Medicines for Intermittent claudication

What it is

Intermittent claudication is a cramping pain, ache or tiredness in the leg muscles (usually the calves, but sometimes the thighs or buttocks) that comes on with walking or exercise and eases with rest. It is the most common symptom of peripheral arterial disease (PAD) — a narrowing of the arteries that supply the legs, usually due to a build-up of fatty deposits (atherosclerosis), the same process that affects the heart's arteries. When walking, the leg muscles need more blood, and if the arteries are narrowed, they cannot supply enough, causing the pain; resting reduces the demand and the pain settles, typically within a few minutes, only to return again on walking a similar distance. As well as the pain, there can be other signs of poor leg circulation. Importantly, PAD is a marker that the arteries elsewhere (such as the heart and brain) are also likely affected, so people with intermittent claudication are at increased risk of heart attack and stroke — which means managing it is not just about the legs but about reducing overall cardiovascular risk. It is more common with age, smoking, diabetes, high blood pressure and high cholesterol. While claudication itself is usually not limb-threatening, and often stable or improves with treatment, it should be assessed, and any progression to rest pain (pain even at rest) needs prompt attention.

How it is treated

Management of intermittent claudication has two main aims: improving the leg symptoms and walking, and, crucially, reducing the overall cardiovascular risk. The foundations are: stopping smoking (the single most important step, as smoking greatly worsens PAD and cardiovascular risk); a supervised or structured exercise programme, especially regular walking (walking to the point of pain, resting, then continuing) which, perhaps surprisingly, is one of the most effective treatments and improves walking distance over time by encouraging the circulation to adapt; and managing cardiovascular risk factors — controlling blood pressure, cholesterol (usually with a statin) and diabetes, and taking medicines to reduce the risk of clots (such as an antiplatelet), which reduce the risk of heart attack and stroke. A healthy diet, weight management and staying active all help. Where symptoms are severe, significantly limiting, or not improving with these measures, or where the circulation is more seriously compromised, procedures to improve blood flow (such as angioplasty to widen the artery, or bypass surgery) may be considered by a vascular specialist. Good foot care is important. Any development of pain at rest, or non-healing wounds or ulcers on the leg or foot, needs urgent assessment, as this indicates more severe disease. The reassuring message is that intermittent claudication is often stable or improves with exercise, stopping smoking and risk-factor control — which also protect the heart and brain — with procedures available for more severe cases.