Claudication is pain caused by too little blood flow. It can occur after walking for a period, or during exercise. Sometimes called intermittent claudication, this condition generally affects the blood vessels in the legs; but claudication can affect the arms, too. At first, you’ll probably notice the pain only when you’re exercising, but as claudication worsens, the pain may affect you even when you’re at rest.

Symptoms

Claudication symptoms include:

• Pain when exercising– You may feel pain or discomfort in your feet, calves, thighs, hips or buttocks, depending on where you might have artery narrowing or damage.
• Intermittent pain– Your pain may come and go as you do less-strenuous activities.
• Pain when at rest– As your condition progresses, you may feel pain in your legs, even when you’re sitting or lying down.
• Discoloured skin or ulcerations– If blood flow is severely reduced, your toes or fingers may look bluish, or feel cold to the touch. You may also develop sores on your lower legs, feet, toes, arms or fingers.

Other possible symptoms include:

• An aching or burning feeling
• Weakness of your legs or arms
• Cold feet

Causes

Development of Atherosclerosis

Claudication is most often a symptom of peripheral artery disease (PAD). With PAD, usually atherosclerosis may result, since the arteries that supply blood to your limbs are damaged. Atherosclerosis can develop in any of your arteries, especially those in your heart. But when it affects your arms and legs, it’s called PAD.

Atherosclerosis narrows the arteries and makes them stiffer and harder. 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’t flow through them. You feel pain because your leg muscles are not getting enough oxygenated blood. Oxygen is the fuel that muscles need to contract.

Atherosclerosis isn’t the only possible cause of your symptoms of claudication. Other conditions associated with similar symptoms that need to be considered include spinal stenosis, peripheral neuropathy, and certain musculoskeletal conditions.

Risk factors

 The risk factors for claudication are the same as those for developing atherosclerosis, including:

• Smoking
• High cholesterol
• High blood pressure
• Obesity (a body mass index over 30)
• Diabetes
• If older than 70 years
• If older than 50 years, and smoke, or have diabetes
• A family history of atherosclerosis, PAD, or claudication

 Complications

 In extreme cases, the circulation in your legs or arms can be so limited, that you feel pain even when you aren’t exercising, and your legs or arms might feel cool to the touch. Severe PAD can lead to poor healing of skin injuries and ulcers. These cuts and ulcers can develop gangrene and require limb amputation.

Prevention

 The best way to prevent claudication is to maintain a healthy lifestyle. That means:

• Quit smoking if you’re a smoker.
• If you have diabetes, keep your blood sugar in good control.
• Exercise regularly.
• Lower your cholesterol and blood pressure levels, if necessary.
• Eat foods that are low in saturated fat.
• Maintain a healthy weight.
• Avoid injury to your feet and legs.
• Wear well-fitted shoes.

 Diagnosis

 Claudication may go undiagnosed because many people consider the pain an unwelcome but inevitable consequence of aging, and some of them just reduce their activity level to avoid the pain. But the tests your doctor may use to diagnose your condition are often non-invasive, and can help you to resume an active life.

Some common tests used to diagnose claudication include:

• Checking the pulses in your palms and feet
• Exercise testing to determine the maximum distance you can walk without pain
• Ankle-brachial index to compare the blood pressure in your ankles to the blood pressure in your arms
• Doppler ultrasound,which monitors blood flow in the area affected
• Magnetic resonance imaging (MRI), or computerized tomography (CT),to show if your blood vessels are narrowed with plaque.

The pain in your legs could be due to another condition, such as spine, joint or muscle problems, or other vascular conditions. Your doctor can make a diagnosis based on your symptoms and a medical history, physical exam, and appropriate tests.

Treatment

 Treatment of claudication and PAD, can help prevent your disease from getting worse, and reduce your symptoms. Lifestyle changes, such as quitting smoking and participating in a regular exercise regimen, are often the first steps in treating claudication.

If your claudication symptoms don’t improve, after implementing a formal exercise programme designed to improve the blood flow, and adopt a healthier lifestyle, your doctor may suggest other treatment options, including:

• Medications– You might be recommended to take aspirin, or other medications, to reduce the chance of blood clots. Very likely, a cholesterol-lowering drug (statin), will also be prescribed to lower your cholesterol, if the blockage is believed to be due to hardening of the arteries (atherosclerosis).
• Angioplasty– Cases of claudication and PAD, that are more serious, may require angioplasty. This is a procedure that widens damaged arteries, using a narrow tube that travels through your blood vessels, with an inflatable balloon on the end, to help improve circulation. Once an artery is widened, a stent may be placed in it, to keep it open.
• Vascular surgeon– A procedure or surgery may be recommended. There are varied ways to allows blood to flow around the blocked or narrowed artery. Therefore, a combination of treatments, such as medications and angioplasty, may also be suggested.

Your feet mirror your general health . . . cherish them!