Intermittent claudication is a predictable pattern of lower leg pain caused by inadequate blood flow to exercising muscle.
The pain of intermittent claudication has three characteristics:
- It is a cramping pain in the calves that is brought on by exertion
- It is relieved by rest
- It is reproducible; that is, it almost always occurs after having walked the same distance, for example. (However, the pain may occur earlier if walking uphill or more quickly.)
Intermittent claudication is caused by arterial insufficiency (inadequate blood supply), primarily due to atherosclerosis. Atherosclerosis is a condition that involves fatty build-up and narrowing of the arteries, which thus occludes or limits blood flow through them; the narrowed areas may be localized or extensive. Cigarette smoking is the most important risk factor for vascular disease bar none. Others include high blood pressure, high cholesterol, diabetes mellitus and a family history of atherosclerosis.
Pain brought on by walking is less serious than pain taking place during sleep or while at rest; these are indications of disease progression, and warrant more aggressive therapy. Patients with these symptoms are classified as “pre-gangrenous”, meaning that deterioration could lead to gangrene, a condition where so little blood reaches the affected tissue that damage is irreversible and tissue death results, requiring amputation. This occurs in 5% of untreated atherosclerotic patients within 5 years.
Inadequate blood flow to the lower extremities may result in deformed toenails, hair loss, skin thinning, and ulcers or infections on the feet or ankles. Small cuts and wounds on the lower legs may heal very slowly; thus foot care is an important part of treatment.
Pain in the lower legs can be caused by arthritis of the spine, herniated vertebral disk, and other diseases of the spine which can pinch the nerves that supply the legs. Muscle cramps can also cause leg pain, but do not exhibit the same three characteristics listed above.
Conventional medicine uses Doppler studies (a specialized ultrasound test) and transcutaneous oxygen pressure measurements to evaluate blood flow. Angiography may be performed to determine the best treatment; this is a method used to visualize the blood vessels using dye injection and X-ray. This test shows the extent of vessel narrowing.
Conservative treatment is indicated in patients who experience symptoms only upon exertion. In these cases, stopping smoking is critical. Blood pressure, lipids and blood sugar (in diabetics) should be lowered and monitored closely. “Blood thinning” drugs (anti-platelet drugs) have not proven helpful in this group of patients, but exercise has.
Signs, symptoms & indicators of Intermittent Claudication
Leg pain from long walks
Counter Indicators
Absence of leg pain on walking
Risk factors for Intermittent Claudication
Buerger's Disease
The initial symptoms of Buerger’s Disease often include claudication (pain induced by insufficient blood flow during exercise) in the feet and/or hands, or pain in these areas at rest. The pain typically begins in the extremities but may radiate to other (more central) parts of the body.
Cigarette Smoke Damage
Cigarette smoking is the most important risk factor for vascular disease bar none.
Intermittent Claudication suggests the following may be present
Buerger's Disease
The initial symptoms of Buerger’s Disease often include claudication (pain induced by insufficient blood flow during exercise) in the feet and/or hands, or pain in these areas at rest. The pain typically begins in the extremities but may radiate to other (more central) parts of the body.
Cigarette Smoke Damage
Cigarette smoking is the most important risk factor for vascular disease bar none.
Recommendations for Intermittent Claudication
Ginkgo Biloba
In a double-blind German study, ginkgo biloba was significantly superior to a placebo in improving symptoms of intermittent claudication [Peters, 1998]. After six months of treatment, pain-free walking distance in the ginkgo group improved by almost 50% compared to baseline measurements.
Chelation Therapy
The benefit of chelation therapy in cases of intermittent claudication is controversial. The controversy has been fueled by two studies showing no benefit. Proponents of chelation therapy have pointed out how these studies were flawed. You can read the details about these flawed studies at Dr. Cranton’s web site.
Tobacco Avoidance
Smoking is the chief cause of intermittent claudication.
Aerobic Exercise
A systematic review of randomized trials suggests that exercise improves symptoms of intermittent claudication. [Physical Therapy 1998 78: pp.278-88]
Vitamin Inositol Hexaniacinate
Inositol hexaniacinate, a special form of vitamin B3, has been used successfully to treat intermittent claudication. A double-blind trial explored the effect of 2gm bid for 3 months. In nonsmokers and in people with unchanged smoking habits, the increase in walking distance was significantly greater than in the placebo group. [Br J Clin Pract 1988;42: pp.141-5, 377-83]
Vitamin E
400 to 2,000 I.U. per day of vitamin E for many months has lead to improvements.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Very strongly or absolutely counter-indicative |
| Likely to help |
| Highly recommended |
Glossary
Claudication
Often Intermittent claudication: Condition caused by interruptions of blood supply to the muscles, characterized by limping and pain chiefly in the calf muscles: symptom characterized by pain during walking.
Atherosclerosis
Common form of arteriosclerosis associated with the formation of atheromas which are deposits of yellow plaques containing cholesterol, lipids, and lipophages within the intima and inner media of arteries. This results in a narrowing of the arteries, which reduces the blood and oxygen flow to the heart and brain as well as to other parts of the body and can lead to a heart attack, stroke, or loss of function or gangrene of other tissues.
Cholesterol
A waxy, fat-like substance manufactured in the liver and found in all tissues, it facilitates the transport and absorption of fatty acids. In foods, only animal products contain cholesterol. An excess of cholesterol in the bloodstream can contribute to the development of atherosclerosis.
Diabetes Mellitus
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Ulcer
Lesion on the skin or mucous membrane.
Arthritis
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
Lipid
Fat-soluble substances derived from animal or vegetable cells by nonpolar solvents (e.g. ether); the term can include the following types of materials: fatty acids, glycerides, phospholipids, alcohols and waxes.