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Claudication, also known as intermittent claudication, is a muscle pain that occurs due to insufficient blood supply to the muscles while moving and disappears with rest and is a circulatory problem that often affects legs after walking or exercising at a given speed and for a certain amount of time.
Claudication arises when muscle cells work harder and require more oxygen than the blood can provide during movement such as exercise. The discomfort associated with claudication is not always constant since it typically begins during physical activity and subsides with rest.
If left untreated, the condition may progress to the point where the pain occurs even at rest. In severe cases, the pain may be debilitating and prevent individuals from engaging in simple activities such as walking. Claudication-related pain can signify major health problems, most often peripheral arterial disease, a narrowing of arteries in the limbs that inhibits blood flow.
There are various treatments available to manage claudication, including lifestyle modifications, medication, and surgery. Treatments are aimed at improving circulation in the areas of pain. Specifically, alleviating discomfort, enhancing mobility, avoiding tissue damage, and minimizing the risk of serious heart and circulation problems.
Symptoms
Claudication is a condition that specifically affects the muscles and does not typically cause joint pain or arthritis. Once physical activity is stopped and the affected muscles are rested, the pain associated with claudication should subside within a few minutes or less. This muscle pain is caused by a lack of oxygen to the muscles, which is triggered by activity and relieved by rest. Symptoms commonly include:
- Typically presents as muscle pain, spasms, cramps, aching, or fatigue in certain muscles that are being used during physical activity
- Calves, thighs, buttocks, hips, or feet pain
- Pain in the shoulders, biceps, and forearms occurs occasionally
- Pain that improves quickly after resting
In some cases, the pain associated with claudication may progress and occur even when the individual is at rest or is no longer active. In severe cases, signs or symptoms of advanced peripheral artery disease may also develop, including:
- Skin feels colder
- Intense, constant pain that advances to feeling of numbness
- Noticeably pale or discoloration of the skin
- Slow to heal wounds
If there is noticeable pain in the legs or arms during exercise, it is important to consult a healthcare provider. Other conditions affecting the blood, nerves, and bones can also cause pain during exercise. Early treatment is crucial in order to prevent or minimize potential complications in the future.
Claudication can set off a cycle that deteriorates cardiovascular health. Activity may become uncomfortable due to pain, and a lack of physical activity may result in poorer health. Peripheral artery disease indicates poor cardiovascular health and a higher risk of heart attack and stroke.
Identifying the underlying cause of pain resembling claudication may involve evaluating several potential illnesses that are significantly more hazardous. A comprehensive examination and appropriate diagnostic tests are necessary to determine various sources of pain.
Causes
A condition known as peripheral artery disease (PAD) is the primary cause of intermittent claudication. The condition of intermittent claudication is caused by atherosclerosis, a buildup of plaque on the inner walls of arteries. With the progression of this accumulation, the arteries narrow, reducing the space for blood to flow through them. If plaque or a blood clot narrows or blocks the arteries, blood can’t get through to nourish organs and other tissues.
Peripheral artery disease is caused by arterial injury that restricts blood flow in an arm or leg (a limb). When a person is at rest, the restricted blood flow is usually sufficient. When an individual is physically active, inadequate oxygen and nutrients are supplied to the muscles affected by intermittent claudication, leading to compromised functionality and diminished overall health.
Because the circulatory system of the body is linked, the effects of PAD might spread beyond the affected limb. People who have atherosclerosis in their legs are more likely to get it in other sections of their bodies.
Risk factors
Several factors may contribute to increasing one’s risk of claudication as well as peripheral artery disease, such as:
- Family history: Having a personal or family history of atherosclerosis, peripheral artery disease or claudication
- Age: Age 70 years or older
- Tobacco use or with diabetes, who are age 50 years and older
- Weight: Obesity increases the risk to develop claudication
Smoking - Other disease: The pre-existing condition could increase the risk of claudication such as chronic kidney disease, diabetes, hypertension (high blood pressure), and high cholesterol
Diagnosis
Intermittent claudication is often disregarded because many individuals assume that discomfort is a common, unpleasant aspect of getting older. Some individuals limit their physical activity to avoid pain. Despite being a symptom rather than a distinct health issue, healthcare providers will likely recommend medical tests to diagnose intermittent claudication and prevent further discomfort.
