# Claudication

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Any impairment or discomfort in walking

Medical condition

Claudication Specialty Neurology, rheumatology, vascular surgery Treatment adrenoceptors alpha 1/alpha 2

**Claudication** is a [medical term](/source/Medical_term) usually referring to impairment in [walking](/source/Walking), or pain, discomfort, [numbness](/source/Numbness), or [tiredness](/source/Tiredness) in the [legs](/source/Human_leg) that occurs during walking or standing and is relieved by rest.[1] The perceived level of pain from claudication can be mild to extremely severe. Claudication is most common in the [calves](/source/Calf_(leg)) but it can also affect the feet, thighs, hips, buttocks, or arms.[2] The word *claudication* comes from [Latin](/source/Latin_language) *claudicare* 'to limp'.

Claudication that appears after a short amount of walking may sometimes be described by US medical professionals by the number of typical [city street blocks](/source/City_block#As_a_unit_of_distance) that the patient can walk before the onset of claudication. Thus, "one-block claudication" appears after walking one block, "two-block claudication" appears after walking two blocks, etc. The term *block* would be understood more exactly locally but is on the order of 100 meters (328 feet).

## Types

### Intermittent vascular

Main article: [Intermittent claudication](/source/Intermittent_claudication)

Intermittent vascular (or arterial) claudication (Latin: *claudicatio intermittens*) most often refers to cramping pains in the buttock or leg muscles, especially the calves. It is caused by poor [circulation](/source/Circulatory_system) of the blood to the affected area, called [peripheral arterial disease](/source/Peripheral_artery_disease). The poor blood flow is often a result of [atherosclerotic blockages](/source/Atherosclerosis) more [proximal](/source/Anatomical_terms_of_location#Proximal_and_distal) to the affected area;[3] individuals with intermittent claudication may have [diabetes](/source/Diabetes_mellitus) — often undiagnosed.[4] Another cause, or exacerbating factor, is [excessive sitting](/source/Sitting_disease) (several hours), especially in the absence of reasonable breaks, along with a general lack of walking or other exercise that stimulates the legs.[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*]

### Spinal or neurogenic

Main article: [Neurogenic claudication](/source/Neurogenic_claudication)

Spinal or neurogenic claudication is not due to lack of blood supply, but rather it is caused by nerve root compression or [stenosis](/source/Stenosis) of the spinal canal,[1] usually from a degenerative spine, most often at the ["L4-L5" or "L5-S1" level](/source/Lumbar_vertebrae). This may result from many factors, including bulging disc, [herniated disc](/source/Spinal_disc_herniation) or fragments from previously herniated discs (post-operative), scar tissue from previous surgeries, [osteophytes](/source/Osteophyte) (bone spurs that jut out from the edge of a vertebra into the foramen, the opening through which the nerve root passes). In most cases neurogenic claudication is bilateral, i.e. symmetrical.[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*]

### Jaw

[Jaw claudication](/source/Jaw_claudication) is pain in the [jaw](/source/Jaw) or [ear](/source/Ear) while chewing. This is caused by insufficiency of the arteries supplying the jaw muscles, associated with [giant cell arteritis](/source/Giant_cell_arteritis).[5][6]

## Diagnosis

### Differential diagnosis

Vascular (or arterial) claudication typically occurs after activity or ambulation for a distance with resultant vascular insufficiency (lack of blood flow) where the muscular demands of oxygen outweighs the supply. Symptoms are lower extremity cramping. Resting from activity even in a standing position may help relieve the symptoms. Spinal or neurogenic claudication may be differentiated from arterial claudication based on activity and position. In neurogenic claudication, positional changes lead to increased [stenosis](/source/Lumbar_spinal_stenosis) (narrowing) of the spinal canal and compression of nerve roots and resultant lower extremity symptoms. Standing and extension of the spine narrows the spinal canal diameter. Sitting and flexion of the spine increases spinal canal diameter. A person with neurogenic claudication will have worsening of leg cramping with standing erect or standing and walking. Symptoms may be relieved by sitting down (flexing the spine) or even by walking while leaning over (flexion of the spine) a shopping cart.[4]

