Claudication

Claudication, sometimes referred to as intermittent claudication, is pain experienced due to decreased amount of blood flow, mostly while exercising.

This condition usually affects the blood vessels in the legs, but sometimes blood vessels of arms can also be affected.

At an early stage, pain is felt only during exercise but as claudication progresses the pain may be experienced even at rest.

Claudication, rarely considered as disease, is indication of some other condition.

Mostly, claudication indicates peripheral artery disease, a condition in which blood vessels supplying your legs or arms are narrowed.

With the available treatments you can live a quality of life. 

Signs and symptoms of claudication are:

• Pain when exercising. Pain can be felt in area where artery is narrowed or damaged. You may feel pain in your feet, calves, thighs, hips or buttocks. Less commonly, you feel pain in your arms.
• Intermittent pain: With decreased physical activities, the pain may come and go.
• Worsening of your condition may cause pain in your legs even at rest.
• Discolored skin or ulcerations: Your toes or fingers may appear bluish or may feel cold due to reduced blood flow
• Other symptoms, such as an aching or burning feeling or weakness, may be experienced.

When to see a doctor?

Visit your doctor if you feel pain in your legs or arms while exercising. Untreated claudication and peripheral artery disease can reduce the quality of your life and cause fatal complications.

Claudication can affect your physical activities and interfere with work.

Peripheral artery disease is the main cause of claudication.

In peripheral artery disease, the arteries supplying blood to your arms and legs are damaged, usually due to atherosclerosis.

Atherosclerosis, deposits of fatty materials in artery, can develop in any of your arteries but mostly in the arteries of your heart.

Arteries become narrowed, stiffened and hardened due to atherosclerosis. Atherosclerotic plaques, fats, cholesterol and other materials, clog the arteries thereby reducing the amount of blood flowing through them.

Because of insufficient supply of oxygenated blood to your leg muscles, you feel pain. However, atherosclerosis isn't the sole cause of your symptoms of claudication.

Different medical conditions that have similar symptoms are

• spinal stenosis,
• peripheral neuropathy,
• certain musculoskeletal conditions
• and deep venous thrombosis.  

Claudication in most of the people may be undiagnosed because they believe the pain occurs due to aging.

Your doctor may refer you to a cardiologist (a doctor who specializes in disorders of the cardiovascular system) or a vascular surgeon.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. List out all the symptoms. Write down your key medical information. Write down the names of all your medications, vitamins or supplements.
Ask a friend or a family member to accompany you during the visit. Make a list of the questions to ask your doctor.

Some typical questions can be:

• What could be probable cause of my symptoms?
• What are the tests that I need?
• Is this condition acute or chronic?
• What are my treatment options and which one is most suitable for me?
• Can lifestyle modifications help me?
• Do I need to take some medications and what are possible side effects?
• Do I need to follow any restrictions?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like:

• When did your symptoms start appearing?
• Do you experience pain while exercising, at rest or both?
• How would you like to rate your pain on a scale of 1 to 10?
• Does anything improve or worsen your symptoms?
• Does sitting down or standing still relieve your symptoms?

In order to avoid pain some people reduces their physical activity. The tests recommended by your doctor are mostly non-invasive.

Some of the tests used in diagnosis of claudication are:

• Measurement of pulse in your feet: Ankle-brachial index, ratio of blood pressure of your ankles to the blood pressure of your arms, is determined to diagnose claudication.
• Doppler ultrasound: It is used to see the amount of blood flow in the affected area.
• Magnetic resonance imaging (MRI) or computerized tomography (CT) angiography is performed to check if your blood vessels are narrowed due to plaque.

Some other medical conditions associated with spine, joint or muscle can also cause leg pain. Diagnosis of your condition is dependent on your symptoms, medical condition, physical examination and appropriate test.

Treatment of claudication and peripheral artery disease is aimed at reducing progression of the disease and relieving your symptoms.

The first and major approach to treat claudication are lifestyle changes, such as quitting smoking and exercising regularly.

