What vitamin deficiency causes intermittent claudication? Intermittent claudication, causes, symptoms and treatment

From the article you will learn what intermittent claudication is. For what reasons, under what diseases it occurs and how the syndrome manifests itself. Types of treatment, prognosis for pathology.

Article publication date: 06/19/2017

Article updated date: 05/29/2019

Intermittent claudication is a growing pain syndrome in the legs that arose against the background of physical activity (walking, lifting, running) and passing after a short rest. This type of pain occurs with a long-term, or chronic, form of impaired blood flow in the arterial vessels and, as a result, insufficiency of blood supply to tissues.

The pathology can occur in any part of the leg or involve it entirely, but in most cases, patients are bothered by pain in the lower legs. Their intensity is so great that it is impossible to continue moving. In the early stages of pathology, rest brings relief and pain subsides. As the disease progresses, the pain syndrome is constant, and any load makes it unbearable.

During the pathological process, the lumen of the arteries narrows due to a number of reasons (described in the corresponding section of the article), blood flow in this area is difficult, and the tissues do not receive enough oxygen and nutrients. With any load, the need for adequate blood supply increases, but pathologically altered arteries do not fully perform their function. Oxygen starvation or tissue ischemia occurs, which manifests itself as an increasing pain syndrome.

The danger of this condition is that changes in the walls of the arteries are not only in the legs - all arterial trunks are affected, including the heart muscle and brain. More than 20% of people with established intermittent claudication syndrome die from coronary and cerebral circulatory disorders within the first 5 years, and 10% lose a leg and become disabled.

There is no complete cure for the disease, but timely conservative therapy or surgical treatment will help save from amputation and prolong life.

This pathology is treated by vascular or, in smaller medical institutions, general surgeons.

Causes of intermittent claudication

Pain in the legs when walking is a symptom of chronic arterial insufficiency, which occurs against the background of various vascular diseases. Their division by frequency of occurrence is presented in the table:

Disease	Quantity in percentage
Atherosclerosis – deposition of cholesterol complexes in the vascular wall	81,6
Nonspecific aortoarteritis – inflammation of the wall of the arterial trunks against the background of changes in the activity of one’s own immunity	9
– secondary pathological changes in the walls of blood vessels against the background of high levels of glucose in the blood	6
Thromboangiitis obliterans - inflammation of all layers of the vessel wall with the formation of blood clots in the lumen and their replacement with connective tissue	1,4
Raynaud's disease is a chronic spasm or narrowing of small capillaries of the microvasculature, including vessels supplying large arterial and venous trunks	1,4

Symptoms of Raynaud's disease

Classification

In angiosurgery, the Fontaine-Pokrovsky classification of chronic disturbances of blood flow in arterial vessels is used:

Stage	Characteristic
The first is intermittent, non-limiting intermittent claudication.	Increased sensitivity to cold Slightly impaired tactile sensitivity (“goosebumps”, “tingling”) Seizure episodes Slower growth of nails and hair
The second is a limiting (limiting) walking disorder	Second A – pain does not occur during normal walking of more than 200 meters Second B – pain in the legs bothers you at a distance of less than 200 meters
Third – pain syndrome without exercise	The initial stage is characterized by pain at night, which goes away when you lower your leg from the bed. Later, the pain syndrome is constant, the leg is swollen, pale with a bluish tint
Fourth – ulcerative-necrotic changes in leg tissue	The appearance of skin ulcerations The ulcers deepen, merge with each other, forming large areas of dead tissue

When we say “pain-free distance,” we evaluate walking on level ground. When going up or along steps, blood flow disturbance appears earlier.

The medical term “chronic critical ischemia of the lower extremities” includes changes in vessels and tissues of stages 3–4 according to the classification, requires constant pain relief and is accompanied by a high risk of leg amputation.

Trophic ulcers on the leg

Based on the level of damage to the arterial trunks, several types of intermittent claudication are distinguished:

Symptoms of pathology

Manifestations of chronic disorders of blood flow in the arterial vessels of the legs include a number of symptoms, the main one being intermittent claudication.

Clinical manifestation	Its features
Pain syndrome	In the first stages, blood supply disturbances occur only during exercise, later - even at rest. The pain is sudden, goes away only after rest (unless there is a critical disturbance in blood flow with the development of tissue necrosis)
Paresthesia	Feeling of numbness in the leg or part of it Local decrease in skin temperature
Changes in the skin and its appendages	Increased moisture in the skin (hyperhidrosis) – with thromboangiitis Very dry skin with abundant areas of peeling, cracking and brittle nails - with atherosclerotic vascular lesions
Osteoporosis	Fragility of bone tissue due to increased calcium excretion
Alopecia	Areas of complete hair loss on the skin of the leg
Tissue atrophy	Destruction of muscle and fat cells due to impaired blood supply to tissues (symptoms of “empty heel” or “empty toe” - with local pressure, the impression remains for a long time)
Tissue death or gangrene	Occurs at stages 3–4 of impaired blood flow in an arterial vessel Dead or necrotic tissue cannot be restored and requires surgical removal

Osteoporosis - like intermittent claudication - can be caused by chronic circulatory failure in the legs

The quality of life of a patient with intermittent claudication depends on the level and stage of arterial vasoconstriction:

• the initial stages of the disease remain unnoticed, since moderate pain in the legs is not so pronounced and does not require rest during exercise;
• the pain syndrome, starting from the second stage of the process, is already quite intense, forcing you to change habits and the amount of one-time workload, making life and work less comfortable;
• extreme degrees of blood flow impairment are accompanied by constant pain, which does not allow even household chores to be performed; patients require outside help.