The ability to ride a stationary bike for a prolonged period of time differentiates neurogenic claudication from vascular claudication. Weakness is also a prominent feature of spinal claudication that is not usually present in intermittent claudication.[4]

## Treatment

Blocking agents of the adrenoceptors alpha 1/alpha 2 are typically used to treat the effects of the vasoconstriction associated with vascular claudication. [Cilostazol](/source/Cilostazol) (trade name: Pletal) is FDA approved for intermittent claudication. It is contraindicated in patients with heart failure, and improvement of symptoms may not be evident for two to three weeks.[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*]

Neurogenic claudication can be treated surgically with [spinal decompression](/source/Spinal_decompression).[7]

## Prognosis

The prognosis for patients with [peripheral vascular disease](/source/Peripheral_vascular_disease) due to [atherosclerosis](/source/Atherosclerosis) is poor; patients with intermittent claudication due to atherosclerosis are at increased risk of death from [cardiovascular disease](/source/Cardiovascular_disease) (e.g. [heart attack](/source/Acute_myocardial_infarction)), because the same disease that affects the legs is often present in the arteries of the heart.[8]

The prognosis for neurogenic claudication is good if the cause of it can be addressed surgically.[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*]

## References

1. ^ [***a***](#cite_ref-PMID19796387_1-0) [***b***](#cite_ref-PMID19796387_1-1) Comer CM, Redmond AC, Bird HA, Conaghan PG (2009). ["Assessment and management of neurogenic claudication associated with lumbar spinal stenosis in a UK primary care musculoskeletal service: a survey of current practice among physiotherapists"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762954). *BMC Musculoskelet Disord*. **10**: 121. [doi](/source/Doi_(identifier)):[10.1186/1471-2474-10-121](https://doi.org/10.1186%2F1471-2474-10-121). [PMC](/source/PMC_(identifier)) [2762954](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762954). [PMID](/source/PMID_(identifier)) [19796387](https://pubmed.ncbi.nlm.nih.gov/19796387).

1. **[^](#cite_ref-Merck_2-0)** [Peripheral Arterial Disease](http://www.merck.com/mmpe/sec07/ch080/ch080f.html) at *[The Merck Manual of Diagnosis and Therapy](/source/The_Merck_Manual_of_Diagnosis_and_Therapy)* Professional Edition

1. **[^](#cite_ref-PMID17413176_3-0)** Simon RW, Simon-Schulthess A, Simon-Schulthess A, Amann-Vesti BR (April 2007). ["Intermittent claudication"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1847882). *BMJ*. **334** (7596): 746. [doi](/source/Doi_(identifier)):[10.1136/bmj.39036.624306.68](https://doi.org/10.1136%2Fbmj.39036.624306.68). [PMC](/source/PMC_(identifier)) [1847882](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1847882). [PMID](/source/PMID_(identifier)) [17413176](https://pubmed.ncbi.nlm.nih.gov/17413176).

1. ^ [***a***](#cite_ref-PMID12637405_4-0) [***b***](#cite_ref-PMID12637405_4-1) [***c***](#cite_ref-PMID12637405_4-2) Burns P, Gough S, Bradbury AW (March 2003). ["Management of peripheral arterial disease in primary care"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1125476). *BMJ*. **326** (7389): 584–8. [doi](/source/Doi_(identifier)):[10.1136/bmj.326.7389.584](https://doi.org/10.1136%2Fbmj.326.7389.584). [PMC](/source/PMC_(identifier)) [1125476](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1125476). [PMID](/source/PMID_(identifier)) [12637405](https://pubmed.ncbi.nlm.nih.gov/12637405).

1. **[^](#cite_ref-5)** Reiter S, Winocur E, Goldsmith C, Emodi-Perlman A, Gorsky M (2009). "Giant cell arteritis misdiagnosed as temporomandibular disorder: a case report and review of the literature". *J Orofac Pain*. **23** (4): 360–5. [PMID](/source/PMID_(identifier)) [19888487](https://pubmed.ncbi.nlm.nih.gov/19888487).

