Intermittent claudication is a tight, aching, or squeezing pain in the calf, foot, thigh, or buttock that occurs during exercise, such as walking up a steep hill or a flight of stairs. This pain usually occurs after the same amount of exercise and as the name suggests, can come and go.
Causes and Development
Caused by arterial insufficiency (inadequate blood supply), this condition is primarily due to atherosclerosis. Atherosclerosis is an ailment that involves fatty build-up and narrowing of the arteries, which limits blood flow through them; the narrowed areas may be localised or extensive.
Signs and Symptoms
The pain of intermittent claudication may be dull and aching, or sharp and crampy; or it may feel like plain old muscle fatigue. Blockages may cause the pain in the thighs or buttocks. However, if the blockage is lower in the leg, that's when the calves or feet may be affected. Just like angina, such pain is the warning cry of oxygen-starved muscles during exertion. If you find that the distance you can walk without pain is growing shorter, it's probable that the condition is getting worse.
Pain in the lower legs can also be caused by arthritis of the spine, herniated vertebral disk, and other diseases of the spine which can pinch the nerves that supply the legs. Muscle cramps can also cause leg pain, but these pain symptoms do not exhibit the three characteristics typical of this condition which are listed:
• Cramps in the calves which are brought on by exertion
• That it can be relieved by rest
• That it's reproducible; for example, it almost always occurs after having walked the same distance.
Inadequate blood flow to the lower extremities may also result in deformed toenails, hair loss, skin thinning, and ulcers or infections of the feet or ankles.
Who typically is affected by Claudication?
It's more common in men than in women. The condition affects 1 per cent - 2 per cent of the population under 60 years of age, increasing in incidence with age, to affect over 18 per cent of persons over 70 years, according to the American Academy of Family Physicians.
• Smoking, the most important risk factor for vascular disease
• High blood pressure
• High cholesterol
• African American descent
• Heart disease
Diagnosis and Tests
A family history of atherosclerosis Pain brought on by walking is less serious than pain occurring during sleep or while at rest; these are indications of disease progression, and warrant more aggressive therapy. Patients with these symptoms are classified as "pre-gangrenous", meaning that deterioration could lead to gangrene, a condition where so little blood reaches the affected tissue that damage is irreversible and tissue death results, requiring amputation. This occurs in 5 per cent of untreated atherosclerotic patients within 5 years.
In more advanced cases, the pain may also come on at rest, especially during the night. It may be relieved by sitting up or dangling the feet over the side of the bed so gravity can bolster the blood supply. In other cases, narrowed leg arteries produce no pain. For example, a person who doesn't walk far enough or fast enough to bring on discomfort may remain unaware of a problem. Someone who suffers decreased sensation in the legs or feet from a condition such as diabetes may also feel no pain.
Conventional medicine uses doppler studies (a specialized ultrasound test) and transcutaneous oxygen pressure measurements to evaluate blood flow. Angiography may be performed to determine the best treatment; this is a method used to visualise the blood vessels using dye injection and X-ray. This test shows the extent of vessel narrowing.
Treatment and Prevention
Conservative treatment is indicated in patients who experience symptoms only upon exertion. In these cases, it is critical to stop smoking. Blood pressure, lipids and blood sugar (in diabetics) should be lowered and monitored closely. "Blood thinning" drugs (anti-platelet drugs) have not proven helpful in this group of patients, but exercise has.
Small cuts and wounds on the lower legs may heal very slowly; thus foot care is an important part of treatment.
Your feet mirror your general health . . . cherish them!
Leana Huntley is an English trained foot health practitioner attached to ALMAWI Limited – The Holistic Clinic. Call to make an appointment at 662-1732 or firstname.lastname@example.org Tuesday - Saturday. Check for the Clinic at www.almawiclinic.com.