Claudication Treatment in Delhi, India

The two most common types of claudication are:

1. Vascular Claudication

   Vascular claudication occurs due to restricted blood flow that causes a lower oxygen supply to the muscles during exercise or walking.

2. Neurogenic Claudication

   Neurogenic claudication is associated with spinal cord and nervous system problems. It is caused due to narrowing in the spinal canal, which puts pressure on the spinal nerves.

Claudication is muscle pain due to a lack of oxygen caused by extreme physical activity. The symptoms of the condition include:

1. Pain, discomfort, or ache in the muscles
2. Numbness and pain in calves' thighs, feet, or hips
3. Pain in forearms, biceps, and shoulders
4. Pain is relieved after resting
5. Cold feet or foot sores
6. Cramping
7. Tingling sensation and weakness

Initially, the pain gets better after resting, but pain may increase even during rest with time.

Claudication is often an early symptom of peripheral artery disease. These arteries are large vessels that carry blood to the arms and legs. Peripheral artery disease refers to damage to any artery that restricts the blood flow in the arm or leg.

When resting, low blood flow does not cause pain in the limbs, but low blood flow leads to a lesser oxygen supply when physically active, causing pain.

The factors that can cause claudication includes:

1. Low blood flow to a body part
2. Narrowed and hardened arteries that lead to blockage
3. Damaged nerves
4. A build-up of plaque (consisting of calcium, cholesterol, fat, and other substances)
5. Bulging artery (aneurysm)
6. Narrowed spinal canal

1. Pulse measurement

   This test measures pulse and blood flow in the arms or feet.

2. Segmental blood pressure measurement test

   This test includes taking blood pressure measurements at different parts of the arm or leg to evaluate the amount of damage to the arteries.

3. Ankle-brachial index

   This test compares the blood pressure in the arms and ankles.

4. Doppler ultrasound

   This test helps the doctor see the blood flow in the blood vessels.

5. Imaging tests

   Imaging tests such as MRI, CT scan, or angiography give a clear image that helps review the narrowed blood vessels and the blockage size.

6. Auscultation

   Auscultation is a physical examination in which the doctor listens to arteries using a stethoscope. The presence of a sound can identify narrowed arteries or restricted blood flow called a bruit.

7. Exercise test

   An exercise test may be conducted to determine the capacity of a person to walk without experiencing pain.

8. Ultrasound

   The ultrasound test uses sound waves that bounce off the red blood cells. This helps to find out how fast the blood flows in the vessels.

Treatment of claudication focuses on lowering the risks of vascular disease. It reduces the pain while increasing mobility and preventing damage to tissues. The treatment option for claudication depends on the person's age, overall health, level of pain, and the ability to handle medications, therapy, or surgery.

Exercise and walking are primary treatments for claudication. Exercise helps to reduce pain, improves overall vascular health, maintains weight, and improves the quality of life. Other treatment options available to treat claudication are medications and surgery.

Exercise and Walking:

1. Walking till a person feels pain
2. Taking a break to relieve the pain
3. Practising walk cycle for a half-hour
4. Walking consistently for some time, at least three days a week

Medications:

Depending on the severity of the pain, the doctor may prescribe medications and pain relievers. The doctor may also give medications to manage the risk for cardiovascular disease and other health problems.

The doctor may give medications to manage:

1. Pain

   Cilostazol may be prescribed to improve blood flow and reduce walking pain.

2. High Blood Pressure

   Drugs may be given to control and reduce high blood pressure. High blood pressure increases the risk of heart attack and stroke.

3. High Cholesterol

   Drugs such as statin can be given to lower cholesterol. High cholesterol can cause plaques in the arteries.

4. Other Heart Diseases

   Antiplatelet drugs may be given to prevent blood clots, reduce the risk of heart attack or stroke, and prevent clots from blocking the blood flow.

As claudication is a symptom of peripheral artery disease, surgery may be advised to treat the arteries if other treatment options do not work.

1. Vascular Surgery

   In vascular surgery, a healthy blood vessel from a different part of the body is taken and replaced with the damaged blood vessel that causes claudication.

2. Angioplasty

   Angioplasty is a surgical procedure that improves the blood flow by widening the damaged artery. A narrow tube with an inflatable balloon is inserted into the blood vessels to expand the artery. A stent (small metal or plastic tube) may be placed in the artery to keep it open.

   Maintaining a healthy lifestyle can improve treatment outcomes and lower the risk of diseases associated with claudication.

Claudication is an early symptom of many other diseases. Ignoring the signs of claudication can lead to complications such as:

1. Atherosclerosis
2. Increase risk of heart attack and stroke
3. Amputation of a limp
4. Gangrene

Claudication can be prevented by maintaining a healthy lifestyle and controlling a few medical conditions.

1. Exercise regularly
2. Avoid food with saturated fats
3. Eat a healthy, nutrition, and well-balanced diet
4. Take proper foot care by wearing socks and comfortable shoes to support the feet
5. Quit smoking and control drinking
6. Maintaining a healthy weight
7. If diabetic, control blood sugar level
8. Monitor cholesterol and blood pressure

Factors that may increase the risk for claudication and possible peripheral artery disease include:

1. Family history of claudication and peripheral artery disease
2. People with diabetes aged above 50
3. Older age (men aged over 55 or women aged over 60)
4. Physically inactive
5. High blood pressure
6. Diabetes or high cholesterol
7. Chronic kidney disease
8. Smoking or heavy drinking
9. Overweight or obese
10. Degradation of the spinal cord due to ageing or injuries

Reviewed by Dr. Achintya Sharma, Consultant & In-charge, Vascular Surgery on 02-Aug-2022