The symptom of intermittent claudication is characteristic of the disease. What is intermittent claudication

General information

Lameness is a change in gait due to the pathology of one of the lower extremities (in some cases, both). With dysfunction of one leg, a person, as a rule, falls on it while walking, that is, he seeks to transfer weight to a healthy limb as soon 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 the weakness of the musculoskeletal system and the presence of chronic joint diseases. However, people of absolutely all age groups can limp. In most cases, speaking of lameness as a symptom, one can suspect the presence of an injury to the lower extremities, but this is not always the case. In some cases, the development of lameness can signal the progression of serious diseases that require diagnosis and treatment.

Causes

In a broad sense, the cause of lameness is one - the pathology of the lower extremities. However, the problem with the legs is not always the primary one. In some cases, dysfunctions of the lower extremities are the result of internal pathologies. Thus, the cause of the development of lameness can be:

Injuries of the lower extremities. Dislocation, fracture or sprains are sometimes characterized by a long recovery period. Depending on the age of the person, the severity of the injury and other related factors, the functions of the lower extremities can be restored completely or partially. This protracted process is invariably accompanied by lameness.

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

Joint diseases. Acute and chronic diseases of the joints in some cases can lead to dysfunction of the lower extremities, which can cause lameness. Especially often this happens with diseases of the hip joint and knees.

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

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

Systemic and metabolic pathologies in the body.

Congenital pathologies of the skeleton. Often there are cases when, from birth, a person has one leg much shorter than the other or has an irregular structure. There are also congenital pathologies of the spine. All these deviations are the cause of lifelong lameness.

Some

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

Treatment of intermittent claudication

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

He recommends for patients with signs of intermittent claudication to walk for an hour a day, 5 times a week. During a walk, when symptoms of pain appear, it is better not to stop immediately, but despite its intensification, set a goal for yourself, say, the next shop, 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 in a row, etc. And such small feats must be performed within an entire hour.

“How many times you have to stop and how fast you move is not important,” says Dr. Santilli. Some first rest every 2-3 minutes. This is fine. If a person sustains such training for a few weeks, the pain symptom of intermittent claudication will subside and stops will become less frequent. In fact, studies show that this method can double the distance you can walk painlessly in just 2-3 months.

Antioxidants for the treatment of intermittent claudication

Usually, with symptoms of intermittent claudication, it becomes 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 conducted in Sweden showed that the signs of intermittent claudication weaken when treated with a dose of 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 action 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 people who quit smoking, intermittent claudication eventually goes away by itself.

Typically, Dr. Weiss prescribes patients with signs of atherosclerosis 400-800 IU of vitamin E and 1000-3000 mg of vitamin C daily 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 used to think of this folk remedy as good for the brain, but in fact it improves blood circulation in general,” says herbalist Mindy Green from Boulder, Colorado, USA. A lot of research has been devoted to the effect of ginkgo on intermittent claudication in the treatment. Some have achieved statistically significant and clinically significant increases in pain-free walking distance. Have your relative take standardized ginkgo extract tablets or capsules according to package directions.

Garlic for the treatment of intermittent claudication

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

Leg cocktail for the treatment of intermittent claudication

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

Magnesium for the treatment of intermittent claudication

Together with arginine, Dr. Weiss recommends taking one of the most important metals for the treatment of intermittent claudication - magnesium. It helps to relax the muscles of the arterial walls, i.e. expansion of vessels, the lumen of which is narrowed by atherosclerotic deposits. It is possible that your relative is generally deficient in magnesium, for example, if he takes medications commonly prescribed for hearts such as diuretics (diuretics) and digitalis glycosides - digitoxin (Cristodigin) or digoxin (Aanikor). Signs of this deficiency are general muscle weakness, nausea, and irritability. For most people, the safe daily dose of a magnesium supplement for treatment is 350 mg. Dr. Weiss advises taking orotate or glycinate of this metal.

