What Is Claudication?
Symptoms, Causes, and Treatment of Pain When Walking
Medically reviewed by Anthony Pearson, MD, FACC
Claudication is pain and discomfort in the thighs, calves, or buttocks that occurs during movement and is relieved by rest. Insufficient blood flow in the limbs causes claudication. It is also called intermittent claudication,
Claudication is most often a symptom of peripheral artery disease (PAD). PAD is a cardiovascular disease in which the arteries of the legs and arms are constricted, affecting circulation. Claudication and other symptoms of PAD can often be improved by exercise, lifestyle changes, and medications.
This article provides an overview of claudication, including its symptoms, causes, diagnosis, and treatment.
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What Are the Symptoms of Claudication?
Typically, claudication involves cramping and pain in various leg muscles during walking, which is subsequently relieved by rest. Symptoms tend to be reproducible, meaning they occur after a certain amount of walking, and go away after a few minutes of rest. When you start walking, the same thing tends to happen all over again.
These symptoms involve one or more of the major muscle groups of the legs—the calves, the thighs, the buttocks, or the feet. Most often affecting the legs, the most prominent signs of it are:
Cramping
Limping
Pain, cramping, or burning feeling in the buttock, thigh, or calf
Fatigue
Symptom relief when walking or activity has stopped
Claudication pain may feel different depending on the location. The calf is the most common location of symptoms, often feeling like a cramp that comes on gradually. In the buttocks, it often is an aching pain, and you may have weakness when climbing stairs.
Because claudication most commonly arises due to PAD, it may appear alongside other symptoms of the condition, which can include:
Muscle weakness
Loss of leg hair
Smooth, shiny skin
Numbness
Lack of pulse in the legs or feet
Cold or numb toes
Sores or ulcers that take longer than usual to heal
Claudication in the Arms
Though claudication is often seen in the legs, PAD can also affect the arms. Approximately 10% of people with PAD experience pain, cramping, numbness, and muscle weakness in the upper limbs.
What Causes Claudication?
Insufficient blood flow to the limbs causes claudication. A characteristic feature of PAD is atherosclerosis, which causes the arteries to narrow or block due to fatty plaque buildup, leading to poor blood flow.
Atherosclerosis can arise due to several factors, which serve as risk factors for claudication. These include:
Smoking (this is the most significant risk factor)
High blood pressure (hypertension)
Chronic kidney disease
Age (over 55 for men, over 60 for women)
Physical inactivity
Having overweight or obesity
Family history of the condition
When to See a Healthcare Provider for Claudication
Claudication is a symptom of conditions that significantly increase your risk of heart attack, stroke, skin ulcers, gangrene, and amputation. See a healthcare provider when you begin to notice signs of claudication. A medical professional will be able to diagnose and address the underlying condition.
If you begin to feel the pain even at rest, this is a sign the blockage in the artery has become worse. See a healthcare provider as soon as possible.
Diagnosis
Health providers take several steps to identify the cause of claudication. They will begin by assessing your medical history and discussing your symptoms. They will likely ask about the following:
The type, intensity, and duration of any pain and discomfort
Any current medical conditions, including high blood pressure or cholesterol, diabetes, or chronic kidney disease
Any health issues in your feet, such as swelling, redness, pain, soreness, or wounds that are slow to heal
Tobacco use; both if you currently use tobacco or did in the past
Family history of PAD, heart disease, or other cardiovascular conditions
In addition, your healthcare provider will perform a physical evaluation, which involves checking the pulse in your legs or arms, listening for abnormal blood flow with a stethoscope, and visually examining wounds, ulcers, or bruises on the extremities.
Tests and Procedures
Your provider may call for further tests to confirm suspected cases or assess claudication severity. These tests include:
Ankle brachial index (ABI) test: Healthcare providers use ultrasound imaging to locate areas of arterial blood flow in the arm and ankle. They then use blood pressure tests to compare the blood pressure in these areas; significant differences are signs of PAD.
Blood tests: You may also need a panel of blood tests to assess any additional health problems that may contribute to the problem. Your provider will look at cholesterol, triglyceride, and blood sugar levels.
Exercise ABI: The ABI test is a way to assess the severity of symptoms and may be taken after you walk or jog on a treadmill. Your provider will compare your results to an ABI performed at rest, with differences over 20% indicating a more severe PAD case.
Six-minute walking test: This test involves measuring how far you can walk in six minutes, giving healthcare providers a sense of the overall impact of your condition.
Doppler ultrasound: Doppler ultrasound is a form of imaging that checks for areas of reduced or blocked blood flow in the body. This test uses a handheld device that transmits images to a computer.
Segmental Doppler pressure test: Similar to ABI, this test assesses for blockages or reductions in blood flow in different body parts. Your provider will place blood pressure cuffs on the thigh, calf, and ankle, with ultrasound allowing providers to hear more or fewer circulation areas.
Angiography
A healthcare provider may call for angiography to assess arterial blood flow. In these tests, your provider will inject a contrast dye into your arteries and use imaging to look for blockages. There are three types of angiography, including the following:
Computed tomography angiography (CTA) employs several X-rays to create real-time circulation imaging.
Magnetic resonance angiography (MRA) relies on magnetic fields and radio waves to image blood flow.
Catheter-based angiography uses a catheter (skinny tube) inserted through an artery in the groin to deliver the contrast dye for imaging.
