Intermittent Claudication (Arteriosclerosis Obliterans)

Intermittent claudication refers to impaired blood circulation in a muscle during exercise. It develops commonly in the legs, causing symptoms that can range from a tired feeling to a crampy ache, a burning sensation, or severe pain. The discomfort occurs most often in the calf but also may arise in the foot, thigh, hip, or buttocks.

Symptoms usually develop after walking for a time. People with this condition can avoid them by resting before pain would normally occur. When discomfort does develop, it often disappears after a few minutes of rest.

As the disease worsens, however, the distance one can walk before pain occurs decreases, and eventually, pain may be felt even during rest. At this stage, the foot might be painful, cold, or numb, and the skin dry and scaly. The poor circulation may result in skin ulcers on the lower leg or foot and, in the worst cases, gangrene.

Intermittent claudication is caused by atherosclerosis, the buildup of fatty deposits, or plaque, on the inner lining of artery walls. Other contributing factors include smoking, hypertension, diabetes, and inactivity.

Diagnostic Studies and Procedures

A doctor immediately suspects intermittent claudication when a patient describes the typical characteristics. Also, the pulse over the arteries in the leg or ankle may be weak. The areas of blockage can be identified by Doppler ultrasonography, the use of sound waves to study blood flow, and an arteriogram, an X-ray of the blood vessels, taken after injection of a dye.

Medical Treatments

Many doctors recommend daily low-dose aspirin (one-half to one regular 325 milligram tablet) to help reduce the risk of blood clots, which develop commonly in arteries narrowed by atherosclerosis. A doctor may prescribe pentoxifylline (Trental), a drug that thins the blood so that it flows more easily through smaller blood vessels. However, this medication helps only about one-third of patients, and many are unable to tolerate its side effects.

In severe cases where pain occurs during rest, invasive procedures are recommended. If there is only a single blockage or a small number of isolated ones, angioplasty is the treatment of first choice. Or surgery might be suggested. One common operation is an endarterectomy, in which the artery is opened, fatty plaque removed, and the vessel re-closed. Alternatively, the affected arteries may be bypassed, which is done by inserting a vein taken from elsewhere in the body or a graft made from synthetic material.

Alternative Therapies

Exercise Conditioning. Mainstream physicians and alternative practitioners alike recommend daily exercise as an integral component of treating intermittent claudication. Most regimens call for walking at least 35 minutes daily, working up to an hour a day. Stop as often as necessary and wait for discomfort to abate. Practiced daily, this program will increase the distance you can walk before pain begins. Using a stationary exercise cycle is an acceptable alternative to walking.

Herbal Medicine. A salve of horse chestnut extract is said to benefit poor circulation. It can be applied directly to the legs to ease leg cramps. Other possible herbal remedies include butchers broom capsules or tea, gingko extract, and hawthorn berry capsules -- all said to improve circulation.

Nutrition Therapy. Vitamin E supplements are recommended to improve circulation in cases of extensive atherosclerosis. Some nutritionists theorize that the vitamin enables muscles to do more work before pain occurs. Lecithin capsules or powder may reduce buildup of fatty plaque; chlorophyll (liquid or pills) is said to enhance circulation.

Self-Treatment

In addition to daily exercises, self-care includes the following:

• Do not smoke, and avoid secondhand smoke. Smoking contributes to atherosclerosis and also reduces the amount of oxygen available to muscles.
• Follow a low-fat, high-fiber diet that emphasizes whole grains, fruits, and vegetables, which can reduce cholesterol levels. Maintain your ideal weight; obesity puts an extra burden on legs.
• Do not wear garters or socks with tight elastic bands, which can further impair blood flow. Choose cotton or wool socks in cold weather to keep feet warm. Make sure that your shoes fit properly and are made of leather or a fabric that allows air to circulate.
• Wash feet gently every day with lukewarm water and mild soap and apply a moisturizer. Have corns, calluses, and other foot problems treated by a podiatrist or doctor to avoid infections. Other Causes of Leg Pain Phlebitis, varicose veins, certain types of arthritis, and sports-related injuries can also cause leg pain.