Claudication
Claudication is a medical condition characterized by pain or cramping in the calf or thigh muscles, typically triggered by physical activity such as walking. This pain arises due to narrowed leg arteries, often caused by atherosclerosis, where fatty deposits accumulate within the artery walls. Common symptoms include mild cramping or heaviness during extended walks, which can worsen over time. If left untreated, claudication may progress to persistent pain, potentially leading to severe complications, including limb loss.
Risk factors for developing claudication include smoking, high blood pressure, heart disease, high cholesterol, and advanced age, with older individuals being more susceptible. Diagnosis usually involves a simple clinical evaluation and may include a painless ankle-brachial index (ABI) test to assess blood flow. Treatment strategies focus on lifestyle changes, such as quitting smoking and engaging in regular exercise, along with medications or surgical interventions in more severe cases. Education and proactive management are crucial for those at risk, as lifestyle modifications can significantly reduce the likelihood of developing this condition.
Claudication
ANATOMY OR SYSTEM AFFECTED: Blood vessels, circulatory system, legs
DEFINITION: Pain in the calf or thigh muscle brought on by walking and relieved by rest
CAUSES: Narrowing in leg arteries from atherosclerosis; risk factors include smoking, high blood pressure, heart disease, high cholesterol, advanced age
SYMPTOMS: Mild cramping or heaviness during long walks, progressing to leg pain at rest and sometimes amputation
DURATION: Chronic, progressive without treatment
TREATMENTS: Smoking cessation, lowering of cholesterol levels, program of long-distance walking, medications (pentoxifylline, cilostazol), surgery (angioplasty, bypass surgery, stents)
Causes and Symptoms
Claudication is pain that develops in the calf or muscle during walking. The pain increases if the patient continues walking and is relieved within a few minutes after walking is terminated. The medical term for this condition is intermittent claudication. The pain is caused by a narrowing in the that supply the leg with blood. This narrowing is commonly caused by atherosclerosis, in which fatty material builds up on the inside wall of the artery. At first, as the fatty material accumulates in the artery, it creates no symptoms. Only after more than 50 percent of the artery is narrowed do symptoms occur. The first symptom is mild cramping or heaviness that develops during a long walk. Over time, the narrowing increases and the distance that the individual is able to walk decreases. If not treated, the narrowing of the artery may increase further and the pain will be present all the time, signaling a more serious condition called that may lead to limb loss.
Factors that may lead to this condition include smoking, high blood pressure, heart disease, high cholesterol, and advanced age. Elderly people are more likely to develop intermittent claudication, but younger individuals with multiple for disease may develop this problem at any age. Sometimes a thrombus may obstruct an artery, causing claudication symptoms to occur suddenly instead of slowly as with atherosclerosis.
The diagnosis of claudication is fairly simple. Clinically, true can be differentiated from a similar but unrelated condition by noting if the symptoms happen every time that the patient walks a similar distance. True claudication will develop every time, while pain from other conditions will occur at some times but not others.
To be more precise in diagnosing this condition, a Doppler study can be performed on an outpatient basis in a hospital or a doctor’s office. The examination, called an ankle-brachial index (ABI), is simple and painless. Blood pressures are taken at the ankles and in the arms before and after exercise. If the pressure at the ankles drops with exercise and goes back to normal a few minutes later, then the diagnosis of intermittent claudication can be made. Ultrasound imaging or angiogram studies may be done to identify the exact location of the narrowing.
Treatment and Therapy
Treatment depends on the severity of the symptoms. Stopping smoking, lowering levels, and beginning a program of long-distance walking may provide enough relief to allow some patients to return to near-normal routines. Medications such as pentoxifylline (Trental or Pentoxil) or cilostazol (Pletal) may provide limited relief from symptoms. More severe cases may require angioplasty, surgery to bypass the narrowed artery, or stenting of the diseased artery.
Perspective and Prospects
Claudication has become more common in the United States as the population ages and sedentary lifestyles become more popular. Although some treatments are effective, it is a difficult problem to manage. Education programs are available to help those at risk for this condition make necessary lifestyle changes that may lessen their chances of developing this ailment. Those changes may include getting plenty of exercise (brisk walking being the best), not smoking, lowering cholesterol, and keeping diabetes under control.
Bibliography:
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