What is Claudication?
Claudication is a reproducible discomfort, fatigue, cramping, aching, or pain in the muscles of the lower extremity (calves, thighs, or buttocks) that occurs with exertion and is relieved within 10 minutes of rest. 1
Underlying Pathophysiology
Claudication results from exercise-induced ischemia due to insufficient arterial blood flow to meet the metabolic demands of active leg muscles during physical activity. 1
Blood flow is adequate at rest, so symptoms are absent when not exercising, but becomes inadequate during exertion when muscular oxygen demand increases. 1
The pathophysiology is complex and extends beyond simple supply-demand mismatch, involving skeletal muscle metabolic dysfunction, neurological effects, and inflammatory processes. 1
Primary Cause
Claudication is the classic symptom of peripheral artery disease (PAD), a progressive atherosclerotic disease affecting over 8 million Americans. 1
PAD affects 3-7% of the general population and 20% of people over 70 years of age. 1
Symptom Location and Arterial Anatomy
Iliac artery disease produces hip, buttock, and thigh pain (as well as calf pain). 1
Femoral and popliteal artery disease typically causes calf pain. 1
Tibial artery disease may produce calf pain or, more rarely, foot pain and numbness. 1
Key Distinguishing Features
Reproducibility: Symptoms occur consistently with similar amounts of exercise. 1
Prompt relief with rest: Discomfort resolves within 10 minutes of stopping activity. 1
Exertional trigger: Pain does not start at rest and requires physical activity to manifest. 2
Important Clinical Pitfall: Pseudoclaudication
Vascular claudication must be distinguished from "pseudoclaudication" caused by non-arterial conditions that mimic these symptoms: 1
Spinal stenosis (neurogenic claudication): The most common non-arterial cause, affecting bilateral buttocks and posterior legs, takes longer to recover, and is relieved by lumbar spine flexion rather than simple rest. 2
Venous claudication: Affects the entire leg with tight, bursting pain that subsides slowly and improves with leg elevation. 2
Hip arthritis: Presents with lateral hip/thigh aching that is not quickly relieved with rest and improves when not bearing weight. 2
Nerve root compression: Causes sharp, lancinating pain radiating down the leg, often present at rest, improving with position changes. 2
Other causes include chronic compartment syndrome, pelvic tumors, and chronic venous occlusion. 1
Clinical Significance
Only about one-third of patients with PAD present with typical claudication symptoms; many have atypical presentations including burning pain, tingling, numbness, or throbbing. 2
Claudication represents an extremely important marker of systemic atherosclerosis—up to 60% of patients with intermittent claudication have significant underlying coronary and/or carotid disease. 3
The condition causes significant functional impairment, mobility loss, and decreased quality of life. 1