intermittent claudication

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Intermittent Claudication



Intermittent claudicationis a pain in the leg that a person experiences when walking or exercising. The pain is intermittent and goes away when the person rests.


Claudication comes from the Latin word that means "to limp," and the condition is characterized by intermittent pain in the leg muscles. Poor circulation produces the pain. The legs do not receive the oxygen-rich blood supply needed for activities like walking and exercising. The decreased blood flow is caused by the narrowing of arteries that bring blood to the leg and foot.
The leg pain produced by claudication is usually experienced as cramping in the thighs, calves, hips, and feet. The pain stops several minutes after the person rests, but returns when the person performs activities that use the leg muscles. If untreated, claudication is no longer intermittent and occurs when a person is resting.
People age 50 or older are at risk of intermittent claudication. The risk increases with age. Statistically, 5% of men and 2.5% of women experience symptoms of this condition, according to the Vascular Disease Foundation (VDF). Many people with this condition have cholesterol plaque build-up in the leg's arteries. Smoking raises the risk, as do high blood pressure, obesity, lack of exercise, and diabetes.
Intermittent claudication is the main symptom of peripheral arterial disease (PAD), which is also known as peripheral vascular disease, and or occlusive arterial disease. Intermittent claudication is an early symptom of the condition that affects peripheral arteries, those blood vessels located outside the heart. PAD is caused by arteriosclerosis, the narrowing and hardening of the arteries.
Women with diabetes are 7.6 times as likely to experience PAD as those without diabetes, according to the American Diabetes Association (ADA). Furthermore, intermittent claudication is related to a two to three times increased risk of coronary heart disease, stroke, or cardiac failure in men with diabetes, according to the association.

Causes & symptoms

Intermittent claudication is caused by poor circulation and is experienced in a person's muscle groups. It affects the peripheral arteries that convey oxygen-rich blood from the heart to the legs. A person with this condition feels pain shortly after beginning to exercise. Walking may trigger the pain in an inactive person. Activities such as climbing stairs, walking rapidly or dancing can cause the pain to increase.
The person feels the pain as tightness in the calf, thigh, or buttocks. The pain stops after the person rests for several minutes. However, it returns when the person reaches the exertion level that previously produced the pain.
Intermittent claudication is the primary symptom of PAD, the condition causing reduced flow of blood and oxygen to tissues. If the intermittent condition is not treated, the person will find that resting does not relieve pain. As arteries become more clogged, the person could feel pain even when not exercising. Symptoms include cold or numb feet and toes, poor balance when standing, a drop in leg strength, sores that heal slowly, and erectile dysfunction (impotence).
In the advanced stages of PAD, the person experiences pain when resting. This condition, ischemic rest pain, is characterized by symptoms visible on the feet and toes. These include ulcers, loss of hair, and the change to red color when feet are suspended. Other symptoms include blue or purple markings on the legs, feet and toes. The coloring is a sign that less oxygen is reaching these areas. Furthermore, black skin on the legs and feet is a sign of gangrene infection.


People experiencing symptoms of intermittent claudication should contact their doctor immediately. The doctor will review the patient's medical history and examine the person for signs of the condition. This examination includes checking for a lower pulse or the absence of a pulse behind the knee, on the ankle, foot, and groin.
The doctor may order an ankle-brachial index (ABI) test to determine whether arteries are blocked. This procedure will verify if the person has PAD and provides information on the severity of the condition. The ABI measures blood pressure in the arms and ankle. Readings are taken when the person is at rest and after exercising lightly by walking on a treadmill. The ABI index is found by dividing the ankle blood pressure by the pressure for the arm. An ABI below 0.90 in a person at rest is a sign of PAD.
The physician may also order a Doppler ultrasound exam to measure the flow of blood through the arteries. Cuffs are placed on four places on each leg. The doctor then moves an ultrasound probe over arteries in the foot. The probe detects signals from the artery.
Testing can last from 20 minutes to an hour. Costs vary by location and facility. In March of 2005, the ABI test was priced from $45 to $150. Some facilities offered a package of tests for around $200. The procedures are usually covered by medical insurance.


Lifestyle changes are the primary form of treating intermittent claudication. Physicians advise people to quit smoking, exercise, and to follow the American Heart Association's healthy diet guidelines. Diabetics need to control blood sugar levels. The patient may need to lower blood pressure and cholesterol levels. Those measurements should drop when a person makes lifestyle changes.
The goal of treatment is stop development of PAD. By exercising, eating a diet that includes fiber and low-fat foods, and not smoking, a person could also reverse the build-up that clogs arteries. After several months of this regimen, many people experience a lessening of leg pain. If pain continues, the doctor may prescribe medication. Furthermore, surgery may be needed in some cases.