1. **[^](#cite_ref-6)** Rieck KL, Kermani TA, Thomsen KM, Harmsen WS, Karban MJ, Warrington KJ (July 2010). "Evaluation for Clinical Predictors of Positive Temporal Artery Biopsy in Giant Cell Arteritis". *J Oral Maxillofac Surg*. **69** (1): 36–40. [doi](/source/Doi_(identifier)):[10.1016/j.joms.2010.02.027](https://doi.org/10.1016%2Fj.joms.2010.02.027). [PMID](/source/PMID_(identifier)) [20674120](https://pubmed.ncbi.nlm.nih.gov/20674120).

1. **[^](#cite_ref-7)** *[Spinal Stenosis~treatment](https://emedicine.medscape.com/article/1913265-treatment)* at [eMedicine](/source/EMedicine)

1. **[^](#cite_ref-PMID17580733_8-0)** Shammas NW (2007). ["Epidemiology, classification, and modifiable risk factors of peripheral arterial disease"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994028). *Vasc Health Risk Manag*. **3** (2): 229–34. [doi](/source/Doi_(identifier)):[10.2147/vhrm.2007.3.2.229](https://doi.org/10.2147%2Fvhrm.2007.3.2.229). [PMC](/source/PMC_(identifier)) [1994028](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1994028). [PMID](/source/PMID_(identifier)) [17580733](https://pubmed.ncbi.nlm.nih.gov/17580733).

## External links

[Scholia](https://www.wikidata.org/wiki/Wikidata:Scholia) has a profile for [**claudication (Q2888709)**](https://iw.toolforge.org/scholia/Q2888709).

Classification D ICD-10: I73.9 ICD-9-CM: 443.9 MeSH: D007383 DiseasesDB: 2777

v t e Cardiovascular disease (vessels) Arteries, arterioles and capillaries Inflammation Arteritis Aortitis Buerger's disease Arteriosclerosis Atherosclerosis Foam cell Fatty streak Atheroma Cholesterol LDL Oxycholesterol Trans fat Monckeberg's arteriosclerosis Hyaline arteriolosclerosis Hyperplastic arteriolosclerosis Peripheral artery disease Stenosis Carotid artery stenosis Renal artery stenosis Aortoiliac occlusive disease Critical limb ischemia Degos disease Erythromelalgia Fibromuscular dysplasia Hepatic artery thrombosis Intermittent claudication Raynaud's phenomenon Aneurysm / dissection / pseudoaneurysm torso: Aortic aneurysm Abdominal aortic aneurysm Thoracic aortic aneurysm Aneurysm of sinus of Valsalva Aortic dissection Aortic rupture Coronary artery aneurysm head / neck: Intracranial aneurysm Intracranial berry aneurysm Carotid artery dissection Vertebral artery dissection Familial aortic dissection legs: Popliteal artery aneurysm Vascular malformation Arteriovenous fistula Arteriovenous malformation Telangiectasia Hereditary hemorrhagic telangiectasia Generalized essential telangiectasia Vascular nevus Cherry hemangioma Halo nevus Spider angioma Veins Inflammation Phlebitis Venous thrombosis / Thrombophlebitis primarily lower limb Deep vein thrombosis abdomen Hepatic veno-occlusive disease Budd–Chiari syndrome May–Thurner syndrome Portal vein thrombosis Renal vein thrombosis upper limb / torso Mondor's disease Paget–Schroetter disease Pulmonary embolism head Cerebral venous sinus thrombosis Post-thrombotic syndrome Varicose veins Gastric varices Portacaval anastomosis Caput medusae Esophageal varices Hemorrhoid Varicocele Other Chronic venous insufficiency Chronic cerebrospinal venous insufficiency Superior vena cava syndrome Inferior vena cava syndrome Venous ulcer Arteries or veins Angiopathy Macroangiopathy Microangiopathy Embolism Pulmonary embolism Cholesterol embolism Paradoxical embolism Thrombosis Vasculitis Blood pressure Hypertension Hypertensive heart disease Hypertensive emergency Hypertensive nephropathy Essential hypertension Secondary hypertension Renovascular hypertension Benign hypertension Pulmonary hypertension Systolic hypertension White coat hypertension Hypotension Orthostatic hypotension Shock (circulatory)

Authority control databases: National Czech Republic

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Adapted from the Wikipedia article [Claudication](https://en.wikipedia.org/wiki/Claudication) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Claudication?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.