Symptom of intermittent claudication

Diagnostics

Method	What does it evaluate?
Questioning (complaints, anamnesis)	Presence of characteristic complaints. Duration of the disease. Features of pain to exclude other causes of pathology.
Inspection	Assessment of the pulse in the central and peripheral arteries: its strength, filling, presence. Assessing signs of changes in tissue nutrition (trophism): ulcerations, hair loss, fragility and layering of nails, swelling, bluishness of the skin.
Functional tests	Opel's test - raise the legs from a lying position by 40 cm, fix for 2 minutes, pronounced pallor and bluishness of the skin is noted on the affected side. Burdenko's test - quickly bend the leg at the knee 10 times; if blood flow is impaired, marbling of the skin is noted. Palchenkov's test - cross your legs in a sitting position for 5-10 minutes; if there is insufficient blood supply, pain and changes in skin color occur.
Ultrasonography (ultrasound Dopplerography)	Assessment of blood flow speed in vessels. Localization of the exact location and extent of the narrowing zone of the artery. Determining the cause of blood flow disturbances. Assessment of the presence of bypass blood supply to the area of ​​interest.
Treadmill test	An assessment of the rate of restoration of normal blood flow in the legs after walking 200 meters is distinguished: limited reserve (recovery less than 15 minutes) and critical reserve (more than 15 minutes). Used to determine indications for surgical treatment.
Transcutaneous oximetry	Determination of the amount of oxygen in arterial blood and in the capillaries of the skin (shows the level of saturation of tissues and their ability to recover independently in conditions of trophic disorders). The norm is 50–60 mm. rt. Art., borderline numbers – 30–40.
Flowmetry (laser Dopplerography)	Assessment of the quality of capillary blood flow.
Angiography	Examination of arteries by introducing a special contrast material visible in X-rays. Accurate determination of the affected area. Assessment of the vascular wall throughout. Resolving the issue of the need and possibilities of surgical treatment.

Angiography of blood vessels. The location of the narrowing of the vessel is indicated by an arrow.

Treatment methods

Intermittent claudication is a condition that takes a lifetime to treat. There is no complete recovery, but with constant therapy, the risk of death is reduced, the quality of life and the ability to perform exercises improve.

General principles of treatment by stage

Conservative treatment

Indicated for patients with any stage of the process, it is carried out continuously, without interruption, until the end of life.

Principle	Specific actions and/or medications
Eliminate risk factors	Quit smoking Normalize blood pressure and weight Compensate for sugar levels
Drink antiplatelet agents - make the blood less viscous	Aspirin
Taking statins improves fat metabolism	Lipobolide Lovastatin Lipostabil
Restore metabolic processes	Trental Vitamins Actovegin
Improve tissue oxygenation	Tocopherol
Drink prostaglandins - suppress inflammation in the vascular wall	Alprostan Vazaprostan
Boost immunity	Polyoxidonium T-activin
Non-drug treatment	Massage Physiotherapy Spa treatment Hydrogen sulfide baths

Surgery

It consists of performing reconstructive operations aimed at restoring normal blood flow in the area with the pathological process.

Scheme of the stenting operation: A – catheter insertion; B – balloon inflation and stent installation; C – removal of the catheter from the lumen of the vessel.

Forecast

Intermittent claudication is the main syndrome of chronic damage to the arterial system, and it is impossible to completely recover from the pathology. The established diagnosis is an indication for permanent, lifelong, conservative therapy, even if reconstructive vascular surgery has been performed.

Pathological changes in arterial vessels are twice as common in the male population.

After diagnosis, 20–30% of patients die within the first 5 years, and 40–70% within 10 years. More than 65% of them die from acute forms of blood flow disorders in the heart vessels or arteries of the brain, since any pathological changes in the vessel wall cannot be local in nature and affect only the legs.

Regarding the preservation of legs, the prognosis is more favorable: with constant treatment, vascular changes stabilize in 70–75%, and pain even decreases in 40–45%. In only 10–20% of patients, signs of blood flow disturbances increase and lead to amputation.

Intermittent claudication (IC) is a rather dangerous pathology that often occurs in people, but medical professionals do not always pay due attention to it.

The development of pathology is rapidly gaining momentum and many patients with untimely treatment of PC are diagnosed with a critical condition of lower extremity ischemia.

A complicated form of intermittent claudication syndrome is limb amputation.

What is intermittent claudication syndrome?

Intermittent claudication syndrome, in Latin claudicatio, is a painful sensation in the lower extremities that manifests itself after exertion of the legs:

• During long walking distances;
• When lifting heavy objects;
• After running.