Signs of intermittent claudication

The natural remedies offered today for the symptoms of intermittent claudication are much safer. We are talking about a chronic pathology, also known as Charcot's syndrome, from the symptoms of which almost every tenth person over 70 suffers. 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. Hypertension, diabetes, smoking, high cholesterol levels predispose to signs of intermittent claudication - the same factors that are fraught with coronary heart disease. In this case, there are also signs of ischemia, i.e. oxygen starvation, but not the myocardium, but the muscles of the foot, lower leg, thigh, sometimes even the buttocks. As a result, burning spasmodic pain occurs in these parts of the body.

Usually, the symptoms of intermittent claudication begin to torment after a person walks a short distance, often less than a city block. The patient stops, rests for a few minutes, and the symptomatic pain stops. He again starts on the road, again stops from pain, etc. Over time, the signs of atherosclerosis and ischemia progress, and as a result, the distance traveled between respite is increasingly reduced.

“Signs of intermittent claudication will certainly reduce the quality of life. However, up to 90% of people suffering from this pathology never go to the doctor with it. Most consider it an inevitable companion of aging. They just think, "What can you do - the years take their toll," says Dr. Stephen Santilli, a Minneapolis-based vascular surgeon. - Such fatalism is not justified by anything. Lifestyle changes, such as quitting smoking and exercising regularly, can greatly improve foot health. Medicine sees no reason to put up with intermittent claudication.” And 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 are twice as likely to develop intermittent claudication than non-smokers. Tobacco smoke narrows the arteries and makes it difficult for muscles to work, including in the legs, and in addition, it contributes to the development of atherosclerosis. Even if a person has been smoking for many years, giving up this bad habit will improve his blood circulation and relieve pain.

Cutting fat to prevent intermittent claudication

"Fatty foods lead to the progression of intermittent claudication," warns Dr. Santilli, "because it promotes atherosclerosis." Have your sick relative "snack" every gram of meat with 4 grams of fruit, vegetables, legumes, or whole grains. This will help him transition to a leaner - and healthier - lifestyle. If he can't do without fat, you can treat him to fried chicken, bacon, or meat sauce once a month.

Disease intermittent claudication caused by impaired blood supply in the lower extremities. If you suspect that you have intermittent claudication, the main symptom of it is pain that occurs in the legs when walking, stopping at rest.

Main reasons

Intermittent claudication signals a serious disease of all the arteries of the body, but the disease (obliterating endarteritis) manifests itself, usually in the lower extremities. Arteries narrow, sometimes almost to the point of their complete closure due to the pathological process that occurs in the walls of blood vessels. The basis of such changes is atherosclerosis. The disease can proceed for a long time without symptoms, gradually progressing. However, there have been cases when it begins with an acute attack.

Intermittent claudication is a consequence of not only vascular diseases (endarteritis), but also infections, trauma, intoxication, diabetes, and so on.

Symptoms of the disease

When diagnosed with intermittent claudication, the symptoms are usually as follows: first, fatigue and paresthesia in the legs, then pain appears when walking, becoming more persistent over time. With this disease, the pulse disappears most often on the foot, sometimes the disappearance of the pulse is observed in the fossa under the knee, the skin color changes (turns pale, and later cyanosis appears). The temperature of the foot and toes drops, sensitivity is lost, the foot is usually always cold, the calf muscles hurt, as well as the nerve trunks of the legs (with pressure on them). Trophic ulcers may occur on the feet. This is a chronic disease with remissions.

Intermittent claudication syndrome most often occurs in 30-40-year-old men, but now women have also begun to get sick. Doctors explain this by the habit of smoking, which provokes endarteritis and is a huge risk factor.

Therapy

If you suspect that you have intermittent claudication, treatment should begin immediately. First, diagnosis is recommended using modern methods, such as ultrasound, rheovasography, X-ray examination of the arteries (angiography). If the diagnosis is confirmed, medications are prescribed to improve blood flow and reduce arterial spasm. Shown physiotherapy treatment, balneotherapy. The doctor must convince the patient to quit smoking.

With the progression of the disease, surgical intervention may be required: from sparing techniques to amputation (for gangrene).

Frequent mistakes in self-treatment!

The progression of the disease and the development of complications of damage to the arteries of the lower extremities, up to the development of gangrene and amputation of the lower extremities.

What professional help do you need?