Walking is frequently an important treatment for intermittent claudication. A person experiencing the pain of intermittent claudication may not feel like walking. However, walking can increase the capacity to exercise. Before starting an exercise program, the person should consult with consult with a doctor.
The physician reviews the patient's medical history, does a physical and may order an exercise stress test on a treadmill. The test shows how long a person walks before claudication starts. Information such as blood pressure is used to evaluate the person's ability to walk. The findings are also used to develop a medically supervised exercise program.
At the beginning, the treadmill is set to cause claudication symptoms in three to five minutes, according to the Vascular Disease Foundation. The person walks until pain is moderately severe. A rest period is scheduled after the person walks eight to 10 minutes.
The person walks and rests, with the goal of walking for a total of 35 minutes. The person walks at least three times weekly. If a treadmill is not available, VDF recommends that people walk on a track. Generally, a person walking three times weekly will be able to walk longer after three to 12 months.


People diagnosed with PAD are at a high risk for a stroke and heart attack. They should take aspirin to reduce this risk. Clopidogrel, a drug marketed as Plavix, worked even better than aspirin in a study. However, it was more costly, with 30 tablets selling for about $119 in 2005. The dosage is one tablet daily.
A doctor may also prescribe cilostazol—sold under the name Pletal—which extends the distance people can walk without pain. One tablet is taken twice daily. The medication cost around $112 for 60 tablets.

Surgical procedures

Surgical procedures may be necessary in cases where intermittent claudication is disabling. The person experiences pain when resting, has open sores that do not heal, or symptoms of gangrene like dying skin in the leg or foot.
Bypass surgery directs blood through a grafted blood vessel, bypassing the damaged artery. The grafted vessel is either a healthy artery or vein or an artificial vessel.
Angioplasty is a procedure to open blocked blood vessels. A catheter (tube) is inserted in the groin and moved to the artery. Then a tiny balloon is inflated to open the artery. Another angioplasty procedure involves the insertion of a stent, a metal device that keeps the vessel open.
Angioplasty is a minimally invasive procedure. Local anesthesia is used, and a person is able to resume normal activities within one to two days. The cost averaged $6,502, according to a 2001 Dartmouth Medical School study. Bypass surgery cost $12,422 on average, according to the study. A non-invasive procedure is not as risky as surgery. However, a bypass may be needed when multiple sections of blood vessels are blocked.
Once a person is diagnosed with intermittent claudication, health plans usually cover part of treatment costs. A study on the overall costs of this condition from diagnosis through treatment should be completed by the end of 2005, according to a Sheryl Benjamin, VDF executive director.

Alternative treatment

Ginkgo biloba extract, an herbal remedy, has been used by people with intermittent claudication. The extract made from the dried leaves of the Gingko tree is thought to improve blood flow, allowing people to walk longer without pain.
However, herbal remedies are not regulated the U.S. Food and Drug Administration, and people should consult with their doctors before taking Ginkgo. Furthermore, use of this remedy could interact adversely when taken with Vitamin E and some medications.


If untreated, intermittent claudication will advance and eventually restrict a person's mobility. In later stages, people feel pain when resting. The leg or foot may feel cold. In the extreme stage, the person might need a cane, walker, or wheelchair. There is more risk of gangrene developing, and amputation might be necessary. Diabetics face an increased risk of amputation.
PAD also increases the risk of heart attacks and strokes.


A healthy lifestyle is the best method for preventing intermittent claudication. Cigarette smokers should quit smoking. Regular exercise and a healthy diet help reduce the risk of this condition. If necessary, people should work to lower cholesterol and blood pressure. Diabetics should strive to manage that condition, obese people should lose weight.
The methods of preventing intermittent claudication are also the means for managing the risks associated with a diagnosis of PAD.
People can learn more about peripheral vascular disease through public education programs like the free Legs for Life screenings held at sites across the nation. The program started the Society of Interventional Radiology features a free ABI testing.



"New Treatment for Leg Pain-Conference News Update." Clinician Reviews, April 2002 [cited March 25, 2005]. 〈〉.
Warkentin, Donald L. "Intermittent Claudication." Clinical Reference Systems. January 1, 2004, 1813.


American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. 800-342-2383.
Society of Interventional Radiology. 10201 Lee Highway, Suite 500, Fairfax, VA 22030. 703-691-1805.
Vascular Disease Foundation. 1075 S. Yukon Street, Suite 320, Lakewood, CO 80226. 866-723-4636. 〈〉.


