Claudication - How To Get Rid Of It?

Optimal blood supply is needed for all body parts to function at their best possible levels. Diseases that affect the blood flow and blood supply cause problems, especially in the target organs. Claudication, which is cramping of the muscles of the legs and arms, especially during exercise, is one such problem.

It is not a disease per se but a symptom of an underlying disease, most common being a peripheral arterial disease. It does not occur constantly, but is intermittent, which worsens during exercise and is relieved with rest. Very rarely, conditions like deep vein thrombosis, spinal stenosis, peripheral neuropathy, and some other musculoskeletal disorders can also cause claudication.

Causes:

Peripheral artery disease is the result of atherosclerosis or hardening of the arteries. With age, there is plaque accumulation along the arterial walls leading to narrowing of the artery. This reduces the vessel thickness and subsequently the amount of blood flow to the target organs. This reduces oxygen supply to the organs, reducing their efficient functioning. In the instance of legs, especially during exercise, optimal blood flow is required for proper muscle contraction and relaxation. However, reduced blood flow will cause pain and cramping during exercise, manifesting as claudication. The damage to the artery could be a transient, one-off instance due to vasospasm (temporary narrowing); atherosclerosis (permanent narrowing); or due to complete blockage of an artery.

Symptoms:

Person with claudication would have extremities that are cool to the touch. In addition,

• Pain when exercising which would be a dull, aching, or throbbing pain. The location and nature of the plaque will determine the severity and area of symptoms. Pain at rest gradually sets in as the disease progresses
• In severe cases, there could be discolouration of the toes and fingers and sores can develop in the feet, toes, arms or fingers. There could also be a burning feeling in this area.
• Poor healing of injuries (cuts, ulcers, etc.) in the arms and legs. These could develop gangrene and even require amputation.

Risk factors: As with any other circulatory disease, risk for peripheral artery disease include:

• Hypertension
• Smoking
• Pre-existing heart disease
• Diabetes (poorer the control, more severe the peripheral artery disease)
• Elevated cholesterol levels
• Age more than 70 years
• Obesity (BMI > 30)

Treatment:

• It can affect the quality of life by reducing the ability to exercise and can even interfere with work. Regular medications and surgery are the two modes of treatment.
• Cilostazol improves blood flow by dilating the arteries and therefore reduces pain.
• Pentoxifylline reduces the blood viscosity and therefore allows for better free flow in the arteries.

In severe cases, revascularization may be used, but is usually managed with lifestyle changes, controlling risk factors, and the above medications.