A diagnosis of claudication and peripheral artery disease is made using various methods, including a symptom review, physical examination, examination of the skin on the limbs, and blood flow tests. These tests can assist determine the source of the discomfort, rule out other conditions or problems, and guide treatment.
- Tests: Claudication may be diagnosed through the following tests:
- Pulse measurement: in the palms, legs, or feet using a stethoscope to evaluate blood flow. The detection of weaker-than-normal or absent pulses in the legs or feet, either through touch or sound, is an alarming sign that requires attention.
- Ankle-brachial index (ABI): Compares and evaluates the ankle and arm blood pressure. If the ankle pressure is significantly lower than the arm pressure, the patient may have claudication in one or both legs.
- Segmental blood pressure measurement: Utilized to identify the extent and location of artery damage. A sequence of blood pressure measurements taken at several points on the arm or leg.
- Exercise test: Establish the highest amount of exertion one can tolerate without pain or establish the farthest distance one can walk.
- Doppler ultrasound: Show blood flow in a specific area.
- MRI or CT angiography: Check for blood vessel constriction or determine the underlying cause of intermittent claudication.
Treatment
The treatment for claudication focuses on the management of symptoms. Since claudication increases the risk of major heart and circulatory problems, the treatment usually includes preventive measures to avoid those complications.
Intermittent claudication is rarely harmful on its own, but it might be an indication of more serious health issues. Exercise is a key component of the treatment. It alleviates pain, lengthens exercise sessions, improves vascular health in affected limbs, and aids in weight management. Long-term exercise at home is essential for continuous claudication management and and enhances overall quality of life.
To manage the pain, healthcare providers may recommend walking programs that involve walking at a pace and distance that elicits tolerable pain or claudication. Patients can take a break and rest until the pain subsides before resuming walking. The walking and resting sessions can gradually increase to 30-45 minutes, with the goal of walking at least three times per week.
- Medications: Medications are frequently used to treat intermittent claudication. These medications help improve circulation or avoid complications caused by claudication and can also minimize risk factors for heart disease. It is important to consult with a doctor before taking any medications or supplements in conjunction with the prescribed treatment to avoid any potential adverse effects or interactions. Medication may be used to treat the following conditions:
- Pain: Cilostazol, medication that enhances blood circulation, relieve pain during workout and improves walking distances may be prescribed.
- High cholesterol: Taking statins may increase walking distance. These drugs lower the blood cholesterol levels. Higher cholesterol levels can accelerate plaque formation in arteries. Lowering those levels helps to prevent that buildup and any associated problems, such as heart attacks.
- Hypertension: Several drugs often relax and enlarge the blood vessels, boosting blood flow. Improving blood flow can significantly reduce or eliminate claudication-related pain. These drugs also aid in the prevention of conditions such as heart attacks and strokes.
- Other cardiovascular risks: Prescribed medications such as aspirin and clopidogrel may be used to aid in the prevention of blood clots, lower the risk of a heart attack, stroke, or clots limiting blood flow to limbs. These drugs are collectively known as anti-platelet drugs.
- Surgical procedures: Treatment for claudication and severe peripheral artery disease may include surgery. This is often recommended if the medications fail to manage the condition. Revascularization techniques aimed at restoring blood flow can help alleviate or reduce the pain associated with intermittent claudication. Common surgical procedures include:
- Angioplasty: This treatment increases blood flow by expanding a blocked artery. A healthcare professional guides the catheter into the blood vessels in order to deliver an inflatable balloon that stretches the artery. They can also insert a stent, which is a scaffold-like structure that keeps the artery open so blood can flow freely.
- Vascular surgery: This surgical procedure helps blood to circulate around the restricted or obstructed artery. This technique uses a blood vessel from another part of the body to create a detour-like path for blood to go. That bypass, once in place, offers adequate blood flow to prevent intermittent claudication.
