Introduction
Claudication can be a very serious condition when left untreated. It can cause severe pain, potentially leading to debilitating and significantly reducing one’s quality of life. This article aims to raise awareness of claudication, including its causes, the complications that may arise if it is left untreated, and the available treatment options.
What is claudication?
Claudication is a painful sensation that occurs due to the lack of oxygen resulting from insufficient blood flow to the muscles during physical exertion. The pain is commonly experienced in the leg muscles during exercise. The ‘pain’ from claudication may feel like:
- Weakness
- Numbness
- Cramping
- Tingling
Claudication is also referred to as intermittent claudication because the pain develops during exercise and goes away with rest; it is not constant.1 However, depending on the severity of the condition, claudication may occur even at rest.
Claudication is a symptom of peripheral artery disease, where the arteries that supply blood to the legs and arms, primarily the legs, are narrowed. The narrowing results from fatty deposits or plaques building up on the walls of the peripheral arteries (arteries outside the heart and brain).
Causes of claudication
Claudication is ultimately caused by a temporary lack of oxygen due to poor blood circulation in the lower extremities, resulting from the buildup of fats, cholesterol, and other substances called plaque a condition known as atherosclerosis.
Types of claudication
Vascular claudication
It occurs when there is a serious problem with the blood flow in your peripheral arteries.2
Neurogenic claudication
It occurs when there are issues with your spine and nervous system. In neurogenic claudication, the space in your lower spine becomes narrowed, putting pressure directly on your spinal cord. This compresses the blood vessels around your spine, making it difficult for blood to flow through and depriving it of oxygen. This condition, known as spinal stenosis, can cause pain that radiates from your lower back down your legs.2
Symptoms of claudications
- Pain or ache in muscles
- Pain in calves, thighs, and feet
- Erectile dysfunction (in men)
- Numbness or weakness in legs
Why should claudication be treated?
As the old saying goes, “prevention is better than cure’. When you pay attention to your pain, you are taking the first step toward addressing it. Preventing the potential development of illnesses associated with untreated claudication ultimately promotes better health and well-being.
It is important to seek medical help if you are experiencing muscle pain that does not disappear even with rest, as it could be claudication. Failure to seek medical treatment for claudication and leaving it untreated could potentially lead to undesirable complications, such as heart attack or stroke, among others. These complications can significantly reduce your quality of life in terms of:
- Limitation of movement
- Worsened body pain
- Bad health
- Poor wellbeing
Complications of untreated claudication
Untreated claudication can lead to the following complications:
Cardiovascular complications
Living with untreated claudication can lead to debilitating and, sometimes, life-threatening cardiovascular problems such as:
- Heart attack
A life-threatening condition that occurs when blood flow to your heart muscle is blocked. It usually requires immediate medical attention. This condition is also known as myocardial infarction.
- Stroke
A condition resulting from an inadequate oxygen supply to parts of your brain due to blocked blood flow. The stroke could be hemorrhagic (when there is bleeding in the brain) or ischemic (when blood flow is blocked).
The buildup of plaque in the arteries of your heart.
Critical limb ischemia
Critical limb ischemia (CLI) is a condition that can be developed if your claudication is left untreated. It involves severe pain, numbness, and slow-healing sores in your limbs, such as the hands, legs, or feet, due to the blockage of blood flow. This occurs because your muscles and tissues struggle to heal without adequate blood flow. However, some people may not experience any pain but show other characteristic symptoms that include:
- Cold hands, feet, or legs
- Weak or absent pulse in legs or feet
- Skin discoloration
- Thick toenail
CLI is a life-threatening condition and a severe stage of peripheral artery disease. It can put you at risk of limb amputation and even death.3
Reduced quality of life
Claudication can negatively impact your quality of life when it comes to physical activity that involves moving around (mobility). The discomfort, usually in the legs, can make it difficult to perform even simple tasks like lifting your leg or walking. Over time, this can lead to muscle loss, weakened muscles, and reduced physical endurance. Claudication may also disrupt your sleep, as the pain often becomes more severe at night.
Psychological impact
Claudication is characterised by pain that has a debilitating psychological impact. Past experiences can create anxiety and fear, leading to stress, anxiety, and heightened anticipation of pain. This cycle can cause frustration, with a head full of thoughts, and potentially result in social isolation. As a consequence, you may experience increased stress, anxiety, and depression.
In cases when patients are not responding to treatment, they may feel like their pain is being exaggerated. This perception can lead to patients feeling unheard or not taken seriously, which further increases their distress.4
Management and treatment of claudication
Claudication is an indicative symptom of peripheral artery disease or similar circulatory conditions. Managing and treating this condition often involves changing unhealthy lifestyle habits that pose risk factors and taking prescription medication to relieve symptoms.