The pain goes away after a period of rest. Such pain occurs during the chronic course of pathologies of the blood flow system in the arteries, causing insufficient blood supply to muscle tissue.

The disease can develop in any part of the limbs, or it can affect one leg or both legs. Most often, symptoms of pain manifest themselves in the area of ​​the ankle joints and lower legs.

During the initial development of the syndrome, rest brings relief, but this pathology tends to progress rapidly, and over a short period of time, the pain intensifies so much that it makes it impossible to move.

Most often, symptoms of pain manifest themselves in the area of ​​the ankle joints and lower legs.

Risk group

The syndrome is typical for patients in the following risk groups:

• Advanced age;
• People suffering from arterial hypertension;
• Patients with diabetes mellitus;
• Alcoholics;
• Patients suffering from nicotine addiction;
• Obese patients;
• Having heart pathologies;
• With metabolic disorders.

What are the dangers of intermittent claudication?

The pathogenesis of this pathological process in the bloodstream system, narrowing of the arteries occurs and impedes the flow of biological fluid in the affected area. Muscle tissue does not receive enough oxygen molecules, as well as nutrients to perform its functions - hypoxia of the blood flow system and ischemia of muscle tissue develops.

Ischemia manifests itself as a painful symptom.

The danger of developing pathology lies in the fact that these changes in the vascular membranes occur not only in the arteries of the lower extremities, but also the pathology extends to the trunks of the arteries and to the arteries of the cardiac organ and to the cerebral vessels.

After the diagnosis of claudication, over the next 5 calendar years, statistics for intermittent claudication syndrome are disappointing:

• 20.0% of patients die due to acute coronary syndrome, as well as from impaired blood supply to the brain cells;
• 10.0% of patients undergo surgical treatment for amputation of the leg - the result is disability.

Intermittent claudication is a disease that cannot be completely cured, but timely therapy and preventive measures can extend the patient’s life years and save limbs from amputation surgery.

Vascular surgeons treat this syndrome.

Causes of intermittent claudication

Intermittent claudication syndrome develops due to chronic arterial insufficiency. Pathology is provoked by vascular diseases.

These vascular diseases are distributed in the table according to the degree of their influence on the development of claudication syndrome:

Name of the disease	Quantity in percentage
Deposition of cholesterol plaques on the walls of arteries - the disease atherosclerosis	81.6
Aortoarteritis of a nonspecific nature is an autoimmune pathology caused by an inflammatory process in the membranes of vascular trunks	9
Diabetic angiopathy is a secondary pathology of diabetes mellitus, in which changes in the vascular membranes occur due to a high glucose index in the blood.	6
Thromboangiitis obliterans is an inflammatory process in all layers of the arterial membranes, when blood clots appear in the lumen of the walls (Buerger's disease)	1.4
Raynaud's syndrome is a chronic pathology of narrowing of capillaries and their spasms in the microcirculation that feeds large-diameter arteries, as well as vein trunks.	1.4

Also, the reasons for the development of intermittent claudication may be:

• Gout disease;
• Disorders in the spinal canal that affect the functioning of nerve endings in the lower extremities (neurogenic intermittent claudication);
• Trauma to the lower extremities;
• Intoxication of the body;
• Infectious pathologies that develop in the body in the acute period, as well as infections that have a chronic period of development;
• Hypothermia of the body and lower extremities.

This pathology often affects people who have bad habits, such as alcoholism and smoking.

The toxic elements of nicotine and alcohol cause damage to blood vessels and provoke thrombosis.

Risk factors for intermittent claudication include:

• Sedentary lifestyle;
• Arterial hypertension;
• Pathology obesity;
• Spinal diseases.

Classification

In medicine, the stages of classification of the course of the pathology of intermittent claudication according to the Pokrovsky-Fontaine system are used:

Stages of pathology development	Characteristics of each stage
Stage No. 1 - non-limiting stage of intermittent claudication	· increased sensitivity in the legs when the temperature drops;
	· goosebumps;
	· tingling in the limbs;
	· cramps in the lower leg;
	· growth of hair on the legs and nails slows down.
Stage No. 2 - limiting stage, with walking impairment	· stage type A - pain syndrome begins to appear after 200.0 meters have been traveled;
	· Stage B - pain begins to appear up to 200.0 meters of the distance traveled.
Stage No. 3 - pain in the limbs at rest and without weight-bearing legs	· at the initial stage of the third stage, a state of pain occurs after the legs are lowered from the bed after rest;
	· with further development, the pain in the legs is constant, swelling and the skin becomes pale and bluish.
Stage No. 4 - ulcers and necrosis of the muscle tissue of the extremities appear on the legs	· at the initial stage of the fourth stage, single ulcers appear on the legs;
	· during the progression period, multiple ulcers cover a large area of ​​the leg, and necrosis of muscle tissue develops.

If we take the distance to determine the signs of the second stage, then this is the distance along a flat road without obstacles.

An established medical diagnosis of critical limb ischemia is fixed at the third, and sometimes fourth stage with lameness. With such a degree of pathology, a person has such pain that can be stopped for a short time with painkillers.

