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Intermittent claudication is a symptom and is by definition diagnosed by a patient reporting a history of leg pain with walking relieved by rest. However, as other conditions such as sciatica can mimic intermittent claudication, testing is often performed to confirm the diagnosis of peripheral artery disease .
It is caused by poor circulation of the blood to the affected area, called peripheral arterial disease. The poor blood flow is often a result of atherosclerotic blockages more proximal to the affected area; [3] individuals with intermittent claudication may have diabetes — often undiagnosed. [4]
Functional ischemia occurs when the blood flow is normal at rest but insufficient during exercise, presenting clinically as intermittent claudication. Critical ischemia is produced when the reduction in blood flow results in a perfusion deficit at rest and is defined by the presence of pain at rest or trophic lesions in the legs.
440.21 Peripheral Arterial Disease with Intermittent Claudication (Also Claudication) 440.23 Peripheral Arterial Disease w/ ulceration; 441 Aortic aneurysm and dissection. 441.0 Aortic Dissection; 441.3 Abdominal Aortic Aneurysm, ruptured; 441.4 Abdominal aortic Aneurysm, w/o rupture; 441.9 Abdominal Aortic Aneurysm, unspecified; 442 Other aneurysm
The symptoms are caused by ischemia of the tissues. Intermittent claudication is manifested by pain, (cramping), numbness, and fatigue in the muscles on exercise. These symptoms are relieved by rest. There may be “rest pain” at night when in bed. Also increased sensitivity to cold, muscular weakness, stiffness of the joints, and paresthesia .
The extent of vasoconstriction may be slight or severe depending on the substance or circumstance. Many vasoconstrictors also cause pupil dilation. Medications that cause vasoconstriction include: antihistamines, decongestants, and stimulants. Severe vasoconstriction may result in symptoms of intermittent claudication. [1]
Critical limb ischemia is diagnosed by the presence of ischemic rest pain, and an ulcers that will not heal or gangrene due to insufficient blood flow. [3] Insufficient blood flow may be confirmed by ankle-brachial index (ABI), ankle pressure, toe-brachial index (TBI), toe systolic pressure, transcutaneous oxygen measurement (TcpO2 ), or skin perfusion pressure (SPP).
The muscle damage is most usually caused by a crush injury, strenuous exercise, medications, or a substance use disorder. [3] Other causes include infections, electrical injury, heat stroke, prolonged immobilization, lack of blood flow to a limb, or snake bites [3] as well as intense or prolonged exercise, particularly in hot conditions. [8]