"Intermittent Claudication: 8 Ways to Ease the Pain." The Doctors Book of Home Remedies, Rodale. [cited March 25, 2005].
"Peripheral Arterial Disease of the Legs." Kaiser Permanente. Updated November 3, 2003 [cited March 25, 2005].

Key terms

Arthrosclerosis — A condition where fatty deposits cause the arteries to narrow.
Gangrene — The decay of tissue in the body; it is caused by an obstruction to the blood supply.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.


limping or lameness.
intermittent claudication see intermittent claudication.
jaw claudication a complex of symptoms like those of intermittent claudication but seen in the muscles of mastication, occurring in giant cell arteritis.
venous claudication intermittent claudication caused by venous stasis.


marked by alternating periods of activity and inactivity.
intermittent claudication a group of symptoms characterized by pain, cramping, and weakness in the calf muscles of one or both lower limbs, brought on by walking and relieved by resting for a few minutes. It is a form of arterial occlusive disease and is caused by atherosclerotic lesions of the limbs, which diminish blood supply to the muscles of the lower leg. Called also angina cruris.

Treatment has traditionally involved vascular reconstructive surgery to bypass the diseased portion of the vessel. Modification of risk factors has also proved beneficial, such as smoking cessation, weight loss, and introduction of a graduated program of walking and exercise.
intermittent explosive disorder a rare impulse control disorder in which a periodic loss of control of aggressive impulses results in serious assault or destruction of property; the outbursts are totally out of proportion to any apparent stress.
intermittent positive pressure breathing (IPPB) a form of respiratory therapy using a ventilator for the treatment of selected patients with atelectasis, those needing occasional assistance breathing, or those requiring some types of aerosol medications. As the name implies, this involves application of pressure only during the inspiratory phase, in order to help the patient breathe more deeply. It is used when other less expensive, less invasive forms of respiratory care have not been effective. Called also intermittent positive pressure ventilation.

Because of their compact size and capability of operating independently of an electrical current, IPPB machines are used widely. Similar treatment can also be delivered with a volume-, pressure-, or time-limited ventilator or manual resuscitation device. The American Association for Respiratory Care has published detailed and comprehensive clinical practice guidelines for the use of intermittent positive pressure breathing, which are available online at
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

in·ter·mit·tent clau·di·ca·tion

a condition caused by ischemia of the muscles; characterized by attacks of lameness and pain, brought on by walking, chiefly in the calf muscles; however, the condition may occur in other muscle groups.
Farlex Partner Medical Dictionary © Farlex 2012

intermittent claudication

A condition caused by ischemia of the leg muscles due to arterial obstruction, characterized by attacks of lameness and pain precipitated by walking.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

intermittent claudication

Vascular disease A condition caused by ASHD-related muscle ischemia Clinical Asymptomatic at rest; with minimal movement, intense pain, weakness, limping
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

in·ter·mit·tent clau·di·ca·tion

(in'tĕr-mit'ĕnt klaw'di-kā'shŭn)
A condition caused by ischemia of the muscles; characterized by attacks of lameness and pain, brought on by walking, chiefly in the calf muscles; however, the condition may occur in other muscle groups.
Synonym(s): Charcot syndrome, myasthenia angiosclerotica.
Medical Dictionary for the Health Professions and Nursing © Farlex 2012

intermittent claudication

Sudden crippling pain in the leg muscles, occurring after walking for a certain, usually relatively constant, distance. Claudication is caused by inadequacy of blood supply to the muscles usually from arterial disease such as ATHEROSCLEROSIS. From the Latin verb claudicare, to be lame or limping and is associated with the limping, grimacing Claudius, Emperor of Rome.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005


