What is the term for leg pain due to poor circulation?

Intermittent Claudication: The Term for Leg Pain Due to Poor Circulation

Intermittent claudication is the medical term for leg pain due to poor circulation, characterized by exertional pain that resolves with rest, caused by inadequate blood flow to the muscles due to peripheral arterial disease (PAD). 1

Understanding Intermittent Claudication

Intermittent claudication is defined as fatigue, discomfort, or pain that occurs in specific limb muscle groups during effort due to exercise-induced ischemia. This pain is:

• Produced consistently by exercise
• Relieved with rest
• Typically affects the calf muscles, but can also involve the hip, buttock, thigh, or foot depending on the location of arterial obstruction 1

The pathophysiology is more complex than simple supply-demand mismatch and involves a range of skeletal muscle metabolic, neurological, and inflammatory effects 1.

Anatomical Correlation with Symptoms

The location of pain often correlates with the site of arterial stenosis:

• Iliac artery disease: Hip, buttock, thigh, and calf pain
• Femoral/popliteal artery disease: Primarily calf pain
• Tibial artery disease: Calf pain or, less commonly, foot pain and numbness 1

Differentiating from "Pseudoclaudication"

Vascular claudication must be distinguished from other causes of exertional leg pain, collectively termed "pseudoclaudication," which include:

• Severe venous obstructive disease
• Chronic compartment syndrome
• Lumbar disease and spinal stenosis
• Osteoarthritis
• Inflammatory muscle diseases 1

Epidemiology and Clinical Significance

PAD affects approximately 8.5 million people in the US and 230 million worldwide 2. Despite its high prevalence:

• PAD is often underdiagnosed because many patients present with atypical symptoms or no symptoms
• More than 70% of primary care providers are unaware of PAD in affected patients 1
• Only about 32.6% of PAD patients present with classic intermittent claudication 1

Diagnostic Approach

The ankle-brachial index (ABI) is the primary diagnostic tool:

• ABI ≤0.9 is diagnostic of PAD
• A low ABI is an independent predictor of increased mortality 1
• For patients with symptoms of claudication but normal resting ABI, post-exercise ABI should be measured 1

Clinical Implications

Intermittent claudication has two major consequences:

1. Decreased quality of life: Pain leads to limited walking, sedentary lifestyle, and potentially depression 1
2. Increased cardiovascular risk: Patients with PAD have approximately twice the rate of all-cause mortality and cardiovascular events at 10-year follow-up compared to those without PAD 2

Treatment Approach

Treatment should address both symptom management and cardiovascular risk reduction:

1. Risk factor modification:

   • Smoking cessation
   • Diabetes control
   • Lipid management with high-dose statins
   • Hypertension management 3

2. Exercise therapy:

   • Supervised treadmill exercise improves walking distance
   • Home-based walking programs with behavioral methods and coaching 2

3. Pharmacotherapy:

   • Antiplatelet therapy
   • Cilostazol: FDA-approved medication that can double maximal walking distance in clinical trials 4, 5

4. Revascularization (for selected patients):

   • Consider for patients with significant disability who have not responded to conservative measures
   • Appropriate for patients with severe symptoms affecting normal work or important activities 1

Key Pitfalls to Avoid

• Misdiagnosis: Don't confuse claudication with pseudoclaudication; carefully assess pain characteristics
• Underestimating cardiovascular risk: PAD patients have high risk of myocardial infarction and stroke
• Focusing only on leg symptoms: Treatment must address both limb symptoms and systemic cardiovascular risk
• Premature invasive intervention: Revascularization should be considered only after appropriate trial of exercise and pharmacotherapy 1

Remember that intermittent claudication is not just a limb problem but a marker of systemic atherosclerosis requiring comprehensive cardiovascular risk management.