At this stage, there is a risk of amputation of the affected limb.

Classification of intermittent claudication by causes

Intermittent claudication is divided into two types according to the etiology of the disease:

• Caudogenic or spinal lameness;
• Myelogenous or peripheral etiology of lameness.

Doctors associate myelogenous claudication with the development of diabetes mellitus and endarteritis, as well as with cholesterol (atherosclerotic) lesions of the vascular walls of the bloodstream system.

At first, the acquired pathology manifests itself in discomfort of the lower extremities, and if timely drug treatment is not provided, then it turns into symptoms of pain, with further destruction of the arterial walls and muscle tissue cells of the leg.

Spinal (caudogenic) type of variable lameness is a consequence of damage to the capillaries that supply the gray matter of the spinal cord with biological fluid.

Types of intermittent claudication according to the level of arterial damage

Based on the level of arterial damage, there are 3 types of intermittent claudication:

Level of arterial damage	Characteristics of the localization of the lesion
High level of arterial injury	pain in the buttocks;
	· pain in the hip;
	Impaired blood flow in the aorta;
	Impaired blood flow in the iliac vessels.
Level of a typical lesion	soreness of the muscle tissues of the lower leg;
	A segment of the arteries under the kneecap is affected.
Low level of arterial disease	· pain in the ankle and foot;
	· the diameter of the ankle part of the arteries narrows.

Symptoms of intermittent claudication

The main symptom of intermittent claudication in a person is a limping gait.

This pathology also has other symptoms:

Clinical symptoms	Characteristics of manifestation
Soreness	· pain at the initial stage of development of the pathology is felt with load on the limbs, and later with the progression of the disease and at rest;
	· in the absence of necrosis of tissue cells, the pain at the initial stage goes away after rest, and as the disease develops, it is relieved with painkillers.
Symptom of paresthesia	· numbness of the affected part of the leg, or both legs;
	· cold extremities.
Changes in the condition of the skin	Skin hyperhidrosis with the development of thromboangiitis;
	· dry skin with peeling of the epidermis, dryness and brittleness of the nail plate.
Osteoporosis of bones	· increased fragility of bones due to increased excretion of calcium from the body.
Symptom of alopecia	· baldness of areas on the skin of the extremities.
Tissue cell atrophy	· destruction of muscle tissue cells;
	· destruction of adipose tissue cells in the leg.
Gangrene of the limbs	· sign of pathology intermittent claudication of the third and fourth stages of development;
	· necrosis of muscle tissue, which is not suitable for restoration, but only needs to be removed.

The symptoms of intermittent claudication are similar to the symptoms of the pathologies that are the root cause of its manifestation. The mild stage of the pathology does not cause pain and the person does not feel signs of a serious illness.

Only timely diagnosis can identify the syndrome and the doctor will prescribe a regimen of adequate qualified treatment.

Diagnostics

To establish a diagnosis of intermittent claudication, you need to go to the clinic to see a general practitioner. The therapist will examine the patient and also find out the nature of the pain and the symptoms of the pathology. Next comes the history taking.

After that, the therapist decides whether consultation of specialized specialists is necessary:

• Cardiologist;
• Phlebologist;
• Vascular surgeon;
• Consultation with a neurologist.

Method of diagnostic research	Study Characteristics
Examination by a doctor	The blood pressure index is measured;
	The pulse is measured;
	The index of blood glucose is measured;
	· examination of the skin;
	· inspection of the nail plate for nail delamination;
	· The degree of swelling of the limbs is checked.
Functional tests	· Opel test - this test is performed in a lying position. The legs are raised 40.0 centimeters in height, and you need to lie in this position for 120 seconds. The skin on the legs is checked for pallor and cyanosis;
	· Burdenko test - you need to quickly bend your leg at the knee joint 10 times. The skin is checked for marbling;
	· Palchenkov test - you need to cross your legs over your legs and sit in this position for 10 minutes. If blood flow is impaired, pain is felt in the affected limb and a change in skin tone.
Doppler ultrasound type (ultrasonography)	· the speed of biological fluid in the bloodstream system is determined;
	· localization of the pathology focus along the arterial bed;
	· establishing the cause of disturbances in the blood flow system;
	· checking the blood supply to the affected area;
	Determination of the part of the artery that cannot be removed during surgical treatment.
Treadmill testing	· there is an assessment of the rate of restoration of blood flow after walking 200.0 meters;
	limited blood flow reserve in the leg - blood supply was restored in less than 15 minutes;
	· critical situation - recovery took longer than 15 minutes;
	Testing is carried out by patients on the eve of surgical intervention.
Oximetry via skin	· the oxygen concentration in the blood of arteries and capillaries is determined;
	· the ability to independently maintain the balance of oxygen in the blood;
	· standard indicator of oxygen in the blood of the extremities is 60.0 - 50.0 mm. rt. Art.;
	· border index - 40.0 - 30.0 mm. rt. Art.
Flowmetry is laser Dopplerography	· blood flow in the capillaries of the extremities is assessed.
Angiography method	· study of the condition of the arteries using contrast fluid;
	· accuracy of determining the area of ​​arterial damage;
	· assessment of the membranes of blood vessels at the location of the lesion.

