Diagnosis

Claudication may go undiagnosed because many people consider the pain an unwelcome but inevitable consequence of aging, and some people just reduce their activity level to avoid the pain. But the tests your doctor may use to diagnose your condition are often noninvasive and can get you back on your way to resuming an active life.

Some common tests used to diagnose claudication include:

  • Checking the pulses in your palms and feet
  • Exercise testing to determine the maximum distance you can walk without pain
  • Ankle-brachial index to compare the blood pressure in your ankles to the blood pressure in your arms
  • Doppler ultrasound, which monitors blood flow in the area affected
  • Magnetic resonance imaging (MRI) or computerized tomography (CT) to show if your blood vessels are narrowed with plaque

The pain in your legs could be due to another condition, such as spine, joint or muscle problems, or other vascular conditions. Your doctor can make a diagnosis based on your symptoms and a medical history, physical exam and appropriate tests.

Treatment

Treatment of claudication and peripheral artery disease can help prevent your disease from getting worse and reduce your symptoms. Lifestyle changes, such as quitting smoking and participating in a regular exercise regimen, are often the first steps in treating claudication.

If your claudication symptoms don't improve after implementing a formal exercise program designed to improve the blood flow and adopt a healthier lifestyle, your doctor may suggest other treatment options, including:

  • Medications. Your doctor might recommend you take aspirin to reduce the chance of blood clots. He or she might also prescribe other medications that help keep your blood from clotting, such as clopidogrel (Plavix), dipyridamole (Persantine) and ticlopidine.

    Cilostazol tablets may help improve blood flow and reduce your symptoms. If you can't take cilostazol or if it doesn't improve your symptoms, your doctor may recommend that you try pentoxifylline.

    Very likely, your doctor will also prescribe a cholesterol-lowering drug (statin) to lower your cholesterol if the blockage is believed to be due to hardening of the arteries (atherosclerosis).

  • Angioplasty. Cases of claudication and peripheral artery disease that are more serious may require angioplasty. This is a procedure that widens damaged arteries using a narrow tube that travels through your blood vessels and has an inflatable balloon on the end that can help improve circulation. Once an artery is widened, your doctor may place a small metal or plastic mesh tube (stent) in the artery to keep it open.
  • Vascular surgery. Your doctor may recommend surgery that takes a healthy blood vessel from another part of your body to replace the vessel that's causing your claudication. This allows blood to flow around the blocked or narrowed artery.

Your doctor may also suggest a combination of treatments, such as medications and angioplasty.

Lifestyle and home remedies

The plaques that have damaged your arteries are often the result of unhealthy lifestyle habits. So a key part of treatment is stopping any unhealthy habits and adopting healthy ones.

If you have claudication or peripheral artery disease, make sure you:

  • Don't smoke. Smoking is the most significant risk factor for the development and worsening of peripheral artery disease. Smoking increases the chance that you'll eventually require an amputation or even die of the disease. Avoid secondhand smoke, too.
  • Exercise. You may wonder how exercise can be helpful if that's 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 eventually mean less pain during exertion.

    Your health care team can help develop a supervised exercise program that will enable you to gradually increase the distance you're able to walk without pain and increase your overall mobility.

  • Know and control your cholesterol levels. If your cholesterol levels aren't what they need to be, your doctor may recommend medication to get them to the proper levels. A meal plan that includes a variety of foods low in animal fats or saturated fats, low in partially hydrogenated fats or trans-fats, emphasizing fruits, vegetables, grains and legumes, can help, too.

    Combined with exercise, a healthy diet can help control your blood pressure and cholesterol levels, both of which can contribute to atherosclerosis.