What Is the Best Treatment for Claudication?
Treatments for claudication are typically tailored to the individual and include lifestyle changes, medications, and other therapies; all play an essential role. The main treatment goals are to improve symptoms and prevent artery disease from getting worse or more dangerous.
The primary step in treating claudication involves managing the condition's risk factors, including:
Quitting smoking: Because smoking is a significant risk factor for PAD, quitting is essential to managing claudication, which can involve taking certain medications, such as Chantix (varenicline), alongside counseling, support groups, and other methods.
Exercise: Your healthcare provider may recommend a regular fitness routine to help with weight management and improve your health. A walking program can also specifically improve your symptoms of claudication.
Diabetes management: Controlling diabetes can also be important in managing claudication. Without an outright cure, medications that manage blood sugar, like insulin, dietary modifications, and exercise, are standard therapies.
Dietary adjustments: Your healthcare provider may recommend weight management techniques such as diet changes because excess weight can make claudication worse and more dangerous. This may also address diabetes and high cholesterol.
Walking to Improve Claudication
A walking program can improve claudication symptoms, reducing pain and building endurance. You can use a treadmill or walk outdoors or indoors.
Walk until your pain is moderate, aiming for a pace or incline where this level of pain is felt after five to seven minutes of walking. Rest until it subsides, and start walking again. Aim for 30 minutes a day of brisk exercise.
The following two drugs have been approved for the treatment of claudication symptoms, although they do not cure the condition:
Pentoxil or Trental (pentoxifylline) reduces the viscosity (thickness) of blood so it can flow more easily in small blood vessels.
Pletal (cilostazol) prevents platelets from clumping together and dilates (widens) blood vessels.
In addition, your provider may prescribe certain medications to lower blood pressure, ease symptoms, and manage associated conditions. Examples include:
Angiotensin converting enzyme (ACE) inhibitors are blood pressure medications, including Lotensin (benazepril) and Capoten (captopril).
Statins are a class of drugs for high cholesterol, including Lipitor (atorvastatin) and Crestor (rosuvastatin).
Angiotensin II receptor blockers (ARBs) are a class of blood pressure–lowering medications, including Edarbi (azilsartan) and Atacand (candesartan).
Antiplatelet medications, also known as blood thinners, include Bayer (aspirin) and Plavix (clopidogrel).
Your provider may also look at the medications you are taking. Some, such as beta-blockers, might not be used due to the presumed effects they can have on peripheral circulation.
In severe PAD cases, people may need a medical procedure to clear blocked or severely impacted arteries. Angioplasty is a minimally invasive procedure involving placing a specialized balloon into a diseased artery, inflating it, and placing a stent to keep the artery clear.
Another approach, reserved for severe and difficult-to-treat cases, is bypass surgery. A surgeon creates an alternative route for a blocked artery by using a piece of blood vessel from another body part.
Coping
Claudication (and the associated PAD) is a chronic condition that requires consistent management. However, you can live well with the disease with proper and timely care. Tips for doing so include:
Keeping up with appointments: As you manage your condition, you must attend appointments and pay close attention to your provider’s advice and orders. Keep track of your symptoms and be sure to report any changes in your health status.
Regular immunization: Keep up to date on your vaccines, including annual influenza (flu) and pneumococcus shots.
Enjoying physical activity: Aim for 30 minutes daily of brisk exercise and reduce your sedentary time. Discuss what activities are best with your healthcare provider.
Wearing shoes and socks: Prevent foot injuries and lacerations by not going barefoot and always wearing shoes and socks.
Checking your feet: Check your feet for any injuries or other issues at least once daily. Ensure your provider is also assessing them. If you have any cuts or wounds, let your healthcare provider know.
Seeking assistance: Living with a chronic condition can severely impact mental health. If you’re struggling, counseling—in individual or group settings—can be a great help. Support groups and online communities can also assist, so don’t be afraid to ask for help from family and friends.
How Can You Prevent Claudication?
While some risk factors for PAD and claudication are not under your control, you can significantly reduce your risks in many ways. These tactics will also reduce your risk of many chronic conditions and serious events like a heart attack or stroke:
Do not smoke: Tobacco smoking is a major risk factor for PAD and claudication. Stop smoking, or do not start.
Prevent or manage type 2 diabetes: Diabetes is another major risk factor for these conditions. See a healthcare provider regularly to check for type 2 diabetes, reduce your risks through diet, exercise, and weight management, and manage the condition if it develops.
Enjoy a healthy diet that reduces the risk of high cholesterol and high blood pressure: Limiting saturated and trans fat can reduce your risk of high cholesterol levels. Include vegetables, fruits, whole grains, nuts, seeds, and olive oil in your diet. Also, limit sodium, added sugars, and red meat.
Be active: Regular physical activity can reduce your risks. Keep your body moving with activities you enjoy. These can be traditional exercise activities, sports, and things like dancing or gardening.
Summary
Claudication is pain and discomfort that occurs reproducibly with physical activity and is relieved by rest. It generally indicates a significant vascular condition that requires medical attention. Treating claudication may involve losing weight and managing existing health conditions, taking certain medications, and in rare cases, surgery.
You can manage claudication with timely treatment and lifestyle modifications. This may reduce your pain and other symptoms of claudication as well as risks of serious complications.
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