Your doctor may advise you to take the following measures to reduce the likelihood of worsening your symptoms:
Lifestyle changes
This involves quitting unhealthy habits and adopting healthy ones. These changes may include:
Smoking cessation
The saying “Smokers are liable to die young” is a reminder of the serious risks associated with smoking. Smoking, in any amount, harms your blood vessels and heart. It is one of the leading risk factors for many diseases and the primary cause of preventable deaths.
It is important to quit smoking as it has numerous benefits, such as reducing your risk of stroke, atherosclerosis, heart disease, and blood clots.
Exercising regularly
Exercise primarily helps to burn fat, which can reduce the risk of plaque buildup and improve blood circulation. Walking is the best exercise for claudication. It is recommended to engage in daily supervised walks of about 20 minutes.
Dietary modification
Reducing the consumption of foods high in saturated fat, cholesterol, and salt is beneficial and healthy in managing claudication. Instead, focus on consuming fruits, vegetables, and whole grains.
Physical therapy
Physical therapy focuses on improving your mobility and physical function with the assistance of healthcare professionals, such as physical therapists, nurses, or even family members.
Medication
It is important to take medications that aim at reducing symptoms and increasing blood circulation. These may include:
- Aspirin or clopidogrel to prevent heart attack and stroke5
- Cilostazol to improve walking distance6
- Statins to lower cholesterol levels and prevent blood clots
Invasive and surgical treatment
These procedures aim at alleviating symptoms and improving quality of life.
- Angioplasty: A minimally invasive procedure performed to widen narrowed arteries by inserting a balloon inside the artery. The balloon presses the built-up plaque against the arterial walls, allowing for easier blood flow.
- Bypass surgery: A surgical procedure that creates a new pathway for blood to flow around blocked arteries.
FAQs
What is the difference between, atherosclerosis, peripheral artery disease, and claudication?
- Atherosclerosis: A condition characterised by the buildup of plaques inside your arteries. This condition can lead to peripheral artery diseases and claudication
- Peripheral artery disease: A condition that is caused by the buildup of fatty deposits in the peripheral arteries
However, claudication is a symptom of peripheral artery disease, caused by atherosclerosis.
How to control the morbidities?
This involves managing underlying health factors that can worsen peripheral artery diseases, such as diabetes, high blood pressure, and cholesterol. You can make lifestyle changes and take medications to help control these conditions. By taking these life-changing steps, the progression of claudication symptoms may be significantly slowed.
Summary
- Claudication is a symptom characterised by pain or cramping in the legs during physical activity that is caused by poor blood flow and insufficient oxygen supply to the affected muscles
- While claudication itself is not life-threatening, it can lead to serious complications that could put you at risk of amputation and developing life-threatening illnesses
- It is important to seek medical treatment if you experience persistent muscle pain, especially after resting, to prevent complications
- Preventative measures include making lifestyle adjustments such as quitting unhealthy habits like smoking, avoiding foods high in fat, cholesterol, and salt, and engaging in healthier practices like regular exercise and consuming more vegetables
- For more serious complications of claudication, additional treatments may include medications and surgical options
References
- Meru AV, Mittra S, Thyagarajan B, Chugh A. Intermittent claudication: An overview. Atherosclerosis [Internet]. 2006 Aug 1 [cited 2024 Sep 4];187(2):221–37. Available from: https://www.sciencedirect.com/science/article/pii/S002191500500777X
- Hawkes CH, Roberts GM. Neurogenic and vascular claudication. Journal of the Neurological Sciences [Internet]. 1978 Oct 1 [cited 2024 Sep 4];38(3):337–45. Available from: https://www.sciencedirect.com/science/article/pii/0022510X78901405
- Katzen B, Neville R, Lookstein R, Zeller T, Miller L, Driver V, et al. Endovascular Today. [cited 2024 Sep 5]. Critical limb ischemia: a threat to life and limb. Available from: https://evtoday.com/articles/2019-may/critical-limb-ischemia-a-threat-to-life-and-limb
- Ragazzo L, Puech-Leao P, Wolosker N, de Luccia N, Saes G, Ritti-Dias RM, et al. Symptoms of anxiety and depression and their relationship with barriers to physical activity in patients with intermittent claudication. Clinics [Internet]. 2021 Jan 20 [cited 2024 Sep 5];76:e1802. Available from: https://www.scielo.br/j/clin/a/Qj8mjXpRnHhN6LwdZR3QLSF/?format=html&lang=en
- Johnston SC, Easton JD, Farrant M, Barsan W, Conwit RA, Elm JJ, et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk tia. N Engl J Med [Internet]. 2018 Jul 19 [cited 2024 Sep 6];379(3):215–25. Available from: http://www.nejm.org/doi/10.1056/NEJMoa1800410
- Brown T, Forster RB, Cleanthis M, Mikhailidis DP, Stansby G, Stewart M. Cilostazol for intermittent claudication. Cochrane Database Syst Rev [Internet]. 2021 Jun 30 [cited 2024 Sep 6];2021(6):CD003748. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245159/