  • Control your blood sugar. Diabetes is a major risk factor for claudication. It is very important for you to control your blood sugar levels. Preventing diabetes, or having the condition under control, is essential to avoiding claudication, especially if your blood sugar is abnormal or in the prediabetes range.
  • Avoid certain medications. Don't use drugs that cause your blood vessels to constrict. Many sinus and cold medications sold over-the-counter contain pseudoephedrine, which is known to constrict blood vessels. Ask your doctor if there are any other medications you need to avoid.
  • Avoid injury to your feet and legs. Reduced blood flow increases your risk of complications from injuries. Choose well-fitting shoes that will protect your feet if you are participating in activities or work that might lead to injury.
  • Keep your legs below your heart. Doing so can help improve the circulation to your feet. To keep the blood flowing well to your legs and feet at night, it helps to raise the head of your bed by 4 to 6 inches.

Alternative medicine

There aren't any alternative medicine treatments that have been proved effective for claudication.

Several treatments have had mixed results, proving beneficial in some studies, but then showing no benefit in others. These include:

  • Ginkgo
  • Propionyl-L-carnitine

Another treatment, L-arginine, appeared to help relieve symptoms of claudication.

Vitamin E and omega-3 fatty acids have also been suggested as treatments for claudication, but when studied in clinical trials, these treatments didn't help relieve symptoms.

Coping and support

It can be frightening to learn that the reason you're having pain is that your blood vessels are narrowing. Learning all you can about what's causing your claudication can put you in control, and you'll know exactly what steps to take to ease your pain.

Some people also find it helpful to talk with other people who are going through the same thing that they are. In a support group, you may find encouragement, advice and maybe even an exercise partner or two. Ask your doctor if there are any support groups in your area.

Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner. However, you may then be referred to a doctor trained in cardiovascular diseases (cardiologist) or a vascular surgeon.

Because appointments can be brief, and there's often a lot to discuss, it's a good idea to arrive well-prepared. Here's some information to help you get ready for your appointment, and know what to expect from your doctor.

What you can do

  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements that you're taking, as well as the dose that you take.
  • Ask a family member or friend to come with you, if possible. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor.

Your time with your doctor may be limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For claudication, some basic questions to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • What kinds of tests do I need?
  • Is this condition temporary or long-lasting?
  • What treatments are available, and which do you recommend?
  • What lifestyle changes can help me?
  • If medication is needed, what side effects might I experience?
  • I have other health conditions. How can I best manage them together?
  • Are there any restrictions that I need to follow?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

  • When did you first begin experiencing symptoms?
  • Do you have pain when you're exercising, when you're at rest or both?
  • On a scale of one to 10, how would you rate the pain?
  • Does anything seem to improve your symptoms, such as stopping exercise?
  • Do you need to sit down to get symptom relief, or does stopping and standing in one place relieve your symptoms?
  • What, if anything, appears to worsen your symptoms?
April 24, 2018
References
  1. Neschis DG. Clinical features, diagnosis, and natural history of lower extremity peripheral arterial disease. http://www.uptodate.com/contents/search. Accessed Dec. 8, 2017.
  2. Eschenhagen T. Treatment of ischemic heart disease. In: Goodman & Gilman's: The Pharmacological Basis of Therapeutics. 13th ed. New York, NY: The McGraw-Hill Companies; 2018. http://www.accessmedicine.mhmedical.com. Accessed Dec. 8, 2017.
  3. Fuster V, et al. Diagnosis and management of diseases of the peripheral arteries. In: Hurst's the Heart. 14th ed. New York, NY: The McGraw-Hill Companies; 2017. http://accessmedicine.mhmedical.com. Accessed Dec. 8, 2017.
  4. Hoyler M, et al. The treatment of claudication. In: Current Surgical Therapy. 12th ed. Philadelphia, PA: Elsevier. https://www.clinicalkey.com. Accessed Dec. 8, 2017.
  5. Harris L, et al. Epidemiology, risk factors, and natural history of peripheral artery disease. http://www.uptodate.com/contents/search. Accessed Dec. 8, 2017.
  6. Davies M, et al. Management of claudication. http://www.uptodate.com/contents/search. Accessed Dec. 8, 2017.