Why does lameness happen? Intermittent claudication: treatment tactics of a practitioner

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

Intermittent claudication is a symptom complex caused by impaired blood supply to the lower extremities and manifests itself as transient pain in the legs that occurs while walking. The reasons are vascular diseases (endarteritis), infections, intoxication (for example, manganese), trauma, etc. Due to spasm of peripheral vessels, insufficient blood supply to the muscles and nerves of the lower extremities (rarely - the upper).

Patients first feel fatigue, paresthesia in the legs, then pain appears while walking; patients are forced to stop for a while, after which the pain disappears and patients can continue walking. Subsequently, the pain becomes more persistent. With intermittent claudication, the pulse in the foot disappears, less often in the popliteal fossa, the color of the skin changes (it turns pale, and in later periods it becomes blue). The temperature and sensitivity of the foot and toes decrease, the foot becomes cold, pain appears in the calf muscles and pain occurs when pressure is applied to the nerve trunks in the legs. Trophic ulcers may appear on the feet. The course of intermittent claudication is chronic with remissions.

Treatment of the underlying disease; prohibition of alcohol and smoking; Tightening the legs (with elastic socks, elastic stockings, etc.) and cooling are contraindicated. Prescribe pachycarpine 0.05-0.1 g 2 times a day for a month, after a break - a repeat course; nicotinic acid 0.025 g 3 times a day (after meals); diathermy, UHF, hydrogen sulfide, radon baths.

Intermittent claudication (claudicatio intermittens, claudicatio ischaemica) is a syndrome that occurs with ischemia of the lower extremities caused by circulatory disorders (most often obliterating endarteritis or arteriosclerosis) and is characterized by the appearance of pain or a feeling of tension, heaviness, paresthesia during walking in one or (less often) in both legs. If the patient stops, the pain goes away and returns when walking. The disease develops more often in elderly and middle-aged men, and is rare in young people. Familial cases of intermittent claudication have been described.

Etiology: acute (,) and chronic () infections, intoxication (alcohol, especially smoking), cooling, physical and mental trauma, diabetes, etc. Some of these points (infections, intoxication) are apparently complicated by the disease endocrine -vegetative apparatus.

Pathogenesis boils down to ischemic phenomena due to vasospasm. The latter is caused by dysfunction of the adrenal system of the adrenal glands (humoral theory), with which the sympathetic nervous system is morphophysiologically connected (neurogenic theory). This leads to insufficient blood supply to the nerves and muscles of the limbs, especially during their activity (walking), and damage to the nerve endings, which in turn increases vascular spasm. As a result of the pathological chain of all these factors, a dystrophic neurovascular process develops. The development of the disease is usually chronic, but an acute course is also described.

Symptoms of intermittent claudication

Peripheral [Charcot (J. Charcot)] and spinal [Dejerine (J. Dejerine)] types of intermittent claudication have been described. With intermittent claudication of the peripheral type, patients often feel fatigue, heaviness or paresthesia in the legs before pain appears when walking. An objective examination reveals a weakening or disappearance of the pulse in the foot, less often in the popliteal fossa, and in old cases in the femoral artery. When examining the skin temperature of the foot and toes, a periodic, then persistent decrease is revealed. Skin color changes. If the patient weighs the affected leg, a pale, bluish coloration of the skin of this leg appears and pain occurs. The symptom of a “white spot” is characteristic.

The pain gradually becomes more frequent and intensifies. Over time, trophic ulcers and hypotrophy of the lower leg muscles may appear. As dystrophic and proliferative processes develop in the vessels, a picture of obliterating endarteritis may develop. During this period, arteriography sometimes reveals changes in the vascular walls and narrowing of their lumen. There is a phased nature of the course of intermittent claudication. The spinal form of intermittent claudication usually appears in the prodromal period of chronic processes (myelitis, syphilis) with damage to the arterioles that supply the gray matter of the spinal cord.

Diagnosis of intermittent claudication

Diagnosis of intermittent claudication is usually not difficult, taking into account the typical occurrence of pain in the legs when walking, their cessation when stopping, weakening or disappearance of the pulse of the main arteries of the leg, as well as subjective and objective temperature disturbances. Sometimes intermittent claudication must be differentiated from polymyositis, sciatica, flat feet, and Raynaud's disease. The prognosis is unfavorable in cases of obliteration of the vessels of the limb, however, there may be remissions during the course of the disease.

Treatment of intermittent claudication

Smoking and drinking alcohol should be prohibited. You should not wear tight shoes, you should avoid humidity, cooling your feet, and pulling your feet with rubber. Intravenous injection is recommended 5-10% NaCl solution 10 ml 10-15 infusions, subcutaneously 1% pilocarpine solution, insulin 10-12 units (No. 10), padutin, preferably depo-padutin (No. 15-20) 1 ampoule intramuscularly, through Repeat 2-4 weeks, 1% solution of nicotinic acid orally, 1 table. l. for a month or intravenously 1% -1 ml (No. 10-15), repeat courses; pachycarpine 0.1 g 3 times a day for 2 months, repeat periodically.

