Category: Miscellaneous Articles Published on Wednesday, 24 February 2016 Written by Yong Tsai, MD

Have you experienced recurring leg pain after walking a specific distance? Does it subside when you sit down and rest? John, a 65-year-old man with diabetes, who has smoked for thirty years, has experienced a few months of calf pain after walking two blocks. However, even though his pain always arises after walking almost exactly two blocks, resting for a while seems to relieve it.

Claudication, from the Latin word claudication meaning “ to limp”, describes calf, thigh, or hip muscle pain that occurs after having walked a certain distance and is relieved after brief resting. Atherosclerosis occurs when fatty material builds up in the artery walls, causing narrowing of the artery. When blood flow into a muscle is inadequate, usually caused by atherosclerotic narrowing of the arteries that supply blood to your legs (peripheral arterial disease or PAD), claudication occurs. At rest, blood flow to leg muscles is adequate because of lower metabolic demands, but becomes insufficient with the increased demands from walking or exercising.

Most patients with PAD have no symptoms and up to 90% of patients with claudication simply accept their diminishing walking tolerance as “getting older” and fail to report their condition to their physician. About 68% of patients with PAD also have coronary heart disease, while 42% have cerebrovascular disease. The primary risk factors for PAD are increased age, smoking, and diabetes while high blood pressure and high cholesterol are secondary predisposing factors. A diagnosis of claudication can be made with relative certainty based on a patient’s history and physical examination. However, the best confirmatory evidence can be obtained by evaluating blood flow via a Doppler study; lower blood pressure in your leg compared to your arm can suggest PAD.

Medications used in the United States to treat PAD include Pietal (cisostazol); the most effective choice for it significantly increases walking distance without pain, and Trental (pentoxifylline) which is somewhat less effective. Antiplatelet treatment such as low dose of aspirin to prevent strokes and heart attacks are also key medications. If a patient develops severe symptoms and fails to respond to optimum medical therapy, surgery may be indicated. Furthermore, a progressive exercise program requiring patients to exercise to or through the onset of claudication, to rest until the pain resolves, and then to resume exercise, can improve exercise tolerance and decrease claudication. Finally, diabetes, hypertension, and high cholesterol must be well controlled and patients should be advised to stop smoking.

Because PAD is a powerful indicator of narrowing of the major arteries within the heart or brain, its detection can predict strokes, heart attacks and possibly even death. Don’t settle for “getting old” as the reason for your pain…it’s not always the culprit.

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