avoidance of all forms of tobacco are all very important for healthy circulation and halting claudication.
- People are encouraged to keep walking even with claudication pain to keep the muscles strong and the blood flow to the area.
Next stepsTips to help you get the most from a visit to your health care provider:
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
- Hanrahan, John, MD
- newMentor board-certified, academically affiliated clinician