Have you ever felt a cramp or pain after just a few minutes of starting to exercise? Then you probably experienced claudication. Intermittent claudication is the name for muscle fatigue, pain, or cramp that occurs when you are active and cease after a couple of minutes while you are resting.8 Claudication can happen in any part of the body but is more common in the legs.3 Intermittent claudication usually occurs due to circulatory disorders but can also happen due to health conditions related to the spine.4
Types of claudication
There are two types of intermittent claudication: neurogenic and vascular.
- Neurogenic claudication is a symptom of problems with the spine and nervous system, especially of symptomatic lumbar spinal stenosis (LSS). It is argued by specialists in the spine, that LSS is the compression of nerve roots because of the narrowing of spine canals (the space that protects the spinal cords and nerve roots).7 This can also put pressure on the blood vessels around the spine interrupting the blood flow4
- Vascular claudication is a symptom of blood flow problems, especially of the disease called peripheral arterial disease or peripheral artery disease (PAD). PAD refers to the blockage or narrowing of the blood vessels (arteries) that go from the heart to the legs.3 Peripheral arterial disease is commonly caused by atherosclerosis, which is the buildup of fatty material (atheroma) in the arteries.3 The severity of leg pain and discomfort experienced depends on how hardened are the arteries. Vascular claudication is associated with a high mortality rate of cardiovascular diseases5
Causes of claudication
The main causes of intermittent claudication are the compression of nerve roots, damaged nerves, or the blockage of blood vessels due to atheromas.4,9 As explained before atheromas appear along the inside lining of the arteries. Depending on how severe they are they can cause a blood clot which blocks blood flow in the body.3 Atheromas can be critical for one's health because they can lead to an aneurysm, heart attack, or stroke.3 Another relevant cause of claudication among the British population is smoking. Smoking increases the chances to develop circulatory diseases.9
Signs and symptoms of claudication
The symptoms of claudication are because of insufficient blood flow and oxygen. The most prevalent symptom is pain in the calf, thigh, and buttocks after some time of doing physical activity.8 You may also experience aches, cramps, heaviness, or tiredness.9 However, there are other symptoms and signs that might be because of claudication such as:
- Hair loss in the lower leg
- Shiny skin
- Brittle toenails
- Presenting an undetectable or very weak pulse in the lower leg
Management and treatment for claudication
The treatments for intermittent claudication vary depending on the severity of the symptoms. The treatment for neurogenic claudication consists of physical therapy, painkillers, and steroid shots to reduce inflammation.4 If the symptoms are more severe, your physician can recommend surgical procedures that will be based on your specific root of the problem.4
Treatment for patients with vascular claudication due to peripheral artery disease is directed at reducing the risk of cardiovascular events by:6
- Quitting tobacco
- Incrementing physical activity
- Medication for high blood pressure
- Cholesterol-lowering drugs
- Antiplatelet drugs
- Medicine for diabetes
For patients whose symptoms have worsened, surgical interventions such as angioplasty or bypass surgery may be recommended. An angioplasty is a procedure that expands a narrowed artery, so the blood flow can be improved.9 A bypass surgery works to bypass a blockage in the artery, and is usually done in the leg.9 If the symptoms are very severe, a patient may be offered a carotid stenting or carotid endarterectomy.
Physicians rely on the medical history of the patient and physical examination to direct the diagnosis of intermittent claudication. The exams that a patient will go under will depend if it is for the diagnosis of vascular claudication or neurogenic claudication.
- The first exams that your physician will ask for are a general health test, levels of cholesterol, and levels of blood glucose.
- Hemodynamic Measurements: Ankle-brachial index (ABI) and Duplex ultrasound.
- Exercise testing
- Evaluation of functional status
After examining for signs of vascular claudication your physician will order the following exams:
- CT scans
Among the risk factor of intermittent claudication, we have:
- Age: The prevalence of claudication symptoms increases with age. Approximately 4.5% of people between the ages of 55-74 years, and 6% of patients with symptoms experience claudication that limit functional abilities6
- Sex: The chances of developing a peripheral disease are more common among young people assigned female at birth (AFAB). However in the older population, there is an equal chance to develop PAD.6 Presence of claudication symptoms have been reported in 16.9% of people assigned male at birth (AMAB) and in 20.5% of people AFAB6
- Ethnic background: Some ethnic groups are more likely to develop claudication symptoms than others. People of South Asian or African Caribbean backgrounds are more at risk of developing cardiovascular disease or diabetes, in consequence, they are at most risk of claudication9
- Family history of cardiovascular diseases
- Health conditions such as diabetes, high blood cholesterol, obesity, or high blood pressure
- Lack of daily physical activity
Vascular claudication due to peripheral arterial disease is not an immediately life-threatening condition, still, it can lead to potentially fatal problems, such as:
- Coronary heart disease: an arterial blockage that can happen in any area of the body; potentially leading to stroke, heart attack, angina, and coronary heart disease8
- Critical limb ischaemia: happens when the blood flow in the legs is severely obstructed; provoking severe leg pain, ulcers, and loss of muscle mass among other symptoms8
- Non-healing ulcers: the reduction of blood flow can affect the ability of the body to heal wounds and ulcers.5 Ulcers or wounds can happen on the feet or lower legs, if severe they can lead to amputation1,7
- Infection: the presence of arterial blockage can lead to a debilitated immune system response which results in patients being at a higher risk of developing infections5
- Reduction of mobility and quality of life: the pain caused by intermittent claudication can limit the ability and engagement in physical activity of an individual8
How can I prevent claudication?
