Intermittent Claudication

What is intermittent claudication?

Intermittent claudication is muscle pain that happens when you’re active and stops when you rest. In some cases, the pain is intense enough that it even interferes with simpler activities like walking. Claudication-related pain happens because of a decrease in blood circulation, which can indicate or serious health conditions.

Why does intermittent claudication happen?

Intermittent claudication is a circulatory problem where a part of your body doesn't have enough blood flow. That lack of blood flow, known as ischemia (iss-key-me-uh), means the affected areas of your body don’t have enough oxygen. If ischemia lasts for too long, that can damage the affected area and even cause the affected cells to die.

Intermittent claudication usually affects your legs and gets its name from the fact that it gets better when you stop and rest. That happens because when you’re physically active, your muscle cells are working harder and need more oxygen than your blood can deliver. Those cells don't need as much oxygen when you're resting, so there’s enough supply to meet the demand.

What causes this symptom?

The main cause of intermittent claudication is a condition called peripheral artery disease (PAD). That condition happens with atherosclerosis, which is a buildup of a wax-like substance called plaque on the inside of your arteries. As that buildup gets worse, there’s less room for blood to flow through those arteries.

PAD happens when plaque buildup causes significant or severe narrowing of the arteries that feed your limbs (especially your legs). Much like a closed lane on a road causes traffic to slow down and back up, narrowing of your blood vessels slows down blood flow to your limbs.

What should I expect to feel with intermittent claudication?

Pain from claudication is usually dull and aching. It may also feel like your muscles are tiring out, or it can feel like a muscle spasm or cramp (sometimes described with the informal term “Charley horse”). The more effort or activity, the worse the pain will feel. In some cases, you may also feel numbness because the nearby nerves also don’t have enough blood flow.

An important detail about claudication is that it affects muscles only. It doesn’t cause arthritis and joint pain. The pain should also stop within a few minutes — or even less — once you stop to rest. If the pain is in one or more joints or lasts for several minutes after you stop to rest, it’s more likely that this is not intermittent claudication.

What medical tests are likely with this symptom?

Though intermittent claudication is a symptom rather than a specific health condition, a healthcare provider will likely order medical tests if you have this symptom. Those tests can pinpoint the cause of the pain, ensure that it isn’t another condition or problem, and help guide treatment.

The following tests are possible if you have intermittent claudication:

Physical examination

A physical examination is where a healthcare provider looks at various parts of your body for any visible signs of a problem. Along with a visual examination, they will also feel for pulses in your legs and feet and listen to those pulses with a stethoscope. A key sign they’re looking for is if the pulses in your legs or feet feel or sound weaker than normal or are impossible to feel or hear.

Ankle-brachial index

The ankle-brachial index (ABI) test measures and compares the blood pressure in your ankle and your arm. If the ankle pressure reading is lower than the arm reading by a wide enough margin, that may mean you have claudication in one or both legs.

In many cases, healthcare providers will measure those pressures, have you walk on a treadmill, and then take the measurements again after you finish walking. Comparing those measurements can help determine the severity of the problem (if you have it).

Arteriogram

This test involves a liquid, called contrast, injected into an artery in the area(s) where intermittent claudication is possible. That contrast is bright and visible on an X-ray and can show healthcare providers the circulation in that area. They can also often see decreases in circulation that happen with intermittent claudication.

Other imaging tests

In some cases, healthcare providers may try other imaging tests that can help with determining the underlying cause of intermittent claudication. These include:

• Magnetic resonance imaging (MRI).
• Computed tomography (CT) scan.
• Vascular ultrasound.

How is this symptom treated?

Claudication treatment can take various forms, all of which focus on improving the circulation in the areas where you feel pain. Unfortunately, claudication also increases your risk for serious heart and circulatory problems, which is why treatment usually involves preventive measures to avoid those complications.

Possible treatments include the ones seen below.

Medications

Drugs can often play a major role in treating intermittent claudication. These drugs typically help improve circulation or prevent serious problems that are more likely because of claudication. These usually include:

• Blood-thinning medications. These drugs reduce your blood’s ability to clot. This is important because it helps prevent life-threatening complications like stroke, pulmonary embolism or clots that can develop and block the arteries in your legs.
• Statins. These medications lower your blood cholesterol levels. Higher cholesterol levels can cause plaque to build up more quickly. Lowering those levels helps prevent that buildup and any related complications like heart attacks.
• Blood pressure medications. These medications typically make your blood vessels relax and widen, improving blood flow. Improving blood flow can ease or stop claudication-related pain entirely. These medications also help prevent problems like heart attack and stroke.
• Diabetes-controlling medications. Diabetes has strong connections to blood pressure, cholesterol levels and your risk of developing heart disease. Controlling your diabetes with medication (if that's necessary) can also help prevent heart and circulatory complications.

