claudication

Claudication, most often referring to intermittent claudication, denotes leg pain, cramping, numbness, or fatigue that occurs with walking or other exercise and is relieved by rest. The symptom is most commonly caused by reduced blood flow to the leg muscles due to peripheral artery disease (PAD), typically from atherosclerosis.

Most cases of claudication are vascular, arising from PAD that narrows or blocks the arteries supplying the legs. Less commonly, leg symptoms during walking may come from neurogenic claudication caused by lumbar spinal stenosis, or from venous insufficiency. Distinguishing among these causes is important, as they have different treatments. Other contributing factors include diabetes, smoking, hypertension, and hyperlipidemia.

Evaluation begins with a focused history and physical examination. A key test is the ankle-brachial index (ABI), with abnormal values suggesting PAD (generally ABI ≤ 0.90). Imaging modalities include duplex ultrasonography, computed tomography angiography (CTA), or magnetic resonance angiography (MRA) to define arterial disease. Functional testing, such as treadmill walking studies, can help assess the severity and impact on walking distance.

Management centers on risk-factor modification and symptom relief. Recommendations include smoking cessation, blood pressure and lipid control, diabetes management, and structured supervised exercise therapy to improve walking distance. Antiplatelet therapy and statins are commonly used; cilostazol can improve walking ability in intermittent claudication but has contraindications. Revascularization—endovascular approaches (angioplasty with or without stenting, atherectomy) or surgical bypass—may be considered for lifestyle-limiting claudication or critical limb ischemia when medical therapy is insufficient.

Prognosis varies; PAD is associated with higher cardiovascular risk, and some patients progress to more severe limb ischemia requiring more invasive intervention. Regular follow-up is essential.