General practitioner or general practitioner (family doctor)
Vascular surgeon
Endocrinologist

What can you do?

For the prevention of vascular diseases, we can recommend:

Physical activity (running, walking, exercising in the fitness center, swimming)
Regular visits to the bath
Taking drugs that strengthen the walls of blood vessels and prevent the formation of blood clots, such as TRANSVEROL

- a fairly common and very dangerous pathology, and often it is not always given due attention by doctors. According to various data, the disease "intermittent claudication" affects about one and a half million Russians, about one hundred thousand are diagnosed with critical leg ischemia, and the number of amputations due to the disease reaches 40 thousand per year.

The predominant cause of intermittent claudication is atherosclerosis, which in most patients has another localization - the heart, kidneys. Sometimes paying close attention to these forms of atherosclerosis, doctors often do not concentrate on the diagnosis and treatment of intermittent claudication, which progresses, leading to severe disability and even death.

Causes of the syndrome of intermittent claudication.

Atherosclerosis - the main cause of the syndrome - intermittent claudication!

It is generally accepted that the main factors in the genesis of intermittent claudication are:

Atherosclerosis of the vessels of the legs.
Diabetic macro- and microangiopathy without concomitant atherosclerosis.
Autoimmune vascular disease (obliterating endarteritis).

As a rule, in nine out of ten patients, intermittent claudication is the result of atherosclerotic lesions of the arteries. And it is highly likely that there are other forms of atherosclerosis. Diabetic angiopathy is considered as the cause of the syndrome of intermittent claudication if it is isolated and not associated with atherosclerosis. Along with this, it increases the likelihood of lipid disorders and fatty deposits in the arteries.

Also, among other causes of the disease, endarteritis, trauma, infection and intoxication, hypothermia are indicated, although these conditions are much less common among the provoking factors of intermittent claudication. Pathologies are more susceptible to older people and mostly men. Since atherosclerosis of other localizations is also diagnosed in them more often than in women. In addition, men are more prone to violation of the regime, bad habits and rare visits to specialists.

Types of intermittent claudication.

Neurogenic (initially radiculoischemia, later degeneration of the nervous tissue joins).
Vascular (the most common cause is obliterating endarteritis, atherosclerosis). Distinctive features of neurogenic (caudogenic) intermittent claudication from claudication in vascular pathology are the presence of previously disturbing lower back pain, diagnosed intervertebral hernia, congenital, acquired stenosis of the spinal canal, pain in the legs is provoked by standing and walking, pain disappears in a position with a bent lower back (when tilted forward). Do not forget about the possible combination of different diseases.
Other causes: genetic diseases (McArdle disease), traumatological (trochanteric bursitis), neurological, psychogenic.

According to anatomical criteria, there are:

Central stenosis - a decrease in the distance from the posterior surface of the vertebral body to the arch at the base of the spinous process; up to 12 mm - relative stenosis, 10 mm - absolute stenosis.
Lateral stenosis - narrowing of the radicular canal and intervertebral foramen to 4 mm or less.
Combined stenosis.

Symptoms and diagnosis of intermittent claudication.

Distinguishing neurogenic intermittent claudication from intermittent claudication in vascular pathology allows the presence of pain not in one, but in both limbs, the presence of a history of lower back pain, verified, as well as the fact that the onset of symptoms is provoked by walking, the pain disappears when the torso is tilted forward, and pulsation was preserved on the vessels of the legs.

In most cases, the differential diagnosis between vascular and neurogenic intermittent claudication can be based on a critical evaluation of clinical symptoms and signs. If there is a pulse on the foot at rest and after exercise, vascular pathology is unlikely. Not so long ago, arteriography was used as a routine research method; Nowadays, non-invasive ultrasonic Doppler methods of examination are more often used.

Diagnostic difficulties usually arise in the presence of vascular occlusion in combination with spinal cord compression. In conjunction with clinical examination, other non-invasive techniques are used: electromyography and measurement of nerve conduction velocity, myelography, radiography of the lumbosacral region of the spine, computed tomography and arteriography.

