Intermittent claudication
Claudication is pain and/or cramping in the lower leg due to inadequate blood flow to the muscles. The pain usually causes the person to limp. The word "claudication" comes from the Latin "claudicare" meaning to limp. Claudication typically is felt while walking, and subsides with rest. It is commonly referred to as "intermittent" claudication because it comes and goes with exertion and rest. In severe claudication, the pain is also felt at rest.
Intermittent claudication may occur in one or both legs and often continues to worsen over time. However, some people complain only of weakness in the legs when walking or a feeling of "tiredness" in the buttocks. Impotence is an occasional complaint in men.
The usually intermittent nature of the pain is due to narrowing of the arteries that supply the leg with blood, limiting the supply of oxygen to the leg muscles, a limitation that is felt especially when the oxygen requirement of these muscles rises with exercise.
Intermittent claudication can be due to temporary artery narrowing due to vasospasm (spasm of the artery), permanent artery narrowing due to atherosclerosis, or complete occlusion (closure) of an artery to the leg. The condition is quite common, more so in men than women. It affects 1-2% of the population under 60 years of age, 3-4% of persons age 60 to 70 and over 5% of people over 70.
The pulses in the legs and feet are evaluated on the clinical exam. Diagnostic tests include blood pressure measurements to compare the arms and legs, Doppler ultrasonography on the legs, duplex Doppler/ultrasound exam of the extremities to visualize arterial blood flow, an ECG, and arteriography (injecting dye that can be visualized in the arteries).
Two drugs are available for the management of intermittent claudication: pentoxifylline (brand name: Trental) and cilostazol (brand name: Pletal). These drugs act differently. Trental decreases the "stickiness" (viscosity) of blood and thereby improves its flow to the legs. Pletal acts to dilate (widen) the arteries by decreasing the action of an enzyme, phosphodiesterase III. It also reduces the ability of blood to clot.
The prognosis with intermittent claudication is generally favorable because the condition often stabilizes or improves in time. Conservative therapy is advisable. Walking often helps increase the distance that the patient can walk without symptoms. A program of daily walking for short periods, and stopping for pain or cramping, often helps improve function by encouraging the development of collateral circulation, that is, the growth of new small blood vessels that bypass the area of obstruction in the artery. It is essential to stop smoking. Avoid applications of heat or cold on legs. Avoid tight shoes.
