Claudication
Claudication is pain from too little blood flow to the muscles during exercise. Often, the pain happens in the legs after walking at a certain speed and for a certain amount of time. But it depends on how much blood flow is blocked.
Claudication is a symptom, not a specific disease or condition. It’s most often related to narrowed arteries in the legs or arms, a condition called peripheral artery disease (PAD).
The condition also is called intermittent claudication. Intermittent means not constant. So the pain from claudication might come and go. It may begin during exercise and get better with rest. But as claudication gets worse, the pain may happen during rest and become constant.
The goal of treatment is to lower the risk of blood vessel damage, lessen pain, boost movement and prevent tissue damage.
The main symptom of claudication is muscle pain or cramping in the legs or arms that starts during exercise and usually ends with rest.
Your muscles may feel tired or achy when you use them. You might have pain in the following body areas:
- Back of the lower leg, called the calf.
- Thigh.
- Buttock.
- Feet.
Some people with claudication have pain in the shoulders, biceps and forearms.
The pain may get worse over time. You may even start to feel pain at rest.
If blood flow is badly reduced or blocked, you might have other symptoms such as:
- Cool skin.
- Severe pain that doesn’t go away.
- Numbness in an arm or leg.
- Changes in skin color.
- Sores that don’t heal.
Talk to a member of your care team if you have pain in your legs or arms when you exercise. Claudication can lead to a cycle that worsens heart and blood vessel health. For example, pain may make it hard or impossible to exercise. A lack of exercise is bad for your overall health.
Many things can cause leg and arm pain during exercise. It’s important to have a full health checkup and proper tests to look for the cause.
Claudication is most often a symptom of peripheral artery disease (PAD). The peripheral arteries are the large vessels that bring blood to the legs and arms. PAD is usually caused by a buildup of fats, cholesterol and other substances in and on the artery walls, a condition called atherosclerosis.
Peripheral artery disease limits the flow of blood in an arm or leg. When you’re resting, the reduced blood flow is often enough. But when you’re active, the muscles don’t get enough blood to meet demand.
Possible risk factors for claudication and conditions that cause it include:
- A family history of atherosclerosis, peripheral artery disease or claudication.
- Age older than 50 years if you also smoke or have diabetes.
- Age older than 70 years.
- Chronic kidney disease.
- Diabetes.
- High blood pressure.
- High cholesterol.
- Obesity, which is a body mass index (BMI) over 30.
- Smoking.
Claudication is a warning symptom of significant atherosclerosis, which raises the risk of heart attack and stroke. Complications may include:
- Skin sores that don’t heal.
- Death of muscle and skin tissues, also called gangrene.
- Need to remove an arm or leg, called amputation.
Following a heart-healthy lifestyle may help prevent claudication. Your care team may recommend the following changes to improve heart and blood vessel health:
- Eat a healthy, well-balanced diet.
- Get regular exercise.
- Keep a healthy weight.
- Manage cholesterol, blood pressure and blood sugar.
- Don’t smoke.
- Get enough sleep.
- Reduce stress.
- Limit or do not drink alcohol.
Claudication may go undiagnosed because some people may think pain is a typical part of aging. Some people might become less active to avoid the pain.
To diagnose claudication, a member of your care team examines you and checks the pulse in your arms and legs. The care team member will likely ask questions about health history and lifestyle habits. The team does tests to check the blood flow.
Tests
Tests used to diagnose claudication may include:
- Blood tests. Blood tests are usually done to check cholesterol and blood sugar levels.
- Ankle-brachial index (ABI). This test compares the blood pressure in the legs with the blood pressure in the arms. The blood pressure in your legs and arms should be the same. A care team member may ask you to walk on a treadmill during this test.
- Doppler ultrasound of the legs or feet. This test uses sound waves to look at blood flow. A health professional may use a special device to check blood pressure at different points along the leg. The measurements can show the speed of blood flow.
- Angiography. X-rays, MRI or CT scans check for blockages in the arteries. Before taking the images, a member of your care team injects dye into a blood vessel. The dye helps the vessels show up more clearly on the images.
The goals of treating claudication are to:
- Lessen pain.
- Improve your ability to walk a longer time or distance.
- Manage risk factors that lead to heart and blood vessel disease.
Claudication treatment may include exercise, medicines, or a procedure or surgery to open blocked arteries.
Exercise
Exercise is an important part of claudication treatment. It can:
- Lessen pain.
- Boost walking distance or time.
