Claudication

What is claudication?

Claudication is the name for muscle pain that happens when you’re active and stops when you rest (it’s sometimes called “intermittent claudication”).

The most common types of claudication are:

• Vascular claudication: This is usually a symptom of serious blood flow problems, especially peripheral artery disease.
• Neurogenic claudication: This is caused by problems with your spine and nervous system.

What does claudication feel like?

Claudication pain is usually described as cramping, but some people describe the pain as dull or aching. Others experience weakness, numbness or tingling.

What causes vascular claudication?

All the cells in your body require oxygen to function. When you’re more active, even just for a light walk, the cells in your muscles need more oxygen to do their job. People who have circulation problems can experience pain when they’re more active because their muscles need more oxygen than their circulation provides. The pain goes away when they rest because their circulation can again keep up with the lower oxygen demand. This type of pain is most common in your legs, but can also happen in your arms.

Claudication is a classic symptom of peripheral artery disease (known as PAD for short), which is a narrowing of the blood vessels in your legs, and atherosclerosis (hardening of the arteries). Peripheral artery disease and atherosclerosis both increase your risk of heart attack and stroke.

Claudication is also a concern because the pain it causes when walking or exercising often keeps people from being active, which only makes the claudication worse.

What causes neurogenic claudication?

Neurogenic claudication is typically caused by spinal stenosis, which is sometimes called pseudoclaudication. This is a narrowing of the space around your lower spine, which can put pressure on your spinal cord directly. It can also compress the blood vessels around the spine, depriving it of oxygen-carrying blood. Either of these two possibilities can cause pain that starts in your lower back and continues down your legs, as well as weakness, tingling or numbness in your legs and feet. It can also make it hard for you to regulate your bowel or bladder.

One key difference between vascular and neurogenic claudication is something that people can do to relieve the pain. In neurogenic claudication, people report that they can relieve the pain by leaning forward. This is called the “shopping cart sign” because it resembles the posture of someone pushing a shopping cart, and it’s not seen in people with vascular claudication.

What are the risk factors for vascular claudication?

Your risk of developing claudication goes up as you get older. The following factors can increase your risk for developing claudication:

• Tobacco use.
• Diabetes.
• Kidney disease.
• High cholesterol.
• High blood pressure.

What are the risk factors for neurogenic claudication?

Some people are born with a naturally narrow spinal canal. Others develop this issue because of injuries, degeneration of the spine because of aging, or a combination of all of these factors.

How is vascular claudication diagnosed?

In order to determine if you have claudication — or how severe your case is — your healthcare provider may conduct the following:

• Physical exam: Your provider will examine your legs and feet, looking for color changes, wounds that are slow to heal or any other signs of poor circulation. They will also feel for your pulse in your legs and feet because one of the key symptoms of PAD is weak or no pulse in the lower legs and feet.
• Ankle-Brachial index: The ankle-brachial index is a test that measures your blood pressure in your arm and ankle and compares the two, looking for lower pressure in your legs.
• Angiography: Angiography is an imaging test that uses a special dye injected into your body. This helps doctors map the relevant blood vessels. It can be done using an X-ray, Computed Tomography (CT) scan and MRI.
• Ultrasound: Ultrasound uses very high-frequency sound waves to help providers visualize the blood vessels in your legs, especially areas that are narrowed or blocked.

How is neurogenic claudication diagnosed?

• Physical exam: Your healthcare provider will examine your legs and feet to look for signs of vascular claudication and feel for pulses in these extremities.
• One or more of the following imaging tests:
  • X-rays.
  • CT scans.
  • MRI.
  • Myelography (especially for patients who can’t have an MRI).

How is vascular claudication treated?

Treating claudication is important because it’s usually an indicator of peripheral artery disease or similar circulatory diseases that are life-changing and even deadly. Treatment can take several forms and your doctor may encourage you to do one or more of the following:

• Quit tobacco. Tobacco use, especially smoking, is one of the biggest risk factors for claudication.
• Walk more. The best type of exercise for claudication is walking. Your doctor can give you resources and information about walking programs that are meant to help people with similar health issues.
• Take prescription medications. These include:
  • Blood pressure medications.
  • Cholesterol-lowering medications.
  • Antiplatelet medications (such as aspirin or clopidogrel, which increase blood flow).

If those treatments don’t work, your healthcare provider may recommend treatment options to increase or reroute blood flow, such as surgery or catheterization. Catheter-based approaches are less-invasive and use a medical device inserted into one of your major blood vessels, which can then treat the narrowed or blocked passage. Your doctor can tell you more about the specific options you have when it comes to this kind of procedure.

How is neurogenic claudication treated?

Nonsurgical treatment of neurogenic claudication includes the use of medication to help manage pain, physical therapy and steroid shots to help reduce inflammation. Your doctor may also recommend stretching, strengthening exercises and other types of activity to help improve your body’s ability to support itself. However, conservative treatment might not be an option for patients whose cases are more severe. If the conservative treatment options don’t work, or for patients whose cases are already more severe, surgery is the next option. Your provider can help explain your options so you can decide together what is best for you.

Can claudication be prevented?

There are many things you can do to prevent vascular claudication or delay its onset. These include:

• Maintain a healthy weight.
• Eat a balanced diet.
• Stay physically active.
• Quit using tobacco products (if you use them).
• Manage any health conditions that can contribute to this problem, including high blood pressure, high cholesterol and diabetes.

Neurogenic claudication is harder to prevent because spinal stenosis is part of the natural aging process. However, while spinal stenosis is more likely to happen as people get older, the majority of people who have it also have no symptoms.

Some recommendations to prevent or delay spinal stenosis include:

• Exercising and staying active.
• Eating a balanced diet.
• Maintaining a healthy weight.

When to call a doctor

Claudication is a symptom that you should always talk about with your healthcare provider because it’s a key symptom in peripheral artery disease. Early diagnosis and treatment can prevent or delay the worsening of claudication symptoms to the point where they impact your life. You should also talk to your provider as soon as possible if this symptom develops or worsens very suddenly.

It’s also important to talk to your provider about claudication even if you don’t have any other health problems because it can also be a sign of a few other diseases and conditions, many of which are more likely to occur in healthy, physically active people. Most of these conditions are serious and some of them are medical emergencies. These include:

• Chronic compartment syndrome: Muscle groups, including their related nerves and blood vessels, are part of a “compartment,” which is contained within a membrane called “fascia” (pronounced “fash-ia”). If the tissue inside a compartment swells, the fascia compresses what’s inside the compartment, limiting blood flow and causing pain. Chronic compartment syndrome isn’t usually an emergency.
• Deep vein thrombosis (DVT): This condition happens when a blood clot forms in a vein (typically a vein in your leg). If a clot breaks free and is carried to your lungs, it can get stuck and block blood flow. This is a life-threatening medical emergency called pulmonary embolism.
• Popliteal artery entrapment syndrome (PAES): This rare condition happens when a muscle defect compresses an artery in your leg, cutting off blood farther down. Surgery is often required to correct the condition, which can be a medical emergency in more severe cases.