Of no small clinical importance is the definition of the ankle-brachial index. These measurements should be taken after loading. Lumbosacral radiography is recommended to be performed in direct, oblique and lateral projections. A constant clinical symptom in all patients is pain in the lower back, lasting from several weeks to several years, radiating to one or both lower limbs. In patients with bilateral pain syndrome, the lesion of one limb may be more pronounced.

Burning, tingling, squeezing pain in the back or in the thigh area, which radiates to the posterolateral areas of the lower leg, ankle, and big toe, are also considered typical symptoms. The feeling of discomfort in the lower extremities sometimes appears only when walking, less often at rest, and when changing the position of the body. As a rule, the symptoms disappear when the movement stops, while resting while sitting or lying down. Urination disorders are not typical; there is a tendency to constipation.

Computed tomography reveals spinal canal narrowing, articular facet hypertrophy, and other soft tissue changes.

The neurogenic origin of the symptoms is confirmed by the effectiveness of the treatment without the use of vascular drugs. Conservative treatment - analgesics, muscle relaxation, wearing a corset - leads to an improvement in the condition of patients.

A more thorough assessment of symptoms should be aimed at finding a neurogenic genesis of the disease in most patients. The neurogenic origin of the disease is indicated primarily by the presence of pathological symptoms that disappear in a sitting or lying position. It is characteristic that the manifestation of the appearance of pain occurs when the patient walks. The gait changes, the patient limps, is forced to stop and rest. During the stop, the pain decreases somewhat, but often in severe stages, even rest no longer brings relief, the pain becomes constant. Usually the disease is unilateral, but both legs can be affected at once.

As vascular disorders worsen, other signs of intermittent claudication appear:

Lowering the temperature of the skin, blanching and cyanosis;
Trophic changes in the form of ulcers;
Loss of pulse in the arteries of the foot.

In the stage of critical ischemia of the lower extremities, the deficiency of arterial blood is so strong that patients begin to notice not only soreness, but also trophic changes - ulcers. Walking a distance of 150-200 meters becomes a real problem for them, because the pain is quite intense, and stopping and resting no longer help.

Depending on the cause of the syndrome - "intermittent claudication" - there are two forms of pathology:

Peripheral.
spinal.

Peripheral intermittent claudication is associated with atherosclerosis, endarteritis, and diabetes. It is accompanied by fatigue and discomfort in the legs, which are replaced by pain. The limb turns pale, becomes cold, the pulse on the arteries disappears. In the severe stage, trophic ulcers appear.

The spinal form develops when small vessels that supply blood to the gray matter of the spinal cord are affected. It is characteristic of some chronic diseases (myelitis, syphilis) and may be their early symptom.

Treatment of intermittent claudication.

It is important for the patient to refuse heavy physical exertion, taking medications as prescribed by the doctor.

Basically, conservative treatment is carried out for patients with mild and moderate intermittent claudication syndrome for 1-3 months. In case of ineffectiveness of conservative treatment, gross changes according to CT, MRI, with the consent of the patient, surgical treatment is performed.

Operative treatment.

The operation is performed under endotracheal anesthesia. The position of the patient on the operating table is determined by the planned operation. The type of operation is determined for each patient individually, depending on the cause of the pathology. The main goal of the operation is the decompression of neural structures, which is well defined by MRI examination.

Eg:

Posterior approach with removal of the arches at the affected levels and the adjacent yellow ligament, if necessary, supplemented by foraminotomy (partial resection of the superior articular process when it compresses the root), with transpedicular fixation (using rods, a transverse beam for structural strength, with and without distraction ) with or without spinal fusion, if indicated. Discectomy with cage implantation (both titanium metal and polymer), both anterior and posterior access, endoscopically, laminoplasty.

Both before and after surgery, the patient undergoes conservative treatment, the purpose of which is to correct concomitant pathology, relieve swelling of the spinal cord roots, and prevent infection. The normalization of blood pressure is also considered a rather important component of treatment. In the event that, in addition to the disease - intermittent claudication - there is no concomitant pathology, then the pressure should not exceed 140/90 mm Hg. Art. In case of presence, cardiac ischemia, chronic heart or kidney failure, the recommended maximum pressure is 130/80 mm Hg. Art.