The doctor also prescribes laboratory clinical tests:

• General analysis of blood composition;
• Biochemical study using lipid analysis;
• Analysis to identify the glucose index in the blood.

If necessary, he can prescribe a study using magnetic resonance and computed tomography.

Treatment of intermittent claudication

Intermittent claudication is a pathology that must be treated throughout life. The disease cannot be completely cured, but supportive therapy can alleviate the condition of the patient and prolong his life.

Treatment according to the degree of development of the pathology:

Stages of disease development	Characteristics and type of therapy
Stage No. 1	· conservative drug therapy.
Stage No. 2 - type A	· drug therapy;
	· surgical treatment.
Stage No. 3 - and the second type B	· reconstructive surgical treatment.
Stage No. 4	· reconstructive surgery;
	· removal of necrotic tissue cells;
	· amputation of limbs.

Conservative therapy

Medical conservative treatment is prescribed for life at all stages of the pathology of intermittent claudication.

The principle of drug therapy and conservative treatment is described in the table:

Treatment principle	Clinical recommendations and names of drugs
eliminate the provocateur of pathology	· give up alcohol;
	· give up nicotine addiction;
	· constantly monitor the glucose index and lower it;
	· reduce the cholesterol index in the blood.
take drugs of the antiplatelet group - in order to make the composition of the blood plasma more liquid in order to prevent thrombosis of blood vessels	· drug Aspirin;
	· Plavix product;
	· disaggregant Tiklid.
to regulate lipid metabolism in the body and to reduce the cholesterol index - take statin drugs	· drug Lovastatin;
	· medicinal product Lipobolite;
	· drug Lipostabil.
restore metabolic processes in the body	· take vitamin complexes;
	· drug Trental;
	· Actovegin product.
increase the concentration of oxygen in the blood up to 95%	· drug Tocopherol
group of drugs prostaglandins - reduce the inflammatory process in the vascular membranes	· drug Alprostan;
	· medicine Vasoprostan.
take medications to activate the functions of the immune system and improve its performance	· T-activin;
	· drug Polyoxidonium;
	Viferon remedy.
Treatment without the use of medications	· massotherapy;
	· physiotherapeutic treatment;
	· resort and sanatorium treatment;
	· Exercise therapy;
	· baths of hydrogen sulfide water.

Walking is therapeutic

For patients with intermittent claudication, dosed therapeutic walking is necessary. Activity that does not exceed the time and distance allowed by the doctor for movement.

Walking improves the speed of blood movement in the bloodstream system, which enriches tissues with oxygen more and nutrients reach cells faster for their normal functioning. When walking, muscle tissue is warmed up, and the condition of the arterial membranes improves.

Therapeutic walking should be done daily in the fresh air, or at home on a simulator.

The maximum time of the treatment procedure is no more than 50 minutes. The therapeutic course of such treatment is 12 weeks or more.

Diet for intermittent claudication

In order to reduce the progression of the pathology of intermittent claudication, it is necessary to adhere to a low-cholesterol diet, and also exclude from the diet foods that are prohibited for diabetes.

Include seafood that is rich in omega 3 in your menu.

Introduce large quantities of fresh vegetables, fruits, as well as garden herbs into the diet and actively mix them in salads. Salads should be seasoned with flaxseed, olive, or corn vegetable oil.

Eat cereals and avoid store-bought processed foods that are rich in trans fats.

If you have diabetes or obesity, give up sweets, flour products, and white breads.

All food should be steamed, or by boiling, baking, or stewing. Fried foods are strictly prohibited for consumption.

Do not eat red or fatty meats; it is preferable to eat chicken or turkey, from which the skin has been removed first.

Treatment of intermittent claudication with folk remedies and techniques

Folk remedies for the treatment of intermittent claudication are used:

• Applications from therapeutic mud;
• Apply applications of plantain leaves, as well as string leaves, or chamomile with St. John's wort;
• Use a contrast shower for the whole body and contrast baths for the feet;
• Baths from decoctions of medicinal herbs;
• Hirudotherapy.

Surgical treatment of intermittent claudication

Surgical treatment is based on restoring the duct in the arteries and restoring the normal functioning of the blood flow system.

Method of surgical treatment	Characteristics of the operation
method of surgical treatment - endarterectomy	cutting off part of the affected artery lining
resection technique with arterial replacement	removal of part of the affected vessel and replacing it with part of a vein, or with an artificial vessel
method of vascular bypass	creating bypass paths past the damaged artery, which will improve the movement of blood in the circulatory system
minimally invasive balloon angioplasty	expand the lumen of the artery using a balloon
minimally invasive arterial stenting technique	a mesh is placed in the affected part of the artery to prevent its lining from bursting, or a stand is inserted that can expand the artery and prevent its fragility

In especially severe cases, the course of the disease is intermittent claudication; surgical treatment involves removing the necrotic tissue of the affected limb, and also amputating the limb.

