What Is Claudication?

Claudication is pain and discomfort in the thighs, calves, or buttocks that occurs during movement and is relieved by rest. Caused by insufficient blood flow in the limbs, this condition 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.

This article provides an overview of claudication, including its symptoms, causes, diagnosis, and treatment.

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 in the buttock, thigh, or calf
• Fatigue
• Symptom relief when walking or activity has stopped
  

Because claudication most commonly arises due to PAD, it may appear alongside some 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

What Causes Cauldication?

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
• High blood pressure (hypertension)
• High cholesterol
• Type 2 diabetes
• Chronic kidney disease
• Advanced age

Diagnosis

There are several steps that health providers take 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; more 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 is taken using 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

Lastly, providers 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:

• Computerized 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.
• 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.
• Exercise: Your healthcare provider may recommend a regular fitness routine to help with weight management and improve your health.

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).
• Beta-blockers are blood pressure medications, including Lopressor (metoprolol) and Tenormin (atenolol).
• 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).
• Anti-platelet medications, also known as blood thinners, include Bayer (aspirin) and Plavix (clopidogrel).

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.
• 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.

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.  

A Word From Verywell

Though it can severely impact physical and mental health, you can manage claudication. The key is to be proactive; seek the medical care you need and learn as much as possible about your symptoms and treatment options. It’s important to remember that you’re not alone in this; don’t be afraid to seek support from family and friends.