Claudication

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 26, 2016
StartDiseasesClaudication

Claudication or intermittent claudication is a condition that can be related to cardiovascular disease or neuropathy. In the former case, there is reduced blood flow in the lower body or arms when exercising which causes severe pain. This is usually a function of peripheral artery disease. Recent advances in treatments and therapy techniques have allowed people diagnosed with claudication to live healthy, pain-free lives, but many doctors simply endorse frequent periods of rest.

Contents

Definition & Facts

People who suffer from claudication typically are very susceptible to leg cramping and lower extremity pain. These issues are often the result of severe arterial blockage and poor circulation though may be linked to nerve damage or injury.

Claudication is often referred to as intermittent because the pain and cramping only occur when the body is in motion and symptoms abate when the body is at rest. The term claudication comes from the Latin term 'claudicare', which can mean one who limps or the physical action of limping. Regularly visiting a physician and being honest about pain and symptoms is the only way to address claudication.

Symptoms & Complaints

The main symptom or complaint that people who have claudication have is pain in the lower body. This pain can come in a variety of types and severity: it can be throbbing, burning, a dull ache, or a sharp jolt. Arterial plaque and blockage location, muscle activity, and progression of the condition can all help determine the type of pain that is experienced.

In the case of vascular claudication, if the atherosclerotic blockage occurs below the knee, the pain will only be felt in the thigh, but if it occurs above the knee the pain can be felt throughout the leg and symptoms such as erectile dysfunction or groin cramping can occur.

General weakness and skin discoloration of the extremities are a few other common symptoms of claudication. If blood flow is extremely low, sores may begin developing on the lower legs or feet. Eventually, when the issue compounds further, pain may be felt even when the body is not in motion; this pain will usually be in the lower legs. 

Causes

Claudication can arise from a number of different medical conditions. The most common of these conditions is peripheral artery disease, which causes damage to the arteries carrying blood from the heart to the body's limbs.

Peripheral artery disease is often caused by isolated atherosclerosis plaque that accumulates away from the heart, in the lower legs or forearms. These plaque clumps are composed of fat and cholesterol that cause the narrowing of certain arteries and make it difficult for oxygenated blood to complete its circulation of particular regions. The pain experienced by those with claudication is the result of insufficient oxygen flows to weary and working muscles. 

Claudication symptoms such as muscle pain can also be caused by spinal stenosis and peripheral neuropathy. When the lumbar vertebrae becomes compressed (lumbar spinal stenosis), it can cause neurogenic claudication which produces symptoms that are often indistinguishable from vascular claudication. Peripheral neuropathy describes conditions in which the nerves are damaged or diseased, often as a result of frequent heavy drinking or the onset of diabetes mellitus.

Diagnosis & Tests

Because it is possible for some people with claudication to tolerate its symptoms and simply decrease the amount of physical activity undertaken in order to control the pain, many cases of claudication go undiagnosed by medical professionals.

However, once patients indicate that they are experiencing pain, doctors will take a thorough medical history and attempt to identify the source of the pain through a series of relatively non-invasive tests. Doctors often begin by manually measuring the pulse in the feet to check on the flow of blood in that region; they can move onto the ankle-brachial pressure index, where blood pressure readings at the ankle and arm are compared, if they suspect claudication or an underlying disorder.

After these basic manual tests, doctors may employ an ultrasound machine in order to detect and determine the location of any artery blockages and the severity of the narrowing of the arteries. Doppler ultrasound is able to measure blood flow and blood pressure. Magnetic resonance imaging (MRI) exams and computerized tomography angiograms (CT angiograms) can also be used to detect blockages and map blood flow in impacted regions of the body. 

Treatment & Therapy

Claudication is often treated by combining one or more of the following treatments: antithrombotic (anti-blood clot) medications, revascularization surgery, and angioplasty. Most medicinal treatments focus on improving blood flow throughout the body and decreasing the patient's risk of blood clots.

Aspirin is commonly used to loosen clots, and more advanced medicines like clopidogrel and cilostazol are often used to control symptoms and speed up blood flow. Cholesterol-lowering drugs may be used by the doctor in tandem with other approaches if high cholesterol is deemed to be a prominent cause of the condition. 

The primary surgical option presented to patients is bypass surgery in which blocked blood vessels are bypassed by healthy blood vessels grafted from elsewhere in the body or from artificial blood vessels. Standard angioplasty surgery helps artificially widen arteries by inserting a narrow, balloon-propelled tube into the affected area. Stents, or wire mesh contraptions, are often used to hold the blood vessel open after the angioplasty is completed. 

Surgical approaches to address neurogenic claudication include spinal decompression. This surgery may take the form of removing ligaments or lamina (laminectomy) of the vertebrae in order to reduce compression of nerves and relieve claudication.

Prevention & Prophylaxis

Risk factors for claudication include smoking, high cholesterol, high blood pressure, and obesity, so the best way to prevent the onset of claudication is to maintain a healthy lifestyle.

Maintaining a healthy diet, exercising regularly, treating pre-existing conditions such as diabetes, and improving self-care are all preventative approaches against claudication. For patients over the age of 50, adopting a healthy and active lifestyle is particularly crucial.