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Claudication

Definition

It strikes when you walk — a distinct pain or cramping in your calf. You stop for a few minutes, and the pain goes away. You continue on, and the pain comes back.

Your leg pain may be claudication. Claudication is most often a symptom of peripheral arterial disease, a potentially serious but treatable circulation problem. Fortunately, with treatment, you may be able to maintain an active lifestyle without pain.

Symptoms

One of the classic symptoms of peripheral arterial disease is pain in the muscles of the legs, especially the calves. This pain is called claudication, also known as intermittent claudication. Claudication can also occur in the arteries of your arms. Claudication is sometimes considered a disease, but technically, it's a symptom of a disease.

Some of the signs and symptoms of claudication include:

• Pain in your legs when exercising. The pain could be in your feet, calves, thighs, hips or buttocks depending on where you might have artery narrowing or damage.
• Intermittent pain. Your pain may come and go as you do less-strenuous activities.
• Pain when at rest. If your condition is serious, you may feel pain in your legs even when you're sitting or lying down.
• Discolored skin or ulcerations. If your claudication is severe, your toes may look bluish or feel cold to the touch. You may also develop ulcerations on your lower legs, feet or toes.

Causes

Claudication is a symptom of peripheral arterial disease. In peripheral arterial disease, the arteries that supply blood to your limbs are damaged. This damage is often the result of atherosclerosis. Atherosclerosis can develop in any of your arteries, especially those in your heart. When atherosclerosis affects your arms and legs, it's called peripheral arterial disease.

Atherosclerosis makes arteries hard and narrow. That's because the arteries get clogged with clumps of fat, cholesterol and other material, called atherosclerotic plaques. These plaques can make arteries so narrow that less blood can flow through them. You feel pain because your leg muscles are not getting enough oxygenated blood.

Risk factors

The risk factors for claudication are the same as those for developing atherosclerosis. They include:

• Smoking
• Total blood cholesterol over 240 mg/dL (6.45 mmol/L)
• High blood pressure (a systolic pressure of 140 mm Hg or higher and a diastolic pressure of 90 to 99 mm Hg or higher)
• Obesity (a body mass index over 30)
• Diabetes
• Age over 50 years
• A family history of atherosclerosis, peripheral artery disease or claudication

When to seek medical advice

Talk to your doctor if you have pain in your legs when you exercise. If left untreated, claudication and peripheral arterial disease can reduce the quality of your life. Claudication may limit your ability to participate in social and leisure activities, interfere with work, and make exercise intolerable.

Tests and diagnosis

Claudication often goes undiagnosed because many people consider the pain an unwelcome but inevitable consequence of aging. But the tests your doctor may use to diagnose your condition are often noninvasive and can get you on your way to resuming an active life.

Some common tests used to diagnose claudication include:

• Checking the pulses in your feet.
• Ankle-brachial index. This test compares the blood pressure in your ankle arteries to the blood pressure in your arms.
• Doppler ultrasound. This test monitors blood flow in the area affected.
• Magnetic resonance imaging (MRI) or angiography to show damage to blood vessels.

The pain in your legs could be another condition, such as spine, joint or muscle problems. Your doctor can make a diagnosis based on your symptoms and a medical history, physical exam and appropriate tests.

Complications

Claudication can be worsened by some medications, such as beta blockers. They can reduce blood flow or cause your blood vessels to constrict, interfering with circulation. If you're taking beta blockers, make sure you talk to your doctor about decreasing the dose or stopping this medication. Your claudication may also worsen in colder temperatures.

In extreme cases, the circulation in your legs can be so limited that you feel pain even when you aren't exercising, and your legs might feel cool to the touch. Though rare, severe cases can lead to poor healing of skin injuries and ulcers. These cuts and ulcers can develop gangrene and require amputation.

Treatments and drugs

Treatment of claudication and peripheral arterial disease is designed prevent your disease from getting worse and reduce your symptoms.

If your claudication symptoms don't ease after adopting a healthier lifestyle, your doctor may suggest other treatment options, including:

• Medications. Certain medications can improve your circulation. Your doctor may prescribe a blood thinner such as warfarin (Coumadin) to decrease blood clotting or a cholesterol-lowering drug (statin) to lower your cholesterol. Your doctor might also recommend you take aspirin to reduce the narrowing of your arteries.
• Angioplasty. Cases of claudication and peripheral arterial disease that are more severe may require angioplasty. This is a procedure in which damaged arteries are widened with a balloon catheter to improve circulation. A stent is often implanted at the same time to keep the artery propped open. This is similar to angioplasty of your heart arteries (coronary angioplasty).
• Vascular surgery. Your doctor may recommend surgery that takes a healthy blood vessel from another part of your body to replace the vessel that's causing your claudication. This allows blood to flow around the blocked or narrowed artery.
• Thrombolytic therapy. If you have an artery that's blocked by a blood clot, your doctor may insert a clot-dissolving drug into your artery to break it up.
• Hyperbaric chamber. If you have ulcers on your legs from severe claudication, your doctor may recommend you sit in a hyperbaric chamber to help your ulcers heal. A hyperbaric chamber is an oxygen-rich environment that helps cuts and sores heal and promotes cell growth.

Lifestyle and home remedies

The plaques that have damaged your arteries are often the result of unhealthy lifestyle habits. So a key component of treatment is stopping any unhealthy habits and adopting healthy ones.

If you have claudication or peripheral arterial disease, make sure you:

• Don't smoke. Smoking is the most significant risk factor for the development and worsening of peripheral arterial disease. Smoking increases the chance that you'll eventually require an amputation or even die of the disease. Also avoid secondhand smoke.
• Exercise. You may wonder how exercise can be helpful if that's what brings on the claudication pain. Actually, exercise helps condition your muscles so that they use oxygen more efficiently. So even if your muscles are getting less oxygen, they can use what they do get more effectively. That can mean less pain during exertion. In addition, exercise promotes the growth of new, healthy blood vessels. These new blood vessels provide an alternative path for blood to reach your extremities. Your health care team can help develop a supervised exercise program that will enable you to gradually increase the distance you're able to walk without pain and increase your overall mobility.
• Know and control your cholesterol levels. If your cholesterol levels aren't optimal, your doctor may recommend medications. Also, follow a meal plan that includes a variety of low-fat foods, emphasizing fruits, vegetables, grains and legumes. Combined with exercise, a healthy diet can help control your blood pressure and cholesterol levels, both of which can contribute to atherosclerosis.