INTERMITTENT CLAUDICATION A Patient Information Sheet
The information provided in this patient information sheet is not a substitute for specialist medical
advice or treatment. Christchurch Vascular Group recommends consultation with your family doctor or
vascular specialist.
What is intermittent claudication?
Intermittent claudication is pain in the leg brought on by walking, and is caused by poor blood flow to the
muscles. It is "intermittent" because it only comes on with walking or running, and it goes away after a short
rest: and "claudication" from the Latin word meaning "to limp".
What causes intermittent claudication?
Narrowing or blockage of arteries to the leg is caused by atherosclerosis ("hardening of the arteries"). It means
that the extra blood needed during exercise cannot reach the muscles. When muscles get short of blood they
start to "seize up", with feelings of cramp, tightness, or pain. After a short rest the muscles recover, but more
walking will bring the pain on again.
Blockage or narrowing in any of the arteries carrying blood to the leg can cause intermittent claudication.
Trouble with arteries in the thigh is commonest, but large arteries above the level of the groin, or small arteries
down in the calf can also be affected. Pain is most often felt in the calf muscles, but if larger arteries are
blocked, then muscles in the thigh or the buttock may become painful. Pain often comes on more quickly when
walking faster or when going up hill.
There are other causes of pain in the leg on walking, and specialist examination is often needed to find out
whether narrowed arteries really are the cause.
Is intermittent claudication dangerous?
No: it is a nuisance but not a danger. Most people with intermittent claudication never develop serious problems
with their leg. But it is a warning sign that arteries have started to become blocked and means that the advice
below is important to try to prevent things getting worse.
What tests are needed?
You will have had an examination of your arteries to show whether or not they are causing your symptoms.
Further tests on the arteries, such as scans or x-rays, are only necessary if special treatment is planned. We
will discuss this with you.
Normally a blood test is taken to check if you are anaemic and check your blood sugar. You should be advised
to have a blood test to check on your blood cholesterol. Often, your own doctor will have done these tests for
you.
What treatment is there?
Giving up smoking
Many people with intermittent claudication are smokers, and giving up smoking is very important. Going on
smoking causes more blocks and narrowings to form (both in arteries to the legs and other arteries - for
example in the heart and brain increasing the risk of heart attacks and strokes). Finally, smoking makes any
intervention to clear out or bypass arteries more likely to fail.
Exercise
Taking exercise by regular walking is the best treatment for most patients with intermittent claudication and will
help symptoms to improve. Walking distance can improve a lot because exercise encourages small arteries in
the leg to carry more blood and helps the muscles to work more efficiently. Walking 3 times a week for an hour
is recommended. You can stop and rest as often as you need to during these exercise sessions.
You will do no harm by trying to walk as far as your comfort allows. Some people find they can "walk through"
the pain, but it is unwise to continue if your leg becomes very painful, and especially if exercise makes you feel
unwell in other ways (for example, with shortness of breath or chest pain). You will get further if you walk slowly,
and if you stop for rests before the pain gets too bad.
Diet
If you are overweight, then it is helpful to lose weight by going on a diet and taking as much exercise as you are
able. People who have just given up smoking often find this difficult: not smoking is the most important thing to
do.
Aspirin
A small dose of aspirin each day helps to thin the blood, and provides some protection against blockage of
important arteries over the years. This low dose of aspirin also protects your heart. If you cannot take aspirin
the vascular specialist or your GP will discuss if there is an alternative.
Other medicines
It is important to take any medicines you have been prescribed for diabetes, heart trouble, high blood
pressure, cholesterol and other conditions which affect the circulation.
Balloon angioplasty and arterial surgery
It is sometimes possible to widen or unblock arteries using special balloons passed down the arteries under
local anaesthetic (balloon angioplasty). Balloon angioplasty is usually successful in improving intermittent
claudication but all operations on the arteries have possible side effects and there is a small risk of losing the
leg. Walking exercise carries none of these risks and usually has as good an outcome as balloon angioplasty.
Bypass surgery is reserved for patients who have very severe symptoms.
What is the best treatment in your case?
We will discuss this with you. We will ask for your own opinion on how badly intermittent claudication affects
your life, and what you would like done, considering all the pros and cons of treatment.
We would only request scans or xrays after a decision that treatment by balloon angioplasty or operation
might be possible. If in doubt about whether to get scans or x-rays, it is often wise to wait to see if your
symptoms improve, and to give you time to consider all the possibilities.
Remember, intermittent claudication may not get much worse over many years and can improve, and it
seldom leads to serious trouble. If you give up smoking and keep active, no other treatment may ever by
necessary.