Introduction
Intermittent claudication is a medical condition characterized by poor circulation and blockage of blood in the leg arteries, producing aching, cramping or burning pain the legs. The pain is typically brought on by exercise and is relieved by rest.
Claudication refers to the limping that occurs from leg cramps. The term has been originally derived from the Latin word ‘claudicare’, that means to limp.
In other words, intermittent claudication is a predictable pattern of lower leg pain caused by inadequate blood flow to exercising muscle. Intermittent claudication might occur in one or both legs and often continues to worsen over time.
Characteristics of Pain
One of the most typical signs of intermittent claudication is that the pain occurs intermittently. It disappears after a brief rest and the patient can start walking again until the pain recurs.
The pain of intermittent claudication has three main characteristics, including:
i) Cramping pain brought on by exertion
ii) Relief felt after rest
iii) Reproducable .i.e. almost always occurs after having walked the same distance
Causative Factors
The main cause of pain is the narrowing of the arteries that supply the leg with blood, thus limiting the supply of oxygen to the leg muscles. Such a limitation is especially felt when the oxygen requirement of these muscles rises with exercise.
Intermittent claudication can occur due to:
· Temporary artery narrowing (vasospasm .i.e. spasm of the artery)
· Permanent artery narrowing due to atherosclerosis
· Complete occlusion (closure) of an artery to the leg
Diagnosis
The diagnostic tests available for intermittent claudication include:
· Blood pressure measurement to compare the arms and legs
· Doppler ultrasonography on the legs
· Duplex Doppler/ultrasound exam of the extremities to visualize arterial blood flow
· ECG
· Arteriogrpraphy (a dye is injected that can be visualized in the arteries)
Treatment
There are two main drugs available for management of the condition of intermittent claudication. These include:
i) Pentoxifylline: With the brand name Trental, this drug decreases the viscosity or stickiness of blood, thereby improving its flow to the legs.
ii) Cilostazol: Available under the brand name Pletal, it acts to dilate or widen the arteries by decreasing the action of an enzyme, phosphodiesterase III. It also reduces the ability of blood to clot.
In cases, where all other measures fail, other specific procedures can be used to correct the narrowing of the arteries. These include surgeries such bypass grafting and interventional radiology such as balloon angioplasty.
Self Care
You can take a series of self-care measures in the condition of intermittent claudication. A few of these include:
· Reduce smoking
· Monitor your cholesterol and blood pressure levels
· Exercise regularly
· Control the symptoms of diabetes
· Wear proper footwear
Patients can also develop neuropathic pain secondary to peripheral vascular disease which may require anti-neuropathic medication to treat.