Prevention

As measures to prevent intermittent claudication, it is necessary, first of all:

• Give up bad habits - nicotine and alcohol addiction;
• Constant diet and adherence to nutritional culture;
• Daily physical exercise and adequate exercise;
• Be sure to reduce body weight if you are obese;
• Systematic control of cholesterol in the blood;
• Daily blood glucose monitoring - for diabetes;
• Wear shoes without heels;
• Do not wear shoes that are tight on your feet;
• The toe of the shoe should be soft to avoid injury to the toes (calluses, dropsy);
• Socks on your feet should not have a tight elastic band and should not put pressure on your shins;
• Do not overcool the body;
• Keep your feet warm at all times.

Prognosis for life with the disease intermittent claudication

Intermittent claudication is the main symptom of damage to the arteries of the bloodstream, which occurs in the chronic form of the pathology.

The syndrome is incurable and conservative maintenance therapy is lifelong.

Men suffer from intermittent claudication twice as often as the female half of the population.

After a patient is diagnosed with the syndrome, in the next 5 years, up to 30.0% of patients die—the prognosis is unfavorable.

10 years after diagnosis - up to 70.0% of patients die - the prognosis is unfavorable.

Up to 65.0% of patients with intermittent claudication die due to acute coronary syndrome, or from destruction of the arteries of the brain - stroke - the prognosis is unfavorable.

With timely diagnosis and proper qualified treatment of the pathology, up to 75.0% of patients stabilized the condition of blood vessels and established blood flow in the body - the prognosis is favorable.

In 45.0% of patients, pain in the legs is minimized—the prognosis is favorable.

Intermittent claudication occurs as a result of the development of occlusive-stenotic processes in the arterial vessels of the legs. Patients complain of pain in the legs, fatigue, weakness, and cramps in the calf muscles. All symptoms worsen with physical activity.

The patient walks about 100 meters, after which he develops the symptoms described above. In order for the discomfort to go away, you need to stop and sit or stand for a while. After such a rest, a person resumes his journey and after the same distance he needs rest.

Intermittent claudication is part of a complex of symptoms that indicate damage to the vessels of the lower extremities.
Classification of lower extremity ischemia

This condition is divided into 4 degrees:

1. The patient has damage to the arterial vessels of the lower extremities, but there is still no discomfort or pain when walking a distance of 1 km;
2. This degree is divided into degrees 2a and 2b, which differ from each other only in the walking distance. With degree 2a, the distance varies from 200 meters to 1 km, and with degree 2b - less than 200 meters;
3. Grades 3 and 4 are combined with the term “critical ischemia” and are stages of the disease in which, without proper and timely treatment, the patient loses a leg. At grade 3, pain in the legs is constant, pain relief is necessary;
4. This is the final stage of the disease, in which trophic changes in the soft tissues of the legs occur and gangrene develops.

This type of classification is necessary to select adequate therapy. The above classification allows you to choose treatment.

Features of treatment for different degrees of ischemia

The first degree of ischemia does not require specific treatment. In this situation, it is necessary to adjust the impact of risk factors.

In the second degree of ischemia, which is accompanied by intermittent claudication, medications are prescribed to increase walking distance. Correction of risk factors certainly remains. The patient must also engage in training walking. If conservative treatment does not help and the pain-free walking distance is sharply reduced, surgical treatment is used, since only this type of therapy can increase blood flow in the limb.

Various angioplasty manipulations with the use of stents, as well as without them, can be used as surgical procedures. This type of treatment is basic, or initial. If it is impossible to perform angioplasty surgery, bypass surgery is used to improve blood circulation in the limb.

Directions in the treatment of patients with conditions such as intermittent claudication

Correction of risk factors

Each patient who has been diagnosed with arterial disease of the extremities must change their lifestyle in order for further treatment to be as effective as possible:

• to give up smoking;
• normalization of blood glucose levels;
• normalization of blood pressure.

Thus, the patient should consult a therapist or cardiologist.

Correction of elevated blood lipid levels

If the patient develops intermittent claudication, they must necessarily receive medications that reduce the level of fats in the blood. When using such therapy, the risk of developing not only cardiovascular diseases decreases, but also the distance of pain-free walking increases. According to authoritative studies, when using simvastatin, pain-free walking distance increased by an average of 120% compared to patients in the placebo group. Atorvastatin also increased the distance, but by 22%. The maximum walking distance increases by 164 meters.

Treatment with antiplatelet drugs

Antiplatelet agents are necessary for patients with intermittent claudication as much as they are needed for patients with. These medications, when taken for a long time, have the ability to reduce the risk of blood vessels and also increase walking distance. Antiplatelet drugs in another study increased walking distance by 60 m. In Russia, the antiplatelet drug ticlopidine, which was used in the study, is used. Its effectiveness is a 40% increase in maximum walking distance.

Training walking

The evidence base of this technique is the most complete and realistic. The effectiveness of training walking for intermittent claudication has been proven and confirmed. Studies have been conducted where, under the guidance of instructors, patients were offered exercises to train their legs. After some time, the patients themselves noted a decrease in pain and an increase in endurance during physical activity.

A patient with intermittent claudication must walk for half an hour a day.

