Intermittent Claudication

What is intermittent claudication?

Intermittent claudication is muscle pain that happens when you’re active and then stops when you rest. In some cases, the pain in your legs is intense enough that it makes you stop walking. Claudication-related pain happens because your blood isn’t moving through your body well. This can be a sign of serious health issues.

“Intermittent” means it happens some of the time. “Claudication” comes from a Latin word for “to limp.” The pain usually affects your legs (and sometimes, your butt) and gets better when you stop for a few minutes. When you’re physically active, your muscle cells are working harder and need more oxygen than your blood can deliver. You don’t feel pain when you’re resting because those cells don’t need as much oxygen, so there’s enough supply to meet the demand.

What should I expect to feel with intermittent claudication?

Pain from claudication is usually dull and aching. Intermittent claudication symptoms may also feel like your muscles are tiring out, or like a muscle spasm or cramp. Some people compare it to a “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.

It might feel like the pain is coming from near one of your joints. But intermittent claudication doesn’t cause arthritis or 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 areas or lasts for several minutes after you stop to rest, it’s more likely that it isn’t intermittent claudication.

Are there stages or different severity levels?

Yes, intermittent claudication can range from mild to severe. Intermittent claudication can get worse gradually. But with treatment, most people (more than 70%) can keep it from getting worse for at least five years.

What are the most common causes of intermittent claudication?

This symptom is a circulatory problem — meaning, a part of your body doesn’t have enough blood flow. That lack of blood flow, known as ischemia (pronounced “iss-key-me-uh”), means the affected areas of your body don’t have enough oxygen. If ischemia lasts for too long, it can damage the affected area and even cause the affected cells to die. With treatment, most people don’t get to that point.

The main cause of intermittent claudication is a condition called peripheral artery disease (PAD). This condition happens with atherosclerosis, a buildup of a wax-like substance called plaque (atheroma) 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 narrows 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 medical tests are likely with this symptom?

Tests for intermittent claudication can pinpoint the cause of the pain and help a healthcare provider treat it.

A provider may order the following tests:

• Physical exam: This includes checking pulses in your legs and feet. You may have this symptom if the pulses in your legs or feet are weaker than normal or are impossible to feel or hear.
• Ankle-brachial index (ABI) test: This measures and compares the blood pressure in your ankle and your arm. A large difference between the two may mean you have claudication in your legs.
• Angiogram: This uses an injected contrast dye to show poor circulation on an X-ray.
• MRA: This helps find the blockage with an MRI.
• Computed tomography (CT) angiogram: This helps find the problem area with special X-rays.
• Vascular ultrasound: This helps find the narrowed area with sound waves.

How is intermittent claudication treated?

Intermittent claudication treatment can take various forms. All of them aim to improve blood flow where you feel pain. While treatments can’t cure or reverse this symptom, they can improve it. Most people find relief by taking walks and medicines. They don’t need a procedure.

Possible treatments include changes in habits, medications and procedures.

Changes in habits

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

• Walk regularly. Walking (for at least 30 minutes, three or more times a week) can help intermittent claudication. Stop when you feel pain, rest a couple minutes and start again.
• Reach and maintain a weight that’s healthy for you. Having overweight can worsen PAD and its symptoms, including intermittent claudication.
• Eat healthy foods. Following a healthy meal plan can help with problems like diabetes (potentially delaying or even preventing it), high cholesterol and high blood pressure.
• Quit using tobacco products. This includes cigarettes, cigars, pipes, vaping and smokeless tobacco products (chewing tobacco and snuff).
• Take your medications. This means following your provider’s instructions. Stopping some drugs suddenly, especially blood thinners, can greatly increase your risk of conditions like stroke.
• Manage stress, anxiety and mental health. Your mental health can have a big impact on all parts of your body, especially your heart and circulatory system.

Medications

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

• Blood thinners: These reduce your blood’s ability to clot. This helps prevent life-threatening complications like blood clots that can block the arteries in your legs, brain or lungs.
• Statins: These medications lower your blood cholesterol levels to prevent plaque buildup and any related complications like heart attacks.
• Blood pressure medications: These typically make your blood vessels relax and widen, improving blood flow. This can ease or stop your pain and help prevent heart attack and stroke.
• Diabetes medications: Managing diabetes with medication can help prevent heart and circulatory complications. Diabetes has a strong link to your risk of developing heart disease.

Surgery or minimally invasive procedures

Procedures to restore blood flow may relieve or reduce the pain from intermittent claudication. Possible procedures include the following:

• Angioplasty: This is a minimally invasive procedure that uses a catheter to widen the artery.
• Stent: After angioplasty, a provider can place a stent, a scaffold-like structure that holds 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 make a detour-like route for blood to travel.
• Atherectomy: This procedure uses a catheter device to remove plaque buildup from the inside of narrowed arteries.

What are the possible complications or risks of not treating intermittent claudication?

Claudication increases your risk for serious heart and circulatory problems. This is why treatment usually involves preventive measures to avoid those complications.

When intermittent claudication gets worse, you may have:

• Pain after walking a short distance
• Pain when you’re not moving your legs
• An ulcer on your foot
• Gangrene in your foot

Can intermittent claudication be prevented?

Many of the at-home treatments for intermittent claudication can also help prevent it. 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 increase your risk of problems like heart disease, heart attack, stroke and more.

When should intermittent claudication be treated by a healthcare provider?

If you have intermittent claudication, early diagnosis and treatment can help you avoid or limit serious problems in the future. Several conditions have symptoms similar to intermittent claudication but are much more serious. These include:

• Chronic compartment syndrome
• Deep vein thrombosis (DVT)
• 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. This includes those that need emergency care. In general, you should call your provider when you have:

• Signs of severe blood flow problems (like coldness or numbness) in one of your limbs, especially your feet and legs
• Wounds that are slow to heal, or new sores and ulcers
• Any signs of infection (discoloration, swelling, pain and warmth), especially around a wound or sore
• Chest pain or shortness of breath that happens at the same time or soon after pain in your legs
• Leg pain that doesn’t get better when you stop to rest
• Sudden severe pain or pain that moves from its usual location