Intermittent Claudication

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Latest Edit: Hector 2013-05-21 (EDT)

Intermittent Claudication
Causes Dietary Factors, Smoking, Lack of Movement
See Also Cardiovascular Conditions, Arteriosclerosis, Hypertension, Diabetes
Books Books on Cardiovascular Conditions
Articles Articles on Cardiovascular Conditions

Intermittent claudication is an early manifestation of impaired arterial circulation and is known as the hallmark of peripheral vascular insufficiency. It is characterized by pain in the extremities described as aching or cramp like pains due to ischemia. The most common location is on the lower calf usually worsening with movement or exercise and feeling better with rest.[1], [2]

Naturopathic Assessment

When evaluating individuals with intermittent claudication it is important to rule out non-vascular types of limb pain such as from spinal stenosis or radiculopathy and many others. It is also important to investigate other cardiovascular conditions.[1], [2]

Causal Factors

In order to stimulate the innate ability of the body to heal the causes of disease must be identified and addressed. Intermittent claudication is often a symptom of another related condition and the causes are similar to those implicated in atherosclerosis and hypercholestemia.

Lifestyle

  • Exercise often brings on an episode of intermittent claudication due to muscle ischemia from inability to produce adequate blood flow to supply muscle.[1]

External

Genetics

  • Age
  • Increasing age over 65 or 70 increases the risk of intermittent claudication.[2]

Diagnostic Testing

  • Usually a diagnosis may be made with physical exam and thorough history however some lab studies may help to evaluate the presence or absence of peripheral vascular disorders.[2]
  • Blood tests include:[1] homocysteine, cholesterol panel including apolipoprotein B
  • Other diagnostic testing including:[2] Doppler ultrasound, stress test, duplex ultrasonography, magnetic resonance angiography, computed tomographic angiography,
  • ABI (Ankle Brachial Index) – ratio of ankle to arm systolic pressures – less than 0.9 is indicative of PAD[2]
  • Contrast arteriography especially for those being considered for revascularization.[2]

Related Symptoms and Conditions

Other conditions associated with intermittent claudication include:

Characteristics

Intermittent Claudication presents as:

  • Abnormal pedal pulses and femoral bruits.[1]
  • A slow walking speed or limp, decreased step length and impaired stability.[2]
  • Cramp or ache in the calf or thigh brought on by activity and alleviated at rest.[1]
  • Pain that is present at rest.
  • Redness and increased sense of heat in the extremity.

Intermittent Claudication increases the risk of[1]

  • Ulcerations
  • Necrosis

Naturopathic Treatment

The goal of naturopathic treatment is to support and work in tandem with the healing power of the body and to address the causal factors of disease with individual treatment strategies. Intermittent Claudication is a chronic disease and the treatment strategy is similar to atherosclerosis as they are both peripheral vascular disorders. Only those treatments that are specific to Intermittent Claudication are included on this page. For more detail check out the page on atherosclerosis.

It is always advisable to work with a naturopathic doctor before engaging in any treatment plan.

  • Decreasing intense exercise programs like running and squash are required to limit the risk of aggravation and discomfort. Regular exercise, like walking, stretching and swimming is beneficial.
  • Paying attention to proper alignment of the knee when sitting and standing can aid recovery and decrease symptoms.

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Goroll A, Mulley A, editors.(2009) Primary Care Medicine – Office evaluation and management of the adult patient. Boston: Lippincott Williams and Wilkins;163:pg1134-1137
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Olin JW, Sealove BA(2010)Peripheral artery disease: current insight into the disease and its diagnosis and management.Mayo Clin Proc.;85(7):678-92. PMID:20592174.
  3. Fox CS, Massaro JM, Schlett CL, Lehman SJ, Meigs JB, O'Donnell CJ, Hoffmann U, Murabito JM(2010)Periaortic fat deposition is associated with peripheral arterial disease: the Framingham heart study. Circ Cardiovasc Imaging;3(5):515-9. PMID:20639302.