If your claudication symptoms don't get better after following a healthier lifestyle, your doctor may recommend:

• Medications: Common pain medication Aspirin may be prescribed to reduce the possibility of blood clot formation. Other similar medications such as, clopidogrel, dipyridamole and ticlopidine, can also prevent blood clotting. The medication cilostazol can increase the blood flow and relieve your symptoms. If cilostazol is contraindicated or if it proves to be ineffective, your doctor may prescribe you pentoxifylline. Furthermore, your doctor may recommend statin to lower your cholesterol.

• Angioplasty: Severe claudication and peripheral artery disease, though uncommon, may require angioplasty. In angioplasty, the narrowed arteries are widened by passing a narrow tube containing inflatable balloon through the affected blood vessels to increase circulation. Afterwards, a stent (a small metal or plastic tube) is placed in the widened artery to prevent it from narrowing.

• Vascular surgery: Another treatment option includes replacement the narrowed blood vessels by healthy blood vessels from other parts of your body.

Your doctor can recommend a combination of treatments, such as medications and angioplasty, for the treatment of claudication.

Claudication can be prevented if you maintain healthy life style. Following tips help to reduce the risk:

• Quit smoking
• Control your blood sugar level if you are diabetic
• Exercise regularly
• Lower your blood cholesterol level and blood pressure level, if necessary.
• Avoid foods that are rich in saturated fat.
• Maintain a healthy weight.

No alternative remedies have been found to be effective in treating claudication. Some treatments have been proven to be beneficial in some people but ineffective in others.

The medications are ginkgo, propionyl-L-carnitine. L-arginine has shown to provide relief from symptoms of claudication.

Vitamin E and omega-3 fatty acids, despite being unable to relieve symptoms, have been used as treatments for claudication.

Maintaining a healthy lifestyle is the best way to cope with claudication.

Unhealthy lifestyle can cause deposition of plaques in your arteries. Hence, it is essential to avoid unhealthy habits. Following tips can be useful:

• Quit smoking: Smoking is likely to cause and worsen peripheral artery disease. Smoking may lead to necessity of amputation. Avoid exposure to secondhand smoke.

• Exercise: Exercising helps your muscles to use oxygen effectively which can lessen the pain during physical exertion. Exercise program under the supervision of your health care team will gradually increase motility and your ability to walk without pain.

• Maintain your blood cholesterol level: If your cholesterol levels are high, your doctor may prescribe medication to reduce it to optimum levels. If you have high cholesterol, you may:
  • • Reduce your fat intake: Follow a diet that contains fruits, vegetables, grains and legumes.
    • Exercise: Stay active and follow an exercise regimen after consulting your doctor.

A combination of proper exercise and proper diet can help you manage your blood pressure and cholesterol levels, both of which are responsible for developing atherosclerosis.

• Avoid medications that constrict your blood vessels: Medication for sinusitis and over-the-counter cold medications contain pseudoephedrine that constricts blood vessels. Ask your doctor if there are any medications that should not be taken.

• Avoid foot or leg injury: Injuries in your feet or legs can increase the risk of complications. Wear shoes that are protective even during conditions likely to cause injury. Circulation of blood to your feet can be improved if you keep your legs below your heart. Raising the upper end of bed by 4 to 6 inches can improve blood flow to your legs and feet at night

• Expand your knowledge about claudication. You may find new and safe ways to manage your pain.

• Join support group.

There are several risks and complications associated with claudication.

Risks

• Smoking
• High blood cholesterol level
• High blood pressure
• Obesity
• Diabetes
• Age: Claudication is more common in people above70. If you are a smoker and a diabetic, the risk is further increased after your reach 50
• A family history of atherosclerosis, peripheral artery disease or claudication increases the risk.

Complications

In severe cases, extreme reduction in blood flow to your legs or arms can cause pain even at rest. You may also experience cold legs or arms. Delayed wound healing is common among people with severe peripheral artery disease.

In extreme condition, this can lead to development of gangrene requiring limb amputation.