Claudication: When circulation problems cause leg pain

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.

Don't simply chalk this up to getting a bit older and retire your walking shoes.

Instead, head to your doctor's office. Your leg pain may be claudication. Claudication is most often a symptom of peripheral arterial disease, a potentially serious but treatable circulation problem. Walking may actually become a key component of your treatment program — and a way to return to an active lifestyle.

Understanding the cause of claudication

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.

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.

Claudication is most common in older adults. It rarely affects those under age 50.

If you have claudication, it can be worsened by certain things. Those include cold temperatures or medications, such as beta blockers. They can reduce blood flow or cause your blood vessels to constrict, interfering with circulation.

Identifying the features of claudication

The pain of claudication often has two distinctive features. These features are:

• Pain that's brought on by exercise. When you're exercising, such as walking, your muscles need extra oxygen for fuel. But the narrowed arteries don't let enough oxygen-carrying blood get to your muscles. The need for oxygen outweighs the supply, causing an aching pain. The location of the artery damage affects where you feel pain. If you have a narrowed artery in your thigh, you may have pain in your calf, for instance. You may also have pain in your buttocks, thighs or feet. If the arteries to your arms are affected, you may have similar pain in your arm muscles with activity that involves using your arms.
• Pain that's intermittent. Claudication pain is intermittent — it comes and goes. The pain usually begins shortly after you start exercising, when oxygen need rises. The pain subsides when you stop exercising and oxygen need drops. If you're doing more intense exercise, your pain may be more severe. For instance, your pain may be worse with climbing stairs, dancing or walking fast, which all put more demand on your muscles than, say, taking a leisurely stroll.

If damage to your arteries is severe enough, you may feel pain even when you're at rest. Your toes may be pale or have a bluish tinge. Your feet may feel cold to the touch. You may develop ulcerations on your lower legs, ankles, feet or toes. Though rare, severe cases can lead to gangrene and require amputation.

Diagnosing claudication

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, of course, make exercise intolerable.

Despite that, claudication often goes undiagnosed. That's because many people consider the pain an unwelcome but inevitable consequence of aging and don't consult their doctor. But it doesn't have to be that way.

How do you know if the pain in your legs is claudication and not 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.

Your doctor may check the pulses in your feet. Decreased pulses may indicate that blood flow isn't normal. Your doctor can check the blood pressure in your ankles and compare it with the pressure in your arms. That measurement, called the ankle-brachial index, can help determine the severity of your condition. In addition, Doppler ultrasound can measure blood flow through the arteries to see if your circulation is affected. Magnetic resonance imaging (MRI) and X-ray imaging with dye (angiography) can show damage to your blood vessels.

Not all of these procedures may be necessary to make an accurate diagnosis, though.

Treating claudication with lifestyle changes

Treatment of claudication and peripheral arterial disease is designed to stop it from progressing and reduce your symptoms.

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.

Treating claudication with medications or surgery

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

These treatment options include:

• Medications. Certain medications can improve circulation by decreasing blood clotting, opening clogged arteries and lowering cholesterol.
• 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 create a graft bypass using a vessel from another part of your body or a tube made of synthetic fabric. 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.

Managing claudication for a happier life

Don't ignore leg pain or hope it goes away on its own. Claudication is serious and potentially disabling. Following a healthy lifestyle or pursuing other treatment options can alleviate your symptoms and improve your health. With effective treatment, you can get back on your feet and return to the activities you enjoy.

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