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When talking about “claudication,” doctors often mean vascular claudication, which is when the blood flow in a leg decreases due to an obstruction in the blood vessels. This is usually caused by atherosclerosis, which causes arteries to become narrowed or blocked, leading to decreased arterial blood flow. If this happens, it can lead to pain and potentially amputation as a means of saving one’s life.
What is claudication?
Claudication is a condition in which you feel pain in one or both legs when walking or running. This is caused by a slow blood flow in the arteries, which causes symptoms like leg swelling, decreased blood flow, and increased oxygen use. It can also cause feelings of fatigue and debilitation.
Symptoms of claudication
Claudication typically causes symptoms in both legs at once.
- the most common symptom is pain felt while walking or running on an affected leg (abduction);
- it can also cause pain in the thigh, knee, ankle, and foot;
- people who are more prone to claudication may also experience symptoms in the leg after standing or walking for a long time.
Causes of claudication
There are many potential causes of claudication that impact blood flow to and from various tissues in your body. The three most common causes are:
- atherosclerosis;
- peripheral arterial disease (PAD);
- venous insufficiency.
Types of claudication
- Neural or distal claudication:
the sensation of pain in the leg, usually in the calf, is caused by a problem within the nervous system that interferes with muscular endurance. - Vascular or proximal claudication:
this type of claudication starts in the legs and then progresses to invade and cause problems with other body areas.
What is neural claudication?
Neural claudication, also known as “neuralgia,” can be very painful and cause speech impediment, balance problems, memory loss, headaches, dizziness, and stroke-like symptoms depending on the location of the lesion. Although this type of claudication is not as common as vascular claudication, it occurs more frequently in younger adults between 25 and 45.
Neural claudication occurs when the nerve fibers in the brain are damaged, forming a lesion that can be treated by neurosurgery or radiation. In addition to affecting speech, balance, and memory, neural claudication can lead to temporary or permanent paralysis depending on brain location.
How does neural claudication differ from vascular claudication?
- Unlike neural claudication, the decreased blood flow in vascular claudication is due to arteries becoming blocked. With neural claudication, however, the problem is a lesion in the brain.
- Brain damage occurs faster with neural claudication than vascular claudication since the brain is located in the head and not the leg.
- The symptoms of neural claudication in younger adults are very similar to stroke symptoms, including weakness, balance problems, and speech difficulty. However, with older adults, stroke-like symptoms may occur regardless of the lesion in the brain (e.g., little brain).
- The symptoms associated with vascular claudication are often more sporadic and less severe than those related to neural claudication.
- In vascular claudication, the time to fatal outcome is usually about 4-6 weeks, while in neural claudication, life expectancy is unknown.
Although these symptoms may seem different, they are essentially the same disease process. The main difference between neural and vascular claudication is based on the location of the lesion. This means that to treat one type of claudication, they may both require the same treatment. To have a successful outcome, surgeons need to know whether to operate on the brain’s artery. Some people are at risk for possible stroke due to surgery (and may be unable to undergo surgery), but it can still be done if necessary.
Complications from neural and vascular claudication
Although symptoms of neural and vascular claudication are almost similar, the treatments for them are different. Although most patients with vascular claudication will be treated with medication and physical therapy, this is not always possible in cases where the lesion is located in the brain. In these cases, surgery may be an option.
Neural claudication patients must take special care to prevent blood clotting while they undergo their treatment. Without proper management of their condition, this clotting can lead to a stroke or other serious complications.
The risk for vascular claudication is very high in patients over the age of 60, but it is also possible to develop the condition at any age. This means that anyone experiencing symptoms of claudication should seek medical attention immediately.
There are a few other complications associated with vascular claudication that are not seen with neural claudication. These include heart disease and kidney failure due to increased blood pressure and decreased kidney function, respectively.
Prevention
Despite being one of the most common causes of leg claudication, the exact cause of vascular claudication is still unknown. This means that it is difficult to prevent, but you can do a few different things to help avoid or reduce the chances of developing claudication.
The primary method to prevent vascular claudication would be to undergo regular exercise and muscle strengthening exercises. This will help increase blood flow throughout the body and decrease pressure in arteries. It is important to note that people with atherosclerosis should avoid strenuous activity to prevent further damage and claudication.
Additional ways to reduce vascular claudication include:
1. No smoking
Smoking can cause chronic lung damage and make it harder for the body to fight off claudication. In some cases, nicotine patch therapy may help ease angina pain or block the release of norepinephrine in patients at risk for stroke, but the benefits must be weighed against the risk of smoking.
2. Avoiding high-risk lifestyle choices
People who engage in risky behaviors such as drinking alcohol are at an increased risk of having claudication-related problems later in life. This can result in the adverse effect of alcohol consumption on the heart, brain, and circulation system.
3. Not taking long walks
Although this is not a prevention measure, it should be noted that walking for more than about 30 minutes will increase blood pressure. If your blood pressure is too low, it won’t be able to provide enough oxygen and nutrients to the organs.
Conclusion
Although the two types of claudication are different in symptom presentation and treatment, they are essentially the same disease process. For patients to achieve a successful outcome, they will both require a neurosurgeon to operate on their brain lesion. If the wrong type of treatment is administered, it will hurt the patient’s outcome. This means that patients should understand their disease and their options to make the best treatment decision.
