What is claudication?

Claudication refers to limping because of pain in the thigh, calf, and/or buttocks that occurs when walking. Claudication may be a symptom of peripheral arterial disease (PAD). PAD is caused by a narrowing or blockage of arteries in the legs and/or aorta (the largest artery in the body and the primary blood vessel leading from the heart to the body), which may cause decreased blood flow to the muscles of the calf, thigh, or buttocks. This decreased blood flow may cause claudication. The pain associated with claudication occurs with walking but disappears at rest.

Claudication may be a symptom of underlying systemic artery disease and is seen more often in persons who have blockages in other arteries, including the heart and brain. Because claudication is associated with an increased risk for heart attack or stroke, its presence signals the need for assessment and possible treatment.

According to the National Heart, Lung, and Blood Institute, about 8 to 12 million Americans have peripheral arterial disease (PAD), particularly people age 50 and older. The Vascular Disease Foundation states men (5 percent) and women (2.5 percent) 60 years of age and older have symptoms of intermittent claudication.

Claudication generally occurs when walking the same distance. With progressive vessel disease, the initial claudication distance (that distance at which a person first experiences pain when walking) may decrease or the person may no longer be able to walk.

What causes claudication?

Blockage of an artery in the legs may cause intermittent claudication. Atherosclerosis (a build-up of plaque, which is a deposit of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of an artery) is the most common cause of blockage of arteries.

Blockages in the leg are most common in the thigh and behind the knee but may also occur at other sites in the body including the aorta, groin, or abdomen. A person may have more than one blockage.

What are the risk factors for claudication?

As stated above, atherosclerosis is the most common cause of arterial blockage which can cause claudication. Risk factors for claudication are the same as those for atherosclerosis, and may include:

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases have different risk factors.

Although these risk factors increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors. Knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

What are the symptoms related to claudication?

Claudication itself is a symptom of a narrowing or blockage of an artery. Pain, a burning feeling, or a tired sensation in the legs and buttocks while walking are symptoms of claudication. In some cases, the sound of blood moving through a blockage (a whooshing sound called a bruit), can be heard through a stethoscope.

The skin of the foot or leg may become shiny, hairless, mottled (blotchy) in appearance, or may ulcerate. The affected leg may become pale when elevated and reddened (rubor) when lowered. Additional symptoms that may be present in persons with claudication include cold feet, impotence in men, and leg pain that occurs at night when in bed. Pain that occurs at rest may be a sign of increasing severity of arterial disease in the leg(s).

The symptoms related to claudication may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is claudication diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for claudication may include any, or a combination, of the following:

What is the treatment for claudication?

Specific treatment will be determined by your doctor based on:

Claudication is usually treated conservatively, with the primary goal of treatment being modification of risk factors. Treatment for claudication may include one or more of the following:

For advanced cases in which pain is severe and/or blood flow has been completely or almost completely blocked, an invasive procedure such as angioplasty (a catheter is used to create a larger opening in the vessel to increase blood flow), stent placement (a tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open), or surgery may be needed to open the blocked artery.

In a small percentage of cases where all other treatments have not been effective, amputation of the affected limb may be necessary. Patients who smoke or who have diabetes are at increased risk for poor outcomes in treating claudication.

Can claudication be prevented?

Because many persons who have claudication also have atherosclerotic disease, such as peripheral arterial disease, coronary artery disease, and/or blockages of the carotid artery (carotid stenosis), aggressively modifying risk factors for atherosclerosis can help prevent claudication.

A prevention plan for claudication may also be used to prevent or lessen the progress of PAD associated with claudication once it has been diagnosed. Consult your doctor for diagnosis and treatment.

Preventative measures may include: