Health & Disease Info
All You Wanted to Know About ... Lower Extremity Claudication

What is Claudication?
Claudication is a sensation of severe tiredness, cramping, or pain in the legs when walking. These symptoms cause a change in the way you walk, leading to the term claudication which comes from the Greek word meaning to limp. The exact site of symptoms will depend on which artery would be involved. However, the most common area involved is the calf.

The pain of claudication is a very specific symptom. when muscle is asked to perform work such as walking or running, the metabolic activity of the muscle increases significantly as does the blood flow requirement to do the work. When a to flow through the artery occurs, the increase in blood flow to meet the increased demands of the muscle is unable to occur. In this situation the muscle is forced to metabolize sugar without the presence of oxygen which forms lactic acid. This lactic acid builds up in the tissues causing a characteristic burning pain.

What Causes Claudication?
The underlying disease process in arterial blockage is called atherosclerosis. This very simply is the process in which cholesterol and eventually calcium is deposited in the walls of blood vessels causing the vessels to become more narrowed, and eventually completely blocked. Normally the arteries can carry much more blood that is needed, so symptoms are not experienced until they are about 80% blocked. Major risk factors for atherosclerosis are cigarette smoking, high blood pressure, elevated serum cholesterol, and diabetes mellitus.

What Tests Will Have to be Done?

A lower extremity doppler examination is performed in a vascular laboratory. This is performed by placing blood pressure cuffs on your arms and at four levels on your legs. Blood pressure readings are taken at each of these levels, and tracing of the blood pulsation in each arm will be taken. You then may be asked to walk on a treadmill machine, as long as you can, up to five minutes.

What Treatment Will Be Needed?
The treatment of claudication is quite an active one, both on the part of the physician and also on the part of the patient.

• Stage one disease is intermittent claudication with onset of symptoms after walking greater than one block with no significant physical changes on examination except for the absence of pulses. The majority of patients fall into this category and respond very nicely to an exercise program.
• Stage two disease consists of claudification occurring after walking less than one-half block. Occasionally "invasive" studies and therapeutic intervention such as surgery can be justified, but this is not always necessary.

95% of all patients with claudication fall into the above stages and will never progress to stage three or four.

• Stage three disease presents with rest pain and very short distance claudification. All mentioned physical findings will be present and will be quite severe. Rest pain is a very specific symptom and occurs because the tissues are unable to obtain an adequate supply of oxygen and nutrients even in the resting state. Rest pain consists of pain in the area of the ball of the foot which can be relived by lowering the foot to a dependent position, such as over the bed and may also be relived by occasionally getting up to walk. This is a warning sign and at all times justifies aggressive diagnostic and therapeutic measures.
• Stage four disease is the end stage of arterial blockage consisting of gangrene or non-healing ischemic ulcerations.