It strikes when you walk — a distinct pain or cramping in your calf. You stop for a few minutes, and the pain goes away. You continue on, and the pain comes back.
This leg pain may be claudication. It is most often a symptom of peripheral arterial disease, a potentially serious but treatable circulation problem. Fortunately, with treatment, you may be able to maintain an active lifestyle without pain.
Symptoms
One of the classic symptoms of peripheral arterial disease is pain in the muscles of the legs, especially the calves. This pain is called claudication, also known as intermittent claudication. Claudication can also occur in the arteries of your arms.
Claudication is sometimes considered a disease, but technically, it is a symptom of a disease. Some of the signs and symptoms of claudication include:
* Pain in your legs when exercising. The pain could be in your feet, calves, thighs, hips or buttocks depending on where you might have artery narrowing or damage.
* Intermittent pain. Your pain may come and go as you do less-strenuous activities.
* Pain when at rest. If your condition is serious, you may feel pain in your legs even when you are sitting or lying down.
* Discolored skin or ulcerations. If your claudication is severe, your toes may look bluish or feel cold to the touch. You may also develop ulcerations on your lower legs, feet or toes.
Causes
Claudication is a symptom of peripheral arterial disease where the arteries that supply blood to your limbs are damaged. This damage is often the result of atherosclerosis.
Atherosclerosis can develop in any of your arteries, especially those in your heart. When atherosclerosis affects your arms and legs, it is called peripheral arterial disease.
Atherosclerosis makes arteries hard and narrow. That is because the arteries get clogged with clumps of fat, cholesterol and other material, called atherosclerotic plaques. These plaques can make arteries so narrow that less blood can flow through them.
You feel pain because your leg muscles are not getting enough oxygenated blood.
Risk factors
The risk factors for claudication are the same as those for developing atherosclerosis. They include:
* Smoking
* Total blood cholesterol over 240 mg/dL (6.45 mmol/L)
* High blood pressure (a systolic pressure of 140 mm Hg or higher and a diastolic pressure of 90 to 99 mm Hg or higher)
* Obesity (a body mass index over 30)
* Diabetes
* Age over 50 years
* A family history of atherosclerosis, peripheral artery disease or claudication
When to seek medical advice
Talk to your doctor if you have pain in your legs when you exercise. If left untreated, claudication and peripheral arterial disease can reduce the quality of your life.
Claudication may limit your ability to participate in social and leisure activities, interfere with work, and make exercise intolerable.
Tests and diagnosis
Claudication often goes undiagnosed because many people consider the pain an unwelcome but inevitable consequence of aging. But the tests your doctor may use to diagnose your condition are often noninvasive and can get you on your way to resuming an active life.
Some common tests used to diagnose claudication include:
* Checking the pulses in your feet.
* Ankle-brachial index. This test compares the blood pressure in your ankle arteries to the blood pressure in your arms.
* Doppler ultrasound. This test monitors blood flow in the area affected.
* Magnetic resonance imaging (MRI) or angiography to show damage to blood vessels.
The pain in your legs could be another condition, such as spine, joint or muscle problems. Your doctor can make a diagnosis based on your symptoms and a medical history, physical exam and appropriate tests.
Treatments and drugs
Treatment of claudication and peripheral arterial disease is designed prevent your disease from getting worse and reduce your symptoms.
If your claudication symptoms don’t ease after adopting a healthier lifestyle, your doctor may suggest other treatment options, including:
* Medications. Certain medications can improve your circulation. Your doctor may prescribe a blood thinner to decrease blood clotting or a cholesterol-lowering drug to lower your cholesterol. Your doctor might also recommend you take aspirin to reduce the narrowing of your arteries.
There are also some other ways to manage the problem line angioplasty, vascular surgery, thrombolytic therapy, hyperbaric chamber etc.
Lifestyle and home remedies
The plaques that have damaged your arteries are often the result of unhealthy lifestyle habits. So a key component of treatment is stopping any unhealthy habits and adopting healthy ones.
If you have claudication or peripheral arterial disease, make sure you:
* Don’t smoke. Smoking is the most significant risk factor for the development and worsening of peripheral arterial disease. Smoking increases the chance that you will eventually require an amputation or even die of the disease. Also avoid secondhand smoke.
* Exercise. You may wonder how exercise can be helpful if that is what brings on the claudication pain. Actually, exercise helps condition your muscles so that they use oxygen more efficiently. So even if your muscles are getting less oxygen, they can use what they do get more effectively. That can mean less pain during exertion. In addition, exercise promotes the growth of new, healthy blood vessels. These new blood vessels provide an alternative path for blood to reach your extremities.
* Know and control your cholesterol levels. If your cholesterol levels are not optimal, your doctor may recommend medications. Also, follow a meal plan that includes a variety of low-fat foods, emphasising fruits, vegetables, grains and legumes. Combined with exercise, a healthy diet can help control your blood pressure and cholesterol levels, both of which can contribute to atherosclerosis.
Dr Tareq Salahuddin
Source: The Daily Star, February 15, 2009
