Claudication is pain caused by too little blood flow to muscles during exercise. Most often this pain occurs in the legs after walking at a certain pace and for a certain amount of time — depending on the severity of the condition. Treatments focus on lowering the risks of vascular disease, reducing pain, increasing mobility and preventing damage to tissues.

Symptoms

  • Pain, ache, discomfort or fatigue in muscles every time those muscles are used
  • Pain in the calves, thighs, buttocks, hips or feet
  • Less often, pain in shoulders, biceps and forearms
  • Pain that gets better soon after resting
  • Hair loss in the lower leg
  • Shiny skin
  • Brittle toenails

Causes

Claudication is most often a symptom of peripheral artery disease. The peripheral arteries are the large vessels that deliver blood to the legs and arms.

Peripheral artery disease is damage to an artery that restricts the flow of blood in an arm or leg (a limb). When you’re at rest, the limited blood flow is generally enough. When you’re active, however, the muscles aren’t getting enough oxygen and nutrients to work well and remain healthy.

Damage to peripheral arteries is usually caused by atherosclerosis. Atherosclerosis is the buildup of fats, cholesterol and other substances in and on the artery walls. This buildup is called plaque. The plaque can cause the arteries to narrow, blocking blood flow. The plaque can also burst, leading to a blood clot.

Complications

Claudication is generally considered a warning of significant atherosclerosis, indicating an increased risk of heart attack or stroke. Other complications of peripheral artery disease due to atherosclerosis include:

  • Skin lesions that don’t heal
  • Death of muscle and skin tissues (gangrene)
  • Amputation of a limb

Prevention

The best way to prevent claudication is to maintain a healthy lifestyle and control certain medical conditions. That means:

  • Eat a healthy, well-balanced diet
  • Exercise regularly
  • If you have diabetes, keep your blood sugar in good control
  • Maintain a healthy weight
  • Manage cholesterol and blood pressure
  • Quit smoking if you’re a smoker

Diagnosis

Claudication may go undiagnosed because many people consider the pain to be an unwelcome but typical part of aging. Some people simply reduce their activity level to avoid the pain.

A diagnosis of claudication and peripheral artery disease is based on a review of symptoms, a physical exam, evaluation of the skin on the limbs, and tests to check blood flow.

Tests

Some common tests used to diagnose claudication may include:

  • Pulse measurement in your palms or feet to assess blood flow to the entire limb
  • Ankle-brachial index, a comparison of blood pressure in the ankles with the blood pressure in the arms
  • Segmental blood pressure measurement, a series of blood pressure measurements at different areas on the arm or leg to help determine the amount and location of damage to the arteries
  • Exercise testing to determine the maximum distance you can walk or the maximum exertion without pain
  • Doppler ultrasound to see the flow of blood
  • Magnetic resonance imaging (MRI) or computed tomography (CT) angiography to look for narrowed blood vessels

Treatment

The goals of treating claudication and peripheral artery disease are to reduce pain and manage the risk factors that contribute to heart and blood vessel (cardiovascular) disease.

Exercise is an important part of claudication treatment. Exercise reduces pain, increases exercise duration, improves vascular health in the affected limbs, and contributes to weight management and an overall improvement in quality of life.

Recommended walking programs include:

  • Walking until you feel moderate pain or as far as you can
  • Resting to relieve pain
  • Walking again
  • Repeating the walk-rest-walk cycle for 30 to 45 minutes
  • Walking three or more days a week

Supervised exercise is recommended for beginning the treatment, but long-term exercise at home is important for ongoing management of claudication.

Medications

Your health care provider may prescribe one or more medications to control pain and manage risk factors for cardiovascular disease. For example, medications may be used to manage the following:

  • Pain. The drug cilostazol, which improves blood flow, may reduce pain during exercise and help you to walk further.
  • High cholesterol. Statins are a drugs that help lower cholesterol, a key factor in the formation of plaques in arteries. Taking statins may improve walking distance.
  • High blood pressure. Several different classes of drugs may be prescribed to lower blood pressure and reduce the risk of heart attack or stroke.
  • Other cardiovascular risks. Anti-platelet drugs, which help prevent blood clots, may reduce the risk of heart attack, stroke or clots blocking blood flow to limbs. These drugs include aspirin, clopidogrel (Plavix) and other classes of drugs.

Talk to your doctor about medications or supplements that you shouldn’t take with your prescribed treatment.

Surgery or other procedures

When peripheral artery disease is severe and other treatments don’t work, surgery may be required. Options include:

  • Angioplasty. This procedure improves blood flow by widening a damaged artery. A health care provider guides a narrow tube through blood vessels to deliver an inflatable balloon that expands the artery. Once the artery is widened, the health care provider may place a small metal or plastic mesh tube (stent) in the artery to keep it open.
  • Vascular surgery. During this type of surgery, a surgeon takes a healthy blood vessel from another part of the body to replace the vessel that’s causing claudication. This allows blood to flow around the blocked or narrowed artery.