Claudication

Description

Claudication is pain caused by too little blood flow to the muscles during exercise. More often it occurs, the pain in the legs after walking at a certain pace, and a certain amount of time, depending on the severity of the condition.

The condition is also called intermittent claudication due to which the pain is usually not constant. Starts during the year and ends with the rest. As claudication worsens, however, the pain can occur while resting.

Claudication is technically a symptom of the disease, with increased frequency of peripheral artery disease, a narrowing of the arteries in the extremities, which restricts the flow of blood.

The treatments focus on the reduction of risk of vascular disease, reduce pain, increase mobility and the prevention of damage to the tissues.

Symptoms

Claudication refers to muscle pain due to the lack of oxygen caused by activity and relieved with rest. The symptoms include the following:

  • Pain, pain, discomfort or fatigue in the muscles every time the muscles being used
  • The pain in the calves, thighs, buttocks, hips, or feet
  • Less often, pain in the shoulders, biceps, and forearms
  • The pain that you recover soon after rest

The pain can be more severe with time. You may even begin to have pain at rest.

Signs or symptoms of peripheral artery disease, usually in advanced stages, which include:

  • Cold skin
  • Severe, constant pain that progresses to numbness
  • Discoloration of the skin
  • Wounds that do not heal

When to see a doctor

Talk with your health care provider if you have pain in the legs or arms when you exercise. Claudication can lead to a cycle that results in a worsening of cardiovascular health. The pain can make exercise intolerable, and the lack of results of the exercises found in the worst state of health.

The peripheral arterial disease is a sign of poor cardiovascular health and an increased risk of heart attack and stroke.

Other diseases related to the blood, nerves and bones may contribute to the lower leg and the arm of the pain during the exercise. It is important to have a thorough examination and appropriate tests to diagnose potential causes of pain.

Causes

Claudication is most often a symptom of peripheral arterial disease. The peripheral arteries are the large blood vessels that supply blood to the legs and arms.

The peripheral arterial disease is damage to an artery, which restricts the flow of blood in an arm or a leg (limb). When you're at rest, the limited blood flow is usually sufficient. When it is active, however, the muscles do not receive enough oxygen and nutrients to function properly and stay healthy.

Damage to the peripheral arteries is usually caused by atherosclerosis. Atherosclerosis is the buildup of fat, cholesterol and other substances in the walls of the arteries. This buildup is called plaque. The plate can cause the arteries to become narrow, by blocking the flow of blood. The plaque can also burst, which leads to a blood clot.

Risk factors

The possible risk factors for peripheral arterial disease and claudication include:

  • A family history of atherosclerosis, peripheral arterial disease or claudication
  • Age older than 50 years old, if you also smoke or have diabetes
  • Age older than 70 years
  • Chronic kidney disease
  • Diabetes
  • High blood pressure
  • High cholesterol
  • Obesity (body mass index or body mass index (BMI), more than 30)
  • Smoking

Complications

Claudication is generally regarded as a significant warning of atherosclerosis, which indicates an increased risk of heart attack or stroke. Other complications of peripheral artery disease due to atherosclerosis include:

  • The skin lesions that do not heal
  • The death of the muscles and skin tissue (gangrene)
  • The amputation of a limb

Prevention

The best way to prevent claudication is to maintain a healthy lifestyle and control of certain medical conditions. What it means:

  • Maintaining a healthy diet and well-balanced
  • Exercise regularly
  • If you have diabetes, keep your blood sugar under control
  • Maintain a healthy weight
  • Control your cholesterol and blood pressure
  • Quit smoking if you are a smoker

Claudication

Diagnosis

Claudication may go undiagnosed because many people consider the pain to be an unfortunate but typical part of aging. Some people simply reduce their activity level to avoid the pain.

A diagnosis of claudication and peripheral arterial disease is based on a review of the symptoms, a physical examination, evaluation of the skin in the extremities, and the tests to check the blood flow.

Tests

Some tests are used to diagnose claudication may include:

  • Measurement of the pulse on the palms of the hands or feet to assess the blood flow to the entire limb
  • Ankle-brachial index, a comparison of the blood pressure in the ankle with the blood pressure in the arms
  • Segmental blood pressure measurement, a series of measurements of the blood pressure in different areas in the arm or leg to help determine the amount and location of the damage to the arteries
  • The stress test to determine the maximum distance that you can walk or the maximum effort without pain
  • Doppler ultrasound to see the flow of blood
  • Magnetic resonance imaging (MRI) or computed tomography (CT) angiography to look for narrowing of the blood vessels

Treatment

The objectives of the treatment of claudication and peripheral arterial disease are to reduce the pain and manage the risk factors that contribute to heart and blood vessel (cardiovascular) disease.