Drugs to increase pain-free walking distance

The remaining medications present on the Russian market for the treatment of intermittent claudication do not have any evidence base.

Summarizing

1. Ischemia of the lower extremities is characterized by a decrease in blood flow in the arterial vessels;
2. Patients with intermittent claudication are currently treated conservatively;
3. Treatment of the disease should begin with the correction of risk factors;
4. Among medications, it is worth taking antilipid and antiplatelet drugs;
5. Pentoxifylline is also used for therapy, the effectiveness of which has a high evidence base. In Russia, you can use the long-acting drug Vazonit.

The good old days, when there were few doctors and self-medication was extremely common, truly amazing ones were found among folk remedies. For example, in case of intermittent claudication, or rather a symptom of pain in the leg, one was supposed to rub it with turpentine and sit in front of the fire until it began to tingle. One can only hope that the patients who used such dubious treatment did not burn alive. In our article we will talk about the signs of intermittent claudication and the treatment of intermittent claudication.

Treatment of intermittent claudication

Yes, the same exercise that leads to leg pain is also one of the best treatments for intermittent claudication. “When I tell patients that they need to go out more, they look at me like I’m crazy. People want pills for treatment. However, we really don't have a pill that works better than walking for intermittent claudication,” says Dr. Jay Coffman, chief of vascular pathology at Boston University Medical Center. “Regularly exercising the muscles during claudication symptoms increases their ability to extract oxygen from the blood,” explains Dr. Santilli. Therefore, if you walk more, the leg muscles will learn to use the limited amount of it more efficiently and will suffer less from oxygen starvation, and therefore from pain and cramps.

He recommends that patients with signs of intermittent claudication walk for an hour a day, 5 times a week, for treatment. While walking, if symptoms of pain appear, it is better not to stop immediately, but despite its intensification, set a goal for yourself, say, the next bench, try to get there and only after that give yourself a break. Then move on. At the next attack of pain, it is advisable to set yourself a more ambitious task, for example, to reach the second bench, etc. And such small feats must be accomplished within the entire hour.

"It doesn't matter how many times you have to stop or how fast you go," Dr. Santilli says. Some people rest every 2-3 minutes at first. This is fine. If a person maintains this type of training for several weeks, the symptom of pain from intermittent claudication will subside and stoppages will become less frequent. In fact, studies show that using this method can double the pain-free distance you can walk in just 2-3 months.

Antioxidants for the treatment of intermittent claudication

Usually, the symptoms of intermittent claudication become easier if you take antioxidants for treatment, in particular vitamins E and C, which inhibit the development of atherosclerosis, especially in its early stages. Vitamin E is prescribed in the treatment of intermittent claudication, one might say traditionally. One study in Sweden showed that signs of intermittent claudication were reduced when treated with 300 IU per day.

However, for smokers with signs of intermittent claudication, vitamin E does not seem to help. In all likelihood, according to Dr. Weiss, its antioxidant effect is not able to neutralize the damage caused to the cardiovascular system by tobacco smoke. The first step is to give up this bad habit to treat the symptoms of intermittent claudication. By the way, for many who quit smoking, intermittent claudication goes away on its own over time.

Typically, Dr. Weiss prescribes 400-800 IU of vitamin E and 1,000-3,000 mg of vitamin C daily for patients with signs of atherosclerosis for treatment. The first of them prevents the oxidation of “bad cholesterol” (low-density lipoproteins) - a process that directly leads to the formation and growth of atherosclerotic plaques in the vascular walls. Vitamin C, in the treatment of intermittent claudication, restores the active form of vitamin E, and also promotes the release of nitric oxide by the endothelium, which, as already mentioned, dilates the arteries. The most effective vitamin E preparations for the treatment of intermittent claudication are O-alpha tocopherol and a mixture of tocopherols.

Folk remedies for intermittent claudication

Ginkgo - a folk remedy for the treatment of intermittent claudication

“We tend to think of this folk remedy as being good for the brain, but it actually improves overall circulation,” says Boulder, Colorado-based herbalist Mindy Green. Much research has been devoted to the effect of ginkgo on intermittent claudication during treatment. Some of them achieved statistically significant and clinically significant increases in pain-free walking distance. Have your relative take standardized ginkgo extract tablets or capsules according to the package directions.

Garlic for treating intermittent claudication

It's not clear why, but garlic seems to improve blood circulation in all parts of the body. The most convenient (and least odoriferous) form of this medication is capsules. Let your patient with signs of intermittent claudication take two pieces two to three times a day for 2-6 months until symptoms disappear.

Foot cocktail for the treatment of intermittent claudication

The amino acid arginine is needed to produce nitric oxide to treat intermittent claudication. It is secreted by the endothelium (the lining of the arteries) and helps them relax and widen, increasing blood flow, explains Decker Weiss, a naturopath at the Arizona Heart Institute in Phoenix. The standard dose of treatment is 1 capsule with 500 mg of arginine up to three times a day.