For the correction of blood pressure, drugs from the angiotensin-converting enzyme group (lisinopril, perindopril) are indicated. It has been argued that these funds not only fight hypertension, but also significantly reduce the risk of vascular accidents and associated heart attacks and.

In order to improve the rheological parameters of the blood, antiplatelet agents are indicated. Particularly popular drugs based on acetylsalicylic acid (thrombo Ass, aspirin cardio). Anticoagulants for oral administration are not prescribed to patients with intermittent claudication, since there is a high risk of cardiovascular complications.

In order to correct metabolic disorders in tissues, pentoxifylline is used in a daily dose of 1200 mg. The drug improves microcirculation and blood rheology, dilates blood vessels, and the result is an increase in the distance that the patient can walk before the onset of pain.

Improves blood flow, reduces blood viscosity, normalizes the state of the endothelium, the drug sulodexide. Previously, it was prescribed only for critical tissue ischemia, but today it is also recommended for intermittent claudication. It is recognized that when taken orally and intravenously, the distance that the patient travels before the onset of pain is almost doubled.

Angiotensin-converting enzyme inhibitors (perindopril), beta-blockers (nebivolol), and angiotensin II receptor blockers (losartan) can improve endothelial function. Given the presence of hypertension and cardiac pathology in many patients, they are all the more appropriate and not contraindicated in the syndrome - intermittent claudication.

Folk remedies for intermittent claudication.

ginkgo- folk remedy

A lot of research has been devoted to the effect of ginkgo on intermittent claudication in the treatment. Some have achieved statistically significant and clinically significant increases in pain-free walking distance. Have your family member take standardized ginkgo extract tablets or capsules according to package directions.

Garlic for the treatment of intermittent claudication.

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

Leg Cocktail for the treatment of intermittent claudication.

Prevention. It is necessary to exclude smoking, physical overwork, cooling, excessive mental stress.

Intermittent claudication syndrome (angina cruris, Charcot's syndrome, claudication) is a fairly common pathology, the main symptom of which is a violation of the circulatory process in the vessels of the lower extremities. The anomaly leads to the appearance of pronounced pain in the legs, both when walking and at rest, due to which the person begins to limp.

Approximately one and a half million inhabitants of Russia suffer from the PH syndrome, among which about one hundred thousand are diagnosed with coronary artery disease of the legs. The number of limb amputations annually exceeds 40,000.

Among the main causes of the development of the disease are: atherosclerosis of the vessels of the lower extremities, infectious diseases, transferred recently, intoxication, severe injuries. HRP develops against the background of ischemia in the lower arterial pool, which spreads to the thoracic, lumbar and sacral regions of the spinal cord. The syndrome requires timely medical treatment, otherwise dangerous complications appear, and the risk of disability or death increases.

Most often, the anomaly develops in adults, mainly the elderly. Men are especially susceptible to the disease, as they are more prone to atherosclerosis. And the presence of addictions, irregular daily routine and rare visits to medical specialists only increase the risk of PC formation.

The main causes of the syndrome include the following pathologies:

Atherosclerosis. In about nine out of ten cases, the anomaly is the result of atherosclerotic vascular lesions. Damage to the aorta, iliac and femoral arteries leads to a decrease in the amount of oxygen that is carried in the blood. Ischemia occurs.
. Diabetes mellitus leads to the deposition of fatty plaques in the arteries, so the risk of developing the syndrome increases many times already during the first stage of the course of the disease.
Vasospasm. Due to a violation of the nervous regulation of the tone of the arteries of the legs, their lumen narrows, and the volume of blood flowing to the limbs is insufficient. One of the representatives of vasospastic diseases is Raynaud's syndrome.
Obliterating vascular diseases. and obliterating endarteritis are the result of an inflammatory process in the vessel wall, which reduces its lumen. These pathologies are characterized by the symmetry of the lesion of the limbs.
occlusive thrombosis. In its advanced form, the anomaly causes a violation of vascular obstruction due to the almost complete closure of their lumen in a certain area.

