Venous Claudication
The correct answer is B. Venous Claudication, which characteristically presents with tight, bursting pain in the entire leg (especially the calf) after walking, subsides slowly with rest, and is notably relieved faster by leg elevation. 1
Key Distinguishing Features
Venous claudication has a unique clinical presentation that differentiates it from other causes of exertional leg pain:
- Pain quality: Tight, bursting sensation affecting the entire leg, with particular intensity in the calf region 1
- Timing: Occurs after walking or exercise 1
- Relief pattern: Subsides slowly (not quickly like arterial claudication), but relief is specifically accelerated by leg elevation 1, 2
- Associated history: Strong association with prior iliofemoral deep vein thrombosis 1, 2, 3
- Physical findings: Edema and signs of venous stasis are typically present 1
Differential Diagnosis Comparison
The other conditions have distinctly different presentations:
Peripheral Arterial Disease (Option A)
- Pain described as cramping, aching, or tired/fatigued feeling in specific muscle groups (buttocks, thigh, calf, or foot) 1
- Occurs consistently during walking at reproducible distances 1
- Relieved quickly within approximately 10 minutes of rest 1
- Not specifically improved by leg elevation 1
Nerve Root Compression (Option C)
- Sharp, lancinating pain that radiates down the leg 1
- Can be induced by sitting, standing, or walking (variable pattern) 1
- Often present at rest 1
- Improved by change in position, not specifically by elevation 1
- History of back problems is common 1
Hip Arthritis (Option D)
- Aching discomfort in lateral hip and thigh 1
- Occurs after variable degrees of exercise 1
- Not quickly relieved by rest 1
- Improved when not bearing weight, but not specifically by elevation 1
Clinical Pitfall
The key distinguishing feature is the relief pattern with leg elevation—this is pathognomonic for venous claudication and directly relates to the underlying pathophysiology of venous hypertension. 1, 2 Arterial claudication improves simply with rest (stopping walking), while venous claudication requires the additional maneuver of leg elevation to accelerate symptom relief by reducing venous pressure through gravitational drainage. 1