Intermittent claudication

Intermittent claudication: what causes it?

Intermittent claudication is a result of peripheral arterial disease (PAD). Hardening of the arteries, also called atherosclerosis, causes narrowing in the arteries of the pelvis or legs. At rest, your leg muscles still get enough blood. While walking, they need more oxygen than can be supplied through the narrowing. The muscles then build up acid and you feel this as a cramping, tired pain. Because the narrowing is often in the femoral artery, you usually feel the pain in the calf. With a narrowing higher up in the pelvis, the pain can also be in the buttock or thigh.

Smoking is the most important risk factor. Diabetes, high blood pressure, high cholesterol, ageing, being overweight, lack of exercise and cardiovascular disease in the family also play a role. Intermittent claudication is also a sign that blood vessels elsewhere in the body may be affected. That is why your GP also checks your risk of a heart attack or stroke.

The stages of intermittent claudication

Doctors often classify peripheral arterial disease according to the Fontaine stages:

• Stage 1: there is a narrowing, but you do not yet have symptoms.
• Stage 2: pain when walking that disappears at rest. This is intermittent claudication, the stage in which walking exercise is the first treatment.
• Stage 3: pain at rest, especially at night when your legs are lying flat.
• Stage 4: wounds that heal poorly or tissue death on the toes or foot. This requires immediate care from a vascular specialist.

How to recognise intermittent claudication

The pattern of pain in intermittent claudication is very characteristic. If you recognise the following points, see your GP first to have your blood vessels examined:

• A cramping, tired or burning pain in the calf while walking.
• Pain that disappears when you stand still for a few minutes, without having to sit down.
• Pain that returns after roughly the same walking distance each time.
• Pain coming on sooner when walking uphill, into the wind or faster.
• Cold feet or pale skin on the affected leg.
• Less hair growth on the lower leg and slow-growing toenails.

Do you have pain at rest, especially at night, that eases when you let your leg hang out of bed, or do you have wounds on your foot or toes that do not heal? Then your GP needs to look at your leg that same day. If your leg suddenly becomes cold, pale, painful and numb, call 112 immediately. The same applies to chest pain.

Walking exercise: the first treatment for intermittent claudication

According to the guidelines, supervised exercise therapy, together with stopping smoking and medication through your GP, is the first step in the treatment of intermittent claudication. By regularly walking until the pain is close to maximal, new small blood vessels develop around the narrowing and your muscles use oxygen more efficiently. Research shows that supervised walking exercise works better than just the advice to walk more. For some people, this means that angioplasty or surgery is not needed. Before you start, the diagnosis must have been made by your GP, for example by measuring the ankle-brachial index, or by a vascular surgeon.

Supervised exercise therapy at De Fysio Man

The exercise therapy is a programme lasting several months, in which the supervision gradually decreases as you train more independently.

What the training looks like

• Explanation of arterial disease and why walking on until the pain is almost maximal is safe and effective.
• A walking test at the start to record your pain-free and maximum walking distance.
• Interval training on the treadmill, in which you walk until the pain is considerable, rest briefly and then carry on.
• Walking assignments for home, so you train at least three times a week.
• Strength and fitness exercises for the legs.
• Support with lifestyle, such as stopping smoking and moving more, in cooperation with your GP, practice nurse or vascular surgeon.

Reimbursement of exercise therapy

Supervised exercise therapy for intermittent claudication is often (partly) reimbursed from the basic health insurance, after referral by your GP or medical specialist. Your compulsory excess applies. Insurers may set extra conditions, for example regarding the practice where you train. So check your policy or ask your health insurer.

Intermittent claudication, calf cramp and chronic calf pain

Not all calf pain while walking comes from the blood vessels. An ordinary calf cramp comes on suddenly, often at night, and is not linked to a fixed walking distance. With chronic calf pain from overuse, the pain is in an overloaded muscle and is often still there after walking. Leg pain that only disappears when you sit down or bend forwards may instead come from the lower back, due to a narrowing of the spinal canal. On the page about calf complaints, you can find more about the different causes.

Keeping it up in the long term

Arterial disease is a chronic condition. The gains from exercise therapy only last if you keep walking after the programme, preferably at least three times a week for half an hour to an hour. Stopping smoking, a healthy weight and well-controlled blood pressure, cholesterol and blood sugar slow down the further development of the narrowing. If you have diabetes, check your feet for wounds every day.

How we work at De Fysio Man

1. Intake and assessment

We go through the diagnosis and referral from your GP or vascular surgeon, discuss your risk factors and use a walking test to measure how far you can walk with and without pain.

2. Tailored treatment plan

Together, we set goals, such as doing your shopping independently or a one-hour walk. We match the frequency and intensity of the walking exercise to these goals.

3. Walking further

We measure your walking distance again regularly and guide you towards a situation in which you keep training independently and maintain your walking distance.