Among other factors that provoke the syndrome of venous intermittent claudication, there are:

severe intoxication;
long-term infections;
frequent;
hereditary predisposition;
trauma;
regular hypothermia;
obesity;
hypodynamia;
bad habits.

Classification

In medicine, there is a classification of forms of pathology, among which are the following:

Caudogenic (neurogenic). It develops with transient ischemia of the cauda equina roots, usually with narrowing of the spinal canal at the level of the lumbar spine. Lameness can be both congenital and acquired. In the second case, the caudal syndrome occurs against the background of an exacerbation of osteochondrosis or spondylopathy.
Vascular (vascular). This form is characterized by damage to the walls of blood vessels and a violation of their structure. As a result, tissues receive less oxygen, which provokes pathological changes.
Myelogenous. Appears due to impaired spinal circulation after long-term walking or increased physical activity.

Scientists distinguish 4 stages of the development of the disease, which help determine the further tactics of therapy:

1 stage. The patient has already identified various abnormalities in the functioning of the circulatory system, but he still does not experience pain while walking. The main sign of PX here is the discomfort that occurs in the legs after a long walk on foot or when climbing stairs. Quite often, the stage goes unnoticed, so the disease is actively progressing. It can be observed only on one leg - left or right, and maybe on both.
2 stage. It is divided into: 2A degree, when the patient can walk from 200 to 1000 meters without pain, and 2B, when the patient cannot walk even 200 meters. This stage still assumes a conservative impact.
3 stage. Is critical. Discomfort in the lower extremities does not disappear even at rest, while the skin becomes bluish, signs of blood stasis develop. Urgent surgery is needed to save the limb.
4 stage. Leads to tissue necrosis of the affected area and gangrene. It is impossible to do without surgical intervention, since the risk of death of the patient due to septic complications increases.

Characteristic symptoms

The main sign of the development of the syndrome is severe pain in the lower extremities when walking. In addition to the occurrence of discomfort, a decrease in skin sensitivity and slight weakness are considered a typical symptom, which is often confused with ordinary overwork. We recommend that you watch the video on the topic:

Over time, the lack of arterial blood increases and leads to discomfort, heaviness in the legs. The pain may be burning or throbbing, dull or aching. The localization of pain in this case can tell which diseases provoked P.Kh.

Pain in the foot and lower leg (low intermittent claudication) is observed with thromboangiitis obliterans.
If the pain is localized in the calf muscles and thigh muscles, this indicates obliterating atherosclerosis.
Pain in the gluteal muscles and in the muscles of the lumbar region (high intermittent claudication), which means there is an occlusion of the abdominal aorta.

A person with HP cannot walk for long periods of time, limps and often stops to rest. The patient's gait changes. In advanced cases, neither rest nor special painkillers help to get rid of pain. Most often, the anomaly is unilateral, but can affect two legs at the same time.

As the disorder progresses, other symptoms of the disease also progress. The patient is concerned about:

blanching of the skin;
decrease in temperature stop;
the appearance of trophic ulcers on the legs;
lack of pulse in the arteries of the lower extremities.

Intermittent claudication in advanced form can lead to the development of necrosis, to death. Therefore, do not delay the treatment of the disease.

How to diagnose?

To make a correct diagnosis and determine further treatment tactics, it is necessary to contact a vascular surgeon. The doctor must examine the patient and examine his medical history, as well as prescribe a number of instrumental studies, a study of blood and urine tests.

To confirm their own assumptions, the patient's pulse is felt and the limbs are palpated, paying attention to the piriformis muscle area.

Then the following types of examinations are carried out:

ultrasound and laser dopplerography, which allows you to assess the speed of blood movement in the vessels and determine the causes of blood flow disorders;
transcutaneous oximetry, aimed at counting the amount of oxygen in the capillaries of the skin and arterial vessels;
(pictured), which involves assessing the rate of restoration of normal blood flow in the limbs after walking 200 meters;
angiography - a contrast study of blood vessels, which determines the affected area and assesses the condition of the vascular walls;
functional tests of Opel, Palchenkov and Burdenko.

Differential diagnosis of PH is carried out with pseudo-intermittent claudication. About 90% of all cases of the syndrome are caused by obliterating endarteritis of the canal.