- Make blood vessel health better in the affected arms and legs.
- Help with weight management.
- Make quality of life better.
Your care team may suggest a walking program such as the following:
- Walk as far as you can or until you feel some pain.
- Rest to ease pain.
- Walk again.
- Repeat the walk-rest-walk cycle for 30 to 45 minutes.
- Walk three or more days a week.
Supervised exercise is recommended when beginning the walking program. But it’s important to keep exercising at home to manage claudication.
Medications
A member of your care team may prescribe one or more medicines to manage claudication pain. Also, medicines can help manage any risk factors for heart and blood vessel disease.
Medicines to treat claudication and its cause may include:
- Cholesterol medicine. Medicines called statins help lower cholesterol and plaque buildup in arteries. They often are used to treat people with peripheral artery disease (PAD), which can cause claudication. Taking statins may improve walking distance.
- Blood pressure medicine. Over time, high blood pressure can make the arteries hard and stiff. This can slow blood flow. A care team member may recommend a blood pressure medicine.
- Blood sugar medicine. Diabetes raises the risk of developing PAD, a risk factor for claudication. Your care team may prescribe medicines to help manage blood sugar levels.
- Blood thinners. Medicines such as aspirin or clopidogrel (Plavix) can help blood flow and keep blood clots from happening.
- Medicine for leg pain. Cilostazol is used to make blood flow better. This medicine might lessen pain during exercise and help you walk a longer time or distance.
Tell your healthcare team about all the medicines, vitamins and supplements you take, including those you buy without a prescription.
Surgery or other procedures
Some people with claudication need a procedure or surgery to open or fix a narrowed artery. Treatments may include:
- Angioplasty and stent placement. This treatment is done to open clogged arteries. A doctor guides a thin, flexible tube called a catheter to the narrowed part of the artery. A tiny balloon is inflated to improve blood flow. A doctor may place a small wire mesh tube called a stent in the artery to keep it open.
- Bypass surgery. A surgeon takes a healthy blood vessel from another part of the body or uses a manufactured blood vessel to create a path around the blocked artery.
- Thrombolytic therapy. A clot-dissolving medicine may be given directly into an artery blocked by a blood clot.
Making healthy lifestyle changes may help you manage claudication and stop it from getting worse.
- Don’t smoke. Smoking damages the arteries. It raises the risk for peripheral artery disease (PAD). If you have PAD, smoking can make the condition worse. If you need help quitting smoking, ask your care team about treatments that can help.
- Exercise. Follow the exercise plan recommended by your healthcare professional. Regular exercise is important for weight management and good heart health.
- Eat a healthy diet. Eat plenty of low-starch vegetables, fruits and whole grains. Choose lean meats, poultry, fish and low-fat dairy.
- Foot care. Talk with your healthcare team about proper foot care. Know how to check your feet for injuries and infection. Get a health checkup if you notice a sore or injury to your skin. Wear well-fitting shoes and thick, dry socks.
Make an appointment for a health checkup if you have leg pain or any other symptoms of claudication. You may be sent to a doctor trained in blood vessel conditions, called a vascular specialist. You also may see a doctor trained in heart disease, called a cardiologist.
Appointments can be brief. There’s often a lot to discuss. So it’s a good idea to be prepared for your appointment. Here’s some information to help you prepare for your appointment.
What you can do
- Be aware of anything you need to do ahead of time. When you make the appointment, ask if there’s anything you need to do in advance. For example, you may be told not to eat or drink for a few hours before a cholesterol test.
- Write down any symptoms you’re having. Write down any that may not seem related to claudication. Note when they started and what you were doing when they started.
- Write down important personal information. Include any family history of heart disease, stroke, high blood pressure or diabetes, and any major stresses or recent life changes.
- Make a list of all medicines, vitamins and supplements you’re taking. Include those bought without a prescription. Include the dosages.
- Take someone along, if possible. Someone who goes with you can help you remember information you’re given.
- Write down questions. Include anything you want to ask your healthcare team about.
Some basic questions to ask your care team include:
- What is the likely cause of my symptoms or condition?
- What are other possible causes?
- What kinds of tests will I need?
- What’s the proper treatment?
- What are other treatment options?
- What’s the right level of physical activity for me?
- Are there any other restrictions that I need to follow?
- I have other health conditions. How can I best manage them together?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
Don’t hesitate to ask any other questions during your appointment.
