Intermittent Claudication
Intermittent Claudication
8 Ways to Ease the Pain
Intermittent claudication, a chronic pain experienced in the calf when walking, afflicts more than one million people over the age of 50 in the United States every year. Though a painful and serious condition in its own right, intermittent claudication is really the symptom of a larger, more serious problem—peripheral vascular disease.
Just as clogged blood vessels in the heart lead to angina (chest pains), intermittent claudication signals the onset of restricted blood flow in the "periphery," that is, the area furthermost from the heart—the arms and legs.
"We're talking about the symptom phase of arterial disease," says Jess R. Young, M.D., chairman of the Department of Vascular Medicine at the Cleveland Clinic Foundation in Ohio. "If you get arterial disease in the heart, you get angina and heart attacks. If you get it in the head circulation, you get strokes. Intermittent claudication's the same process, but in the legs and arms."
For that reason, intermittent claudication should not be taken lightly. If you've been diagnosed as having this condition, you should continue seeing your doctor so he can monitor the underlying disease that has resulted in the pain you now feel in your legs. The pain, after all, is only a symptom. The real disease is a killer.
On the up side, there are a number of things you can do at home to rid yourself of claudication's pain and help slow the progression of peripheral vascular disease.
Stop smoking. "The number-one thing on everyone's list with this affliction should be to stop smoking," says Dr. Young. "About 75 to 90 percent of all claudicators are smokers."
Stopping smoking is so important, in fact, that our experts say you must quit before any other remedy listed below will work. Is it worth it? Consider the following: Cigarette smoking increases the damage the disease can do by substituting carbon monoxide for oxygen in the already oxygen-starved muscles of your legs. Nicotine also causes constriction of the arteries, which further restricts blood flow, possibly damaging the arteries themselves and leading to blood clots. Such clots can result in gangrene and make amputation necessary.
"Stopping smoking is the most important thing, period," notes Robert Ginsburg, M.D., director of the Center for Interventional Vascular Therapy at Stanford University Hospital in California.
Start walking. "Next to stopping smoking, exercise is most important," says Dr. Young. The type of exercise he's talking about, and the type our experts overwhelmingly recommend, is the simplest of all—walking.
"Get out every day for at least an hour of walking exercise," says Dr. Young. "You can break that up any way you want, but you have to bring on the discomfort of intermittent claudication to have the walking do any good." Walk until you bring on the pain, he says, but don't stop at the first sign of pain. "Wait until it gets moderately severe. Then stop and rest a minute or two until it goes away, then start up walking again." Repeat that pain/walk cycle as often as you can during your 60 minutes of daily walking.
Be warned, however, that improvement won't happen overnight. "It will be two or three months, minimum, before you see results," says Dr. Young. So don't get discouraged.
Don't let foul weather stop you. "Walking is the best singular exercise," says Dr. Ginsburg, "but bicycling on a stationary bike can also help if it works the calves." In fact, any indoor exercise that works the calves enough to bring on the pain of claudication can help. Some exercises to try include toe raises, stair climbing, running in place, jumping rope, and dancing (get your doctor's okay before trying these more strenuous exercises.)
"Indoor exercises are better than trudging out through a foot of snow in the middle of winter and getting the feet wet," Dr. Ginsburg notes. But, he adds, walking is still the best exercise whenever weather permits.
Take care of your feet. "Anytime there's a break in the skin on the feet, you have to be on guard that it heals up in short order," says Michael D. Dake, M.D., a vascular specialist at the Miami Vascular Institute in Florida. "Nonhealing foot problems that get infected are probably the leading cause of amputation."
Foot problems that are minor inconveniences for people with healthy circulation can become major infections for those with impaired blood flow to the limbs.
Many problems can be avoided, however, with proper care of the toenails, treatment of athlete's foot, and avoidance of extremely hot or cold temperatures. The feet should be carefully inspected every day, and you should get prompt medical attention for any signs of injury of infection.
MEDICAL ALERT
The Danger of Infection Chronic foot problems that get infected are a leading cause of amputation in people who suffer with intermittent claudication. If you have a cut, scrape, blister, or other foot problem that develops the redness, swelling, heat, and pain of infection, seek immediate medical help. |
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Take a load off. Obesity can be a major problem for those with claudication, not only because of the strain it places on circulation, but because of the damage it inflicts on the feet.
"You're traumatizing tissue in the feet that just doesn't have a good enough blood supply to take that abuse and heal," notes Dr. Young.
Avoid heating pads. Because of the restricted blood flow in the legs, people who suffer from intermittent claudication often suffer from cold feet, too. But regardless of how cold your feet may be, they should never be warmed with a heating pad or hot-water bottle. "You need the increased blood flow to help dissipate the heat," Dr. Young explains. "If the blood flow is limited, however, it can't get down to where you're putting the heat and you'll burn the skin." Try loose wool stockings to warm your feet instead.
Know your blood pressure and cholesterol level. "If you suffer with intermittent claudication, you should also be checked for hypertension and hyperlipidemia," says Dr. Young. "These are important risk factors that tend to markedly increase the severity of the underlying disease, and it's very important to keep both of those conditions tightly controlled."
Get to know your cardiologist. "If you have intermittent claudication and haven't seen a cardiologist," warns Dr. Ginsburg, "make an appointment to see one." The reason for that warning becomes apparent when you examine the statistics. The incidence of coronary artery disease in people with peripheral vascular disease is about 75 to 80 percent. Intermittent claudication is a symptom of peripheral vascular disease.
"If a person comes in and has symptoms of a lack of blood flow in the legs," Dr. Ginsburg says, "there's a strong possibility that he or she already has blockages in the heart, or in the carotid arteries going to the brain. So it's very important that this person be evaluated not only for problems with the vessels, but with the organs those vessels are feeding."
PANEL OF ADVISERS
Michael D. Dake, M.D., is a vascular specialist at the Miami Vascular Institute in Florida.
Robert Ginsburg, M.D., is director of the Center for Interventional Vascular Therapy at Stanford University Hospital in California.
Jess R. Young, M.D., is chairman of the Department of Vascular Medicine at the Cleveland Clinic Foundation in Ohio.
