Claudication is a common condition where pain occurs in the legs with exercise due to a reduction in the circulation. The cause is hardening of the arteries otherwise known as atherosclerosis. The common symptom is of a cramp like pain developing in the calf muscles on walking. The thigh and buttock muscles may also be involved. After a brief rest the pain resolves and it is possible to walk on again. The distance walked along the flat (not up hills) before the pain starts is used as a rough guide to the severity of the condition. During walking the leg muscles use more oxygen which is supplied by the circulating blood. If the supply is reduced the oxygen is used up and the muscles become painful. After a rest the oxygen levels return to normal and it is possible to walk again.
With the above symptoms and an examination of the pulses in the leg (weak or absent) it is often possible to diagnose claudication without any tests. The blood pressure in the legs can be measured with doppler, at rest and after walking on a treadmill, to confirm the diagnosis.
The most important part of the treatment is to make sure your arteries do not get any worse. Atherosclerosis not only affects the arteries in your leg, but also those to your heart causing heart attacks, and your brain causing strokes. If you smoke it is vital that you stop altogether. You will be tested for diabetes, high blood pressure and raised cholesterol. These may require you to go on a diet or start some medication if you are not already on treatment. If you are overweight, losing weight will help your arteries and enable you to walk further. Lastly, it has been shown that taking a small dose of aspirin (75 mgs) once a day also helps the arteries.
Regular exercise is good for the legs. Although walking can be frustrating because of the frequent stops when the legs are painful, it is important to persist and try to walk each day, increasing the distance as the legs improve. Do not try to “walk through the pain”. Over a period of 3 - 6 months the muscles in the legs will become more efficient enabling you to walk further on the limited blood supply. In addition the blood flow in the leg will increase as smaller undiseased arteries increase in size. It is uncommon for the legs to get worse. Many patients are worried they may lose their leg but with the above treatment this is extremely unlikely and not a cause for concern.
If the claudication remains troublesome then you will need an ultrasound scan of the leg or an angiogram to see exactly where the narrowings or blockages in the arteries are.
ANGIOGRAM: this can be performed with a CT or MRI scan with some dye injected into the bloodstream, which allows the scan to highlight the arteries. If you are allergic to the dye or have reduced kidney function then this investigation may not be appropriate for you or special precautions may need to be taken.
Some narrowings and blockages in your arteries can be treated by using a balloon to stretch the artery open again. This is called an angioplasty . In some arteries the results of angioplasty can be improved by also putting a stent inside the artery. This is like an internal sophisticated “scaffold” that holds the artery open. Medication can be attached to the stent to reduce the risk of the stent being narrowed by growth of new tissue into the artery.
If there is a long or very hard blockage in the artery, it may not be possible to get through an perform an angioplasty. In these circumstances, if the claudication is bad, a bypass operation will be considered and discussed with you. In some cases the risks of surgery are to high and a longer period spent exercising, losing weight etc.. is needed.