Jean Martin, French neurologist, 1825-1893.
Charcot arteries - any one of a variety of small cerebral arteries. Synonym(s): lenticulostriate arteries
Charcot arthritis
Charcot arthropathy
Charcot bath - for patients with arterial disorders.
Charcot change
Charcot disease - Synonym(s): Lou Gehrig disease
Charcot fever - Synonym(s): Charcot intermittent fever
Charcot gait - the gait of hereditary ataxia.
Charcot intermittent fever - fever, chills, right upper quadrant pain, and jaundice associated with intermittently obstructing common duct stones. Synonym(s): Charcot fever
Charcot joint - a neuropathic arthropathy that occurs with tabes dorsalis (tabetic neurosyphilis). Synonym(s): tabetic arthropathy
Charcot laryngeal vertigo - fainting as a result of a coughing spell, most often occurring in heavy-set male smokers with chronic bronchitis. Synonym(s): Charcot vertigo; tussive syncope
Charcot spine
Charcot syndrome - a condition caused by ischemia of the muscles. Synonym(s): intermittent claudication
Charcot triad - (1) in multiple (disseminated) sclerosis, the three symptoms: nystagmus, tremor, and scanning speech; - (2) combination of jaundice, fever, and upper abdominal pain that occurs as a result of cholangitis.
Charcot vertigo - Synonym(s): Charcot laryngeal vertigo
Charcot-Böttcher crystalloids - spindle-shaped crystalloids found in human Sertoli cells.
Charcot-Leyden crystals - crystals found in the sputum in bronchial asthma. Synonym(s): asthma crystals; Charcot-Neumann crystals; Charcot-Robin crystals; Leyden crystals
Charcot-Marie-Tooth disease - a group of three familial peripheral neuromuscular disorders, sharing the common feature of marked wasting of the more distal extremities. Synonym(s): peroneal muscular atrophy; Tooth disease
Charcot-Neumann crystals - Synonym(s): Charcot-Leyden crystals
Charcot-Robin crystals - Synonym(s): Charcot-Leyden crystals
Charcot-Weiss-Baker syndrome - stimulation of a hyperactive carotid sinus, causing a marked fall in blood pressure. Synonym(s): carotid sinus syndrome
Charcot-Wilbrand syndrome - inability to recognize objects by sight, usually caused by bilateral parieto-occipital lesions.
Erb-Charcot disease - see under Erb
Medical Eponyms © Farlex 2012

Patient discussion about intermittent claudication

Q. Does anyone suffer with Charcot disease of bilateal feet? Any suggestions you may have w/ treatment? Thanks! I was diagnosed with Charcot about 2 years ago but did not believe I had same at that time. After going thru many medical issues with my husband and myself, this was put on the back burner, so to speak, until other items could be addressed. I am mostly confined to a wheelchair now and find it best off, for now, to wear those "Croc RX" shoes (maybe around $40) and also inserts inside the Croc shoes. Initially I was just buying the inserts, but as the bones collapsed further, with the bone on the right foot actually coming through the bottom of the right foot, I had some made which were made of a more soft, pliable material. Luckily for me, I have access to a person who makes them or else I would not be able to afford them; they are so expensive and often times not worth your money. Do not let people talk you into buying inserts until you talk with others or else you will be, like I was initially, just out hundreds of dollars. I did find a few websites whereby I was able to order shoes with larger toe room and heel room to accommodate the inserts better, another issue you have to think of. YOu just cannot stick inserts into shoes like you used to wear, it will no longer work that way. I would love to share any helpful hints, suggestions, and also hear from others. AS a medical transcriptionist for many years, I HAD typed the term before, just was not familiar with the ravages it can cause and the misunderstanding of friends and family members. Also, I have these grandchildren whom I would die for and my one wish in the whole world is to take them to Disneyland and just watch them for a day HAVE FUN! I have an older electric scooter but cannot yet bring myself to use it inside the house...our home is not that large anyway and certainly -- as I have found out the hard way! -- NOT HANDICAPPED FRIENDLY! I have not driven a car since Oct of 07 and I worked for nearly 18 years or so at a hospital in Apple Valley, California, and I miss working so much. If it were not for my sense of humor, my drive, my being a military wife (husband retired U.S. Army), my good friends and good family and, this part SHOULD have gone first!, my faith in God and in Jesus Christ, I do not know how I would have reached this point. I know EVERYONE is having problems...even the billionaires (and yes, I can feel sorry for them too). We are ALL in this together and to just love one another and help one another should be EVERYONE's top goal. I am certainly no saint here...still love to joke around and if it were not for the pain meds, I might even have a beer once in a while, but I want to do what is right and I want my legs back! I am also interested to know if anyone knows anything at all regarding stem cell research...I heard in N. California they are beginning some type of stem cell research plan for spinal cord injuries on human volunteers - ones I believe who have perhaps lost the use of their legs - so I would be greatly interested in knowing more about this aspect as well. Thanks for reading this and thanks in advance for any and all information, websites, names of other individuals, anything in order to help educate myself, and others, regarding Charcot disease. God bless all of you reading this and may all your own aches and pains be small ones! Blessings your way always - Barbara

A. wow...BARBS- your story is harsh...and (not from my own experience) i know that it's a not an easy illness, it's more or less just like MS. although i do not have CMT i thank you for the great offer to help and share tips, it's wonderful to know there are people like you out there that are willing to share experience!
what i do know is that there's the "Charcot-Marie-Tooth Association" which have a very good site with the latest news and even a big database project that you may participate and help find a cure to that horrible disease.

thanks so much!!

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