Magnesium for the treatment of intermittent claudication

Along with arginine, Dr. Weiss recommends taking one of the most important metals for the treatment of intermittent claudication - magnesium. It promotes relaxation of the muscles of the arterial walls, i.e. expansion of blood vessels, the lumen of which is narrowed by atherosclerotic deposits. It is possible that your relative may have a general magnesium deficiency, for example, if he takes medications commonly prescribed for heart patients such as diuretics (diuretics) and digitalis glycosides - digitoxin (Christodigine) or digoxin (Aanicor). Signs of this deficiency are general muscle weakness, nausea, irritability. For most people, a safe daily dose of magnesium supplement for treatment is 350 mg. Dr. Weiss recommends taking orotate or glycinate of this metal.

Signs of intermittent claudication

The natural remedies offered these days for the symptoms of intermittent claudication are much safer. We are talking about a chronic pathology, also known as Charcot's syndrome, the symptoms of which affect almost every tenth person over 70 years of age. signs of intermittent claudication are caused by atherosclerosis - hardening of the walls and narrowing of the lumen of the peripheral arteries that carry blood with oxygen and nutrients to the legs. Predisposing signs of intermittent claudication are hypertension, diabetes, smoking, and high cholesterol—the same factors that risk coronary heart disease. In this case, signs of ischemia also appear, i.e. oxygen starvation, but not of the myocardium, but of the muscles of the foot, lower leg, thigh, and sometimes even buttocks. As a result, a burning, cramping pain occurs in these parts of the body.

Typically, signs of intermittent claudication begin to occur after a person has walked a short distance, often less than a city block. The patient stops, rests for a few minutes, and symptomatic pain stops. He sets off again, stops again from pain, etc. Over time, the signs of atherosclerosis and ischemia progress, and as a result, the distance traveled between breaks is increasingly reduced.

“Signs of intermittent claudication certainly reduce quality of life. However, up to 90% of people suffering from this pathology never see a doctor about it. Most consider it an inevitable accompaniment of aging. They just think, “What can you do, the years are taking their toll,” says Dr. Steven Santilli, a vascular surgery specialist in Minneapolis. - Such fatalism is not justified in any way. Lifestyle changes, such as quitting smoking and regular exercise, can significantly improve the condition of your feet. Medicine sees no reason to put up with intermittent claudication.” Here are some effective ways to treat intermittent claudication.

Prevention of intermittent claudication

Smoking cessation as a way to prevent intermittent claudication

According to Dr. Santilli, smokers have twice the risk of intermittent claudication as non-smokers. Tobacco smoke narrows the arteries and makes it difficult for muscles to work, including in the legs, and in addition, contributes to the development of atherosclerosis. Even if a person has smoked for many years, quitting this bad habit will improve his blood circulation and relieve pain.

Fat reduction to prevent intermittent claudication

“Fatty foods lead to the progression of intermittent claudication,” warns Dr. Santilli, “because they promote the development of atherosclerosis.” Have your sick relative snack on 4 grams of fruit, vegetables, legumes, or whole grains for every gram of meat. This will help him transition to a leaner - and healthier - lifestyle. If he just can't do without fatty foods, you can treat him to fried chicken, bacon or meat gravy once a month.

General information

Lameness is a change in gait due to pathology of one of the lower extremities (in some cases, both). When one leg is dysfunctional, a person usually falls on it while walking, that is, he strives to transfer weight to the healthy limb as quickly as possible. With pathology of both limbs, the gait becomes uncertain and swaying. Depending on the nature of the pathology of the legs, the degree of its severity and the reasons that provoked it, the gait can acquire various features.

As a rule, lameness is associated with older people due to the fact that they have it due to weakness of the musculoskeletal system and the presence of chronic joint diseases. However, people of absolutely all age groups can limp. In most cases, claudication as a symptom suggests a lower extremity injury, but this is not always the case. In some cases, the development of lameness may signal the progression of serious diseases that require diagnosis and treatment.

Causes

In a broad sense, there is only one cause of lameness - pathology of the lower extremities. However, the problem with the legs is not always primary. In some cases, dysfunction of the lower extremities is a consequence of internal pathologies. Thus, the cause of lameness may be:

Injuries of the lower extremities. Dislocations, fractures or sprains are sometimes characterized by a long recovery period. Depending on the person's age, the severity of the injury, and other related factors, lower extremity function may be fully or partially restored. This protracted process is invariably accompanied by lameness.

• Foot diseases. There are many different foot pathologies, including fungal infections and diabetic foot syndrome due to diabetes mellitus. Considering that the foot is directly involved in walking, these pathologies are almost always accompanied by lameness.

• Joint diseases. Acute and chronic joint diseases can in some cases lead to dysfunction of the lower extremities, which can cause lameness. This occurs especially often in diseases of the hip joint and knees.

• Muscle diseases. Inflammatory diseases of the muscles of the lower extremities of various etiologies can cause difficulty walking and lameness.

• Bone diseases (both acute and chronic of various etiologies).

• Systemic and metabolic pathologies in the body.

• Congenital skeletal pathologies. There are often cases when, from birth, a person has one leg that is significantly shorter than the other or has an irregular structure. Congenital pathologies of the spine also occur. All these abnormalities are the cause of lifelong lameness.

• Some