What to expect from your doctor
During a health checkup, you are usually asked many questions. Being ready to answer them may save time to go over any details you want to spend more time on. You may be asked:
- When did the symptoms start?
- Do your symptoms get worse when you exercise?
- Do your symptoms get better when you’re resting?
- How would you rate the pain on a scale of 1 to 10, with 10 being the worst?
- Is the pain keeping you from regular exercise or usual daily activities?
- Do you have any other symptoms?
- Have you recently started or stopped taking any medicines or supplements?
- Do you have a personal or family history of high blood pressure, high cholesterol, diabetes, heart disease or stroke?
- Do you smoke or have you ever smoked?
What you can do in the meantime
If you smoke, quit. Smoking increases the risk of peripheral artery disease, which can cause claudication. If you need help quitting, ask your care team for strategies that can help.
References
- Ropper AH, et al. Viral encephalitis and meningitis. In: Adams and Victor’s Principles of Neurology. 11th ed. McGraw Hill; 2019. https://accessmedicine.mhmedical.com. Accessed Dec. 9, 2022.
- Barer MR, et al., eds. Prion diseases (transmissible spongiform encephalopathies): Creutzfeldt-Jakob disease; Gerstmann-Strussler-Scheinker syndrome; fatal familial insomnia; iatrogenic Creutzfeldt-Jakob disease; kuru; variant Creutzfeldt-Jakob disease; bovine spongiform encephalopathy; scrapie and chronic wasting disease. In: Medical Microbiology: A Guide to Microbial Infections — Pathogenesis, Immunity, Laboratory Investigation and Control. 19th ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed Dec. 9, 2022.
- Appleby B, et al. Creutzfeldt-Jakob disease. https://www.uptodate.com/contents/search. Accessed Dec. 9, 2022.
- Creutzfeldt-Jakob disease. Alzheimer’s Association. https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/creutzfeldt-jakob-disease. Accessed Dec. 9, 2022.
- Creutzfeldt-Jakob disease fact sheet. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/creutzfeldt-jakob-disease-fact-sheet. Accessed Dec. 9, 2022.
- Chronic wasting disease (CWD): Prevention. Centers for Disease Control and Prevention. https://www.cdc.gov/prions/cwd/prevention.html. Accessed Dec. 9, 2022.
- Recommendations to reduce the possible risk of transmission of Creutzfeldt-Jakob disease and variant Creutzfeldt-Jakob disease by blood and blood components. U.S. Food and Drug Administration. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/recommendations-reduce-possible-risk-transmission-creutzfeldt-jakob-disease-and-variant-creutzfeldt. Accessed Dec. 9, 2022.
- Goering RV, et al. Prions. In: Mim’s Medical Microbiology and Immunology. 6th ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed Dec. 9, 2022.
- Ferri FF. Creutzfeldt-Jakob disease. In: Ferri’s Clinical Advisor 2023. Elsevier; 2023. https://www.clinicalkey.com. Accessed Dec. 9, 2022.
- vCJD cases reported in the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/prions/vcjd/vcjd-reported.html. Accessed Dec. 16, 2022.
- Ritchie DL, et al. Variant CJD: Reflection of a quarter of a century on. Pathogens. 2021; doi:10.3390/pathogens10111413.
- Eligibility reference material. American Red Cross. https://www.redcrossblood.org/donate-blood/how-to-donate/eligibility-requirements/eligibility-criteria-alphabetical/eligibility-reference-material.html#:~:text=If%20you%20have%20been%20diagnosed,(hGH)%20you%20cannot%20donate. Accessed Dec. 19, 2022.
- Prevention: Creutzfeldt-Jakob disease. NHS. https://www.nhs.uk/conditions/creutzfeldt-jakob-disease-cjd/prevention/. Accessed Dec. 19, 2022.
- Variably protease-sensitive prionopathy (VPSPr). Merck Manual Professional Version. https://www.merckmanuals.com/professional/neurologic-disorders/ prion-diseases/variably-protease-sensitive-prionopathy-vpspr. Accessed Jan. 5, 2023.
- Gerstmann-Straussler-Scheinker disease (GSS). Merck Manual Professional Version. https://www.merckmanuals.com/professional/neurologic-disorders/prion-diseases/gerstmann- str%C3%A4ussler-scheinker-disease-gss. Accessed Jan. 5, 2023.
- Appleby BS, et al. Genetic aspects of human prion diseases. Frontiers in Neurology. 2022; doi:10.3389/fneur.2022.1003056.
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