The most important thing to prevent claudication is making changes to your lifestyle:
- Avoid or reduce the intake of saturated fats such as fried foods, processed meats, and pastries
- Quit smoking
- Increase your daily physical activity
- Control and reduce to healthy measures your levels of cholesterol, blood pressure, and blood sugar
- Maintain a healthy weight
How common is claudication?
Claudication is more common among people AFAB.
What can I expect if I have claudication?
If you have claudication you can expect pain in the calf, thigh, and buttocks after some time of doing physical activity, which will stop after a couple of minutes of resting.
When should I see a doctor?
Intermittent claudication is a key symptom to diagnose peripheral arterial disease or other cardiovascular diseases, so you should always talk about it with your doctor. The early detection of PDA can be key to preventing death from coronary complications.2
Claudication is muscle fatigue, pain, or a cramp that occurs when you are active and cease after a couple of minutes while you are resting. Other symptoms that can be experienced are hair loss in the lower leg, shiny skin, brittle toenails, and weak pulse in the lower leg. There are two types of intermittent claudication neurogenic and vascular. The main causes of intermittent claudication are the compression of nerve roots, damaged nerves, or the blockage of blood vessels due to atheromas. Treatment for patients of intermittent claudication depends on the root of the symptoms. Physicians rely on the medical history of the patient and tests (hemodynamic measurement, angiogram, and others) for the diagnosis. Some potential complications that can happen are coronary heart disease, critical limb ischaemia, non-healing ulcers, infection, and reduction of mobility and quality of life.
- Hiatt WR, Hirsch AT, Regensteiner JG, Brass EP. Clinical trials for claudication: assessment of exercise performance, functional status, and clinical endpoints. Circulation [Internet]. August 1995 [cited 5 of July of 2023];92(3):614-21. Available on: https://www.ahajournals.org/doi/10.1161/01.CIR.92.3.614
- Twomey A, Khan Z. Home-based exercise therapy in the management of intermittent claudication: a systematic review and meta-analysis. Cureus [Internet]. 18 de mayo de 2023 [cited 5 of July of 2023]; Available on:: https://www.cureus.com/articles/157667-home-based-exercise-therapy-in-the-management-of-intermittent-claudication-a-systematic-review-and-meta-analysis
- Rümenapf G, Morbach S, Schmidt A, Sigl M. Intermittent claudication and asymptomatic peripheral arterial disease. Deutsches Ärzteblatt international [Internet]. 13 de marzo de 2020 [cited 5 of July of 2023]; Available on:: https://www.aerzteblatt.de/10.3238/arztebl.2020.0188
- Martini ML, Nistal DA, Deutsch BC, Neifert SN, Lamb CD, Caridi JM. Assessing the impact of neurogenic claudication on outcomes following decompression with lumbar interbody fusions in patients with lumbar spinal stenosis. Global Spine Journal [Internet]. marzo de 2021 [cited 5 of July of 2023];11(2):203-11. Available on:: http://journals.sagepub.com/doi/10.1177/2192568220902746
- Patterson RB, Pinto B, Marcus B, Colucci A, Braun T, Roberts M. Value of a supervised exercise program for the therapy of arterial claudication. Journal of Vascular Surgery [Internet]. febrero de 1997 [cited 5 of July of 2023];25(2):312-9. Available on:: https://linkinghub.elsevier.com/retrieve/pii/S0741521497703525
- Morbi AHM, Coles S, Albayati M, Nordon IM, Shearman C. Understanding patient acceptance of risk with treatment options for intermittent claudication. Annals of Vascular Surgery [Internet]. abril de 2017 [cited 5 of July of 2023];40:223-30. Available on:: https://linkinghub.elsevier.com/retrieve/pii/S0890509616312201
- Nadeau M, Rosas-Arellano MP, Gurr KR, Bailey SI, Taylor DC, Grewal R, et al. The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation. CJS [Internet]. 1 de diciembre de 2013 [cited 5 of July of 2023];56(6):372-7. Available on:: http://www.canjsurg.ca/lookup/doi/10.1503/cjs.016512
- nhs.uk [Internet]. 2017 [cited 5 of July of 2023]. Peripheral arterial disease (Pad). Available on: https://www.nhs.uk/conditions/peripheral-arterial-disease-pad/
- British Heart Foundation [Internet]. [citado 5 de julio de 2023]. Peripheral arterial disease. Available on:: https://www.bhf.org.uk/informationsupport/publications/heart-conditions/peripheral-arterial-disease