Intermittent Claudication
Date issued: November 2023
Review date: November 2025
Ref: A-97/S/V/CC/Intermittent claudication V4
PDF: Intermittent claudication.pdf [pdf] 137KB
What is Intermittent Claudication?
The pain you feel in your legs is called intermittent claudication. It is caused by narrowing or blockages in the main artery taking blood to your leg. Over the years, cholesterol and calcium build up inside the arteries. This leads to hardening of the arteries (atherosclerosis). This occurs much earlier in people who smoke and those who have diabetes, high blood pressure or high levels of cholesterol in the blood.
The blockage means that blood flow in the leg is reduced. The circulation is sufficient when you are resting, but when you start walking, the calf muscles cannot obtain enough blood. This causes cramp and pain which gets better after resting for a few minutes. If greater demands are made on the muscles, such as walking uphill, the pain comes on more quickly.
Does the blockage ever clear itself?
Unfortunately not! However, the situation can improve because smaller arteries (the collateral circulation) may enlarge to carry blood around the blockage. Many people notice some improvement in their pain as the collateral circulation develops.
How can I help myself?
There are several things you can do which may help. The most important is to stop smoking, take regular exercise and lose weight.
Smoking: If you are a smoker you should make a determined effort to give up completely. Tobacco is harmful for two reasons: it speeds up the hardening of the arteries (which is the cause of the trouble) and cigarette smoke prevents development of the collateral vessels (which get blood past the blockage). The best way to give up is to choose a day when you are going to stop completely rather than trying to cut down gradually. If you have trouble giving up, please ask your doctor who may suggest nicotine substitutes, provide information leaflets, or put you in touch with a support group.
Further help is available locally from the: Smoking Advice Service Tel: 0300 123 1044
Exercise: A brisk (the best you can do) walk three times a week lasting 30 minutes will normally noticeably improve walking distance over 3-6 months. In some patients, exercise has been shown to more than double walking distance.
Diet: It is important not to be overweight. This is because the more weight the legs have to carry around, the more blood they need. If necessary, your doctor or dietician will give you advice about a weight-reducing diet. If your blood cholesterol is high, you will need a low-fat diet and may also require cholesterol-lowering drugs.
Do I need treatment?
Claudication is neither limb- nor life-threatening. It is not necessary to treat it if the symptoms are mild. It is a warning signal to control risk factors for heart attack, angina and stroke. Your blood pressure, cholesterol, weight, smoking and diabetes all need good control.
Claudication often remains stable with no deterioration in walking distance over long periods. Less than one in ten patients notice any reduction in walking distance during their lifetime. If symptoms worsen, treatment is available and your Vascular Surgeon will discuss your options with you.
Do drugs help?
There are a number of drugs on the market said to improve walking distance. Generally, these are not used by Vascular Surgeons because the evidence for their usefulness is very limited. There is evidence that taking Aspirin or Clopidogrel daily is generally good for people with circulation disorders (heart, brain and legs). The Heart Protection Study has also shown that even patients with normal cholesterol benefit from taking a statin. It is likely, therefore, that the Surgeon will recommend starting statin therapy even if your cholesterol level is normal.
What about treatment?
Most people with intermittent claudication do not require surgery but if your symptoms are very severe, or if they do not improve, further treatment may be possible:
Angioplasty: (stretching the artery where it is narrowed with a balloon) may help to improve walking distance for some people. Overall, it is less effective in the longer term than simple exercise. Angioplasty is usually limited to narrowings or short complete blockages (usually less than 10cm or 4 inches) in the artery.
Bypass surgery: is usually reserved for longer blockages of the artery when the symptoms are significantly worse. There may be very short distance claudication, pain at rest, ulceration of the skin in the foot or even gangrene in the foot or toes. The decision regarding surgery is usually one to make yourself after your specialist has explained the likelihood of success and the risks involved. More detailed information about these procedures is also available, please ask any member of the Vascular team.
What is the risk of losing my leg?
Very few patients with intermittent claudication will ever be at risk of losing a leg through gangrene. Your specialist will make every effort to avoid this happening. You can minimise the risk of progression of your symptoms by following the advice in this Information Leaflet. It is the simple measures which are the most effective: improve your lifestyle, keep walking, lose weight and stop smoking.
Contact details
Vascular Surgical Unit
Surgical Directorate
Plymouth Hospitals NHS Trust
Derriford Hospital
PL6 8DH
Tel 01752 202082
Consultant Vascular Surgeon and Lead Clinician
Mr Devender Mittapalli
Secretary: 01752 431822
Consultant Vascular and Transplant Surgeon
Mr Jamie Barwell
Secretary: 01752 431822
Consultant Vascular Surgeon
Surgeon Commander Cris Parry RN
Secretary: 01752 431822
Consultant Vascular Surgeon
Miss Catherine Western
Secretary: 01752 431805
Consultant Vascular Surgeon
Lt Col Robert Faulconer
Secretary: 01752 431805
Consultant Vascular Surgeon
Mr Hashem Barakat
Secretary: 01752 431822
Vascular Scientists
- Mrs J George
- Mr A Ellison
- Mr R Craven
01752 439228
Vascular Nurse Specialist
Mr Alan Elstone
01752 431805
Matron
Judy Frame
01752 431847