The exercise is an important part of claudication treatment. Exercise reduces pain, increases exercise duration, improves vascular health in the affected limbs, and contributes to the control of weight and a general improvement in the quality of life.

It is recommended to walking programs include:

  • Walk until you feel moderate pain, or as far as you can
  • Rest to relieve the pain
  • To walk again
  • The repetition of the foot-rest-walk cycle for 30 to 45 minutes
  • Walk three or more days a week

Supervised exercise is recommended for the start of the treatment, but long-term exercise at home is important for the ongoing management of claudication.

Drugs

Your health care provider may prescribe one or more medications to control pain and manage risk factors for cardiovascular disease. For example, medications can be used to manage the following:

  • Pain. The drug cilostazol, which improves the flow of blood, can reduce the pain during the exercise and will help you to walk more.
  • High cholesterol. Statins are drugs that help to lower cholesterol, a key factor in the formation of plaques in the arteries. Taking statins may improve walking distance.
  • The high blood pressure. Several different classes of drugs may be prescribed to lower blood pressure and reduce the risk of heart attack or stroke.
  • Other cardiovascular risk factors. Antiplatelet drugs, which help prevent blood clots, can reduce the risk of heart attack, stroke, or clots block the flow of blood to the extremities. These drugs include aspirin, clopidogrel (Plavix) and other classes of drugs.

Talk with your doctor about any medications or supplements that you should not take with the prescribed treatment.

Surgery or other procedures

When the peripheral arterial disease is severe and other treatments do not work, surgery may be necessary. The options include:

  • The angioplasty. This procedure improves blood flow by dilating of a damaged artery. A health care provider guides of a narrow tube through a blood vessel to provide an inflatable balloon that expands the artery. Once the artery is dilated, the doctor may put a small metal or plastic mesh tube (stent) in the artery to keep it open.
  • Vascular Surgery. During this type of surgery, the surgeon takes a healthy blood vessel from another part of the body to replace the container that is causing claudication. This allows the blood to flow around the obstruction or narrowing of the artery.

Self-care

A healthy lifestyle can help to improve treatment outcomes and reduce the risks associated with claudication and peripheral arterial disease. Recommended lifestyle changes include the following:

  • Stop smoking. Smoking increases the risk of complications from peripheral artery disease. Talk with your health care provider if you need help to stop smoking.
  • Exercise. Follow the exercise plan recommended by your health care provider. Regular exercise is important for weight management and good health of the heart.
  • Eat a healthy diet. Eat plenty of low-starch vegetables, fruits, and whole grains, and modest portions of lean meat, poultry, fish and low-fat dairy products.
  • Care of the feet. Talk with your health care provider about the care of your feet. Know how to inspect your feet to ensure the correct and timely treatment of the injury. Wear socks and shoes that are suitable to support and protect your feet.

Coping and support

Learning all you can about what is the cause of claudication can help you better manage the disease.

Some people also find it helpful to talk with other people who are going through similar experiences. In a support group, you can find encouragement, tips, and maybe even an exercise buddy or two. Ask your health care provider if there are support groups in your area.

Preparing for your appointment

It is likely to start by seeing your health care provider. You may be referred to a doctor trained in heart disease (cardiologist) or of the blood vessels (vascular) surgeon.

To make the best of your appointment time, be prepared to answer the following questions:

  • When did symptoms begin?
  • Do you have pain when you are walking or doing exercise, when you're at rest, or both?
  • On a scale of 1 to 10 (10 being the worst), how would you rate the pain?
  • Nothing seems to improve symptoms, such as resting?
  • Do you need to sit up to get relief from the symptoms, or do not stop and stand in a place to relieve their symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Is the pain prevents you from regular exercise or normal daily activities?
  • Do you have any other symptom?
  • Has recently started or stopped taking any medication or supplement?
  • Do you have a personal history or family history of high blood pressure, high cholesterol, diabetes, heart disease or a stroke?

What you can do

Your doctor may ask you about the medicines you take, including supplements and medicines that you buy without a prescription. Before your appointment, write down each name of the medication, the dose, the reason for taking it, and the name of the prescribing provider. Bring the list with you to your appointment.

Other strategies to help you use your appointment time will also include the following:

  • A member of the family or a friend to help you remember the information they give you.
  • During your appointment, ask your health care provider about anything you do not understand.
  • Take notes or to request a printed document to outline the next steps for the scheduling of examinations or additional appointments.
Symptoms and treatment of Claudication