How to treat the disease?

Treatment of patients with CP in terms of modern ideas about the pathogenesis of HOZANK is carried out through medication or surgical intervention. Treatment in a hospital is indicated for patients with severe pain in the legs, as well as for advanced forms of the disease.

Conservative therapy

Drug treatment is indicated for each patient, regardless of the stage of development of the anomaly. So, even if a sick person has undergone an operation aimed at correcting blood flow, conservative therapy should still continue.

Among the areas of drug exposure are:

Prevention of thrombosis and thromboembolism. You need to take Aspirin Cardio or Thrombo Ass tablets.
Taking drugs that dilate blood vessels. "Sulodexide" and "Pentoxifylline" - such drugs improve microcirculation in the arteries and reduce blood viscosity.
Increased metabolism in affected tissues. Means "Naftidrofuril" stimulates metabolism, which helps to painlessly go long distances.
Stabilization of indicators and glycemia. This can be done by taking the drugs "Pravastatin" or "Simvastatin". Maintaining a normal level of glucose in the patient's blood is the main direction of therapy for the syndrome. Therefore, if a person has diabetes, it is worth resorting to treatment by administering insulin and taking lipid-lowering agents.
Correction of arterial pressure. For this, it is necessary to take Enalapril, Enalakor funds. Such drugs not only normalize blood pressure, but also prevent the risk of heart disease and hemorrhage.

If the patient needs surgery, but it is not yet possible, you should take a course of taking the drug "Iloprost". It not only reduces pain and accelerates the healing process of trophic ulcers, but also allows you to postpone the intervention for limb amputation.

Along with drug exposure, the following physiotherapeutic methods are also necessary:

hydrogen sulfide baths;
diathermy;
UHF therapy;
mud treatment;
hyperbaric oxygenation.

The patient should also avoid hypothermia, wear only comfortable shoes and clothes, follow the rules of foot hygiene. Patients with diabetes need to take care of the diet and strict control of sugar levels.

Special therapeutic walking is also recommended, as the movement stimulates blood circulation in the lower extremities. Hiking should continue until the pain in the legs occurs. After - you should rest and continue walking again. Walks in the fresh air must be carried out at least three times a week for 45 minutes.

Positive dynamics will be noticeable after a few weeks, but the minimum course of such an impact is 12 weeks. The complex of therapeutic measures includes exercises of physiotherapy exercises. They should vary from strength training to walking with sticks and exercises for the upper or lower extremities; It is also very useful to do a special massage and take a contrast shower in the morning.

Operation

Surgical intervention is the main method of therapy in the last stages of development. The most common operation is to amputate a limb.

Thrombectomy, angioplasty and endarterectomy are considered minimally invasive operations, which means they are performed without large incisions. The intervention may be aimed at removing part of the artery of the affected area or at increasing the lumen of the vessels. If it becomes impossible to carry out a full-fledged surgical intervention, bypass surgery is recommended to create a bypass for the movement of blood using one's own vessels or artificial prostheses.

To improve the blood supply to the lower extremities and reduce the number of trophic ulcers, lumbar sympathectomy can be performed. Surgery is necessary when vascular bypass is not possible. But the prognosis of the procedure is often unpredictable, so intervention is considered a fallback option for a limited number of patients.

Traditional medicine

As folk remedies for the treatment of the syndrome, there are:

mud lotions on the legs;
mustard baths;
applications from various types of clay;
bee therapy;
rubbing an ointment from natural sea buckthorn and olive oil into the skin of the feet;
heating with an infrared lamp;
compresses from burdock leaves.

But it is impossible to treat the syndrome with only one means of traditional medicine. Medical treatment is also required. Before you start using the advice of traditional medicine, be sure to consult with your doctor.

Preventive actions

To prevent the development of an anomaly, it is worth:

give up bad habits, especially smoking;
walk as often as possible;
engage in physical therapy under the guidance of an experienced trainer;
visit the pool;
wear only comfortable shoes and clothes made from natural materials;
give up fatty foods.

Intermittent claudication is a dangerous disorder that requires full treatment, which in its advanced form leads to limb amputation.