Surgery or minimally invasive procedures

Revascularization procedures, which restore blood flow, may relieve or reduce the pain from intermittent claudication. Possible procedures include the following:

• Percutaneous transluminal angioplasty: This is a minimally invasive procedure where a medical provider inserts a catheter (a long, tube-shaped device) into a major blood vessel, usually the one at the top of your thigh. They then steer the catheter through your blood vessels to the areas where your arteries are narrow enough to cause claudication. Once they’re at the narrowed area, they can then inflate a balloon to widen the artery. They can also place a stent, a scaffold-like structure that will hold the artery open so blood can flow through easily.
• Bypass surgery. This procedure takes a blood vessel from elsewhere in your body and uses it to craft a detour-like route for blood to travel. Once in place, that bypass provides enough blood flow to prevent intermittent claudication.
• Atherectomy. This procedure uses a catheter device to remove plaque buildup on the inside of narrowed arteries.

What can I do at home to treat this symptom?

You can do several things to limit how often you experience intermittent claudication and reduce the severity of the pain.

• Exercise regularly. Even an activity as simple as walking (for at least 30 minutes, three or more times a week) can help intermittent claudication. One of the key problems with intermittent claudication is that it causes pain while walking, often resulting in you not wanting to walk. Lack of activity worsens claudication, creating a negative, repeating cycle of worsening pain and walking problems.
• Reach and/or maintain a healthy weight. Being overweight can worsen PAD and its symptoms, including intermittent claudication.
• Eat a healthy diet. Improving your diet can help with problems like diabetes (potentially delaying or even preventing this condition’s development), high cholesterol and high blood pressure.
• Quit using tobacco products. This includes cigarettes, cigars, pipes, vaping and smokeless tobacco products (chewing tobacco, snuff).
• Take your medications. That means following your provider's instructions and taking medications as prescribed, not just when you have symptoms. Stopping some medications suddenly, especially blood-thinners, can greatly increase your risk of dangerous conditions like stroke.
• Manage your stress, anxiety and mental health. Your mental health can have a big impact on all parts of your body, especially your heart and circulatory systems.

How can this symptom be prevented?

Many of the items listed above that you can do at home to help this problem are also useful for preventing intermittent claudication. While it’s not always possible to prevent it completely, it may be possible to delay when it develops. That’s important because intermittent claudication is a symptom of PAD, which can significantly increase your risk of problems like heart disease, heart attack, stroke and more.

The most important preventive measures include:

• Quit using tobacco products or don’t start using them at all.
• Drink alcohol in moderation only. Moderate alcohol use is one drink per day in women (no more than seven drinks per week) and two drinks per day in men (no more than 14 drinks per week).
• Maintain a healthy weight.
• Eat a healthy diet.
• Exercise regularly.
• Manage your stress and mental well-being.

When should this symptom be treated by a doctor or healthcare provider?

If you have intermittent claudication, early diagnosis and treatment are very important to avoid or limit serious problems in the future. Several conditions have similar symptoms to intermittent claudication but are much more serious. These include chronic compartment syndrome, deep vein thrombosis (DVT) and popliteal artery entrapment syndrome (PAES).

If you already know you have intermittent claudication, your healthcare provider is the best person to explain possible trouble signs, including those needing emergency care. They are the best ones to offer guidance that best matches your situations and needs. In general, the following are signs that you need to call your doctor:

• Signs of severe blood flow problems in one of your limbs, especially your feet and legs. These include if one of your limbs is noticeably pale, feels colder or numb (in some cases, this is a severe sign of blocked blood flow, which can result in amputation without emergency care).
• Wounds that are slow to heal, or new sores and ulcers.
• Any signs of infection, especially around a wound or sore. These include redness, swelling, pain and warmth.
• Chest pain or shortness of breath that happen at the same time or soon after pain in your legs.
• Pain that doesn’t get better when you stop to rest.
• Sudden severe pain or pain that moves from its usual location.

A note from Cleveland Clinic

Intermittent claudication is usually not dangerous on its own, but it can be a symptom of serious health conditions and problems. It also increases the chances of developing other problems in the future (especially without treatment). If you have symptoms of this condition, it's important to see a healthcare provider who can evaluate these symptoms. With quick diagnosis and care, it's possible to keep this condition from becoming severe or causing severe disruptions in your life.