Perinephric novocaine blockade produces favorable results. Sometimes intra-arterial injection of canned blood into the vessels of the affected limb is successfully used. Physiotherapeutic methods include diathermy, UHF, mud therapy, steam pressure chamber, hydrogen sulfide and radon baths, 2-3 courses each, alternating. For syphilis and atherosclerosis - appropriate treatment and diet. Among the surgical methods proposed are periarterial sympathectomy (see), epinephrectomy; in the gangrenous phase - amputation.

The main cause is circulatory disorders in the lower extremities, due to which there is a deficiency of cell nutrition and gas exchange. The pathological condition is dangerous and requires careful examination and correct therapeutic actions.

Pain may occur over the entire surface of the lower limb. The most common location is the calf muscles. This is explained by the fact that a venous “pump” is concentrated in the lower part of the leg, which pushes the blood to move through the veins back to the heart, delivering carbon dioxide.

The intensity of the pain syndrome is so great that the person cannot move independently. At the beginning of the disease, the pain goes away with prolonged rest. If the condition of the blood vessels worsens over time, the pain becomes constant.

The syndrome of intermittent claudication cannot be ignored; not only the vessels in the lower extremity girdle area are affected, the brain and heart muscles suffer from ischemic manifestations. Serious complications can include myocardial infarction, stroke, and amputation of a limb in critical condition.

Causes

Intermittent claudication appears in pathologies based on arterial insufficiency, which occurs for various reasons:

Atherosclerosis is a vascular pathology with a chronic course. The muscle tissue of blood vessels is affected due to impaired metabolic reactions involving fats and carbohydrates. On the inner surface of the vessel wall, accumulations form in the form of plaques, which close the lumen of the vessel, reducing its throughput.
Takayasu's disease is an inflammatory disease that affects the walls of large arterial vessels. The conflict of immune cells with their own healthy tissues causes an autoimmune process. The pathology leads to complete closure of the vessel with subsequent cessation of blood flow.
Endarteritis is a chronic disease leading to vascular gangrene, localized in the vascular system of the lower extremities.
Angiopathy in diabetes mellitus is a complication of endocrine disease. Vessels are affected when blood sugar levels are high.
Thromboangiitis obliterans - damage to small and medium-sized veins and arteries. Appears in immune disorders that cause pathological processes of self-destruction.
Raynaud's syndrome is impaired blood circulation in the peripheral parts. The main symptom is that during a spasm, the skin on the phalanges turns pale and then acquires a bluish tint. At this time, blood stops flowing through small capillaries; when blood flow is restored, the skin returns to its usual shade.
After trauma or frostbite of the lower extremities, blood circulation is disrupted.
Poisoning with manganese and arsenic contributes to the appearance of intermittent claudication.
Infections caused by streptococci, chlamydia, viruses.

Kinds

Depending on the nature of origin, the following forms are distinguished:

Caudogenic (peripheral), another name is neurogenic peripheral claudication, appears with atherosclerosis, endarteritis, diabetic angiopathy, is accompanied by pain on exertion, pale skin on the legs, decreased pulse in the arteries, and the appearance of non-healing ulcers;
Vascular (spinal), considered true - small vessels that provide nutrition to the spinal cord are affected, the cause of development is syphilis and myelitis.

Each of the forms is united by the presence of pain and discomfort while walking or running. Caudogenic intermittent claudication, in addition to the above symptoms, includes sensory disturbances in the form of numbness of the surface layers and the appearance of a slight tingling and burning sensation, reminiscent of goosebumps.

Symptoms

Intermittent claudication is a consequence of poor circulation. Therefore, there are several stages of the disease with symptoms characteristic of each period:

The first stage is characterized by the appearance of fatigue, a feeling of aching below the knee, burning and painful symptoms of intermittent claudication, having covered 1 km at a calm pace on level ground. During rest, the legs become cold to the touch, the pulse in the foot area is weakly determined.
Second stage: the pathology moves into the period of trophic disorders with the progression of pathological changes in the vessels. The skin becomes dry and flaky, areas of keratinized layers of skin appear on the soles of the feet, and nails and hair do not grow on the feet. The nail plate changes color to brown, small muscles atrophy. Intermittent claudication is a consequence of physical activity of no more than 200 meters.
Third stage: the skin on the legs becomes thin and sensitive, with the slightest damage, non-healing wounds and scratches appear. Intermittent claudication syndrome occurs at rest and is permanent.
In chronic ischemia of the lower extremities, when adequate therapy is not carried out and the process continues to progress, the stage of necrosis develops. The phalanges of the fingers are the first to suffer, with a transition to the overlying tissues. Ulcers with a dirty gray coating form, inflamed around the perimeter. These are signs of developing gangrene, the outcome of which will be high amputation of the limb.

Intermittent claudication is a consequence of narrowing of the lumen of the vessel. The degree of damage to the arteries varies:

high level in case of damage to the main main vessels - the aorta and arteries in the iliac region, while the pain is localized in the buttock and thigh;
the middle level is located on the femoral and popliteal arteries, pain occurs in the calves;
low level - blood flow to the lower leg is blocked, intermittent claudication affects the feet.

Lameness, additional characteristic symptoms:

The patient's leg is lame due to severe pain. In adults, the symptom appears quite often. If after vaccination a child limps and complains of pain, it is necessary to urgently show him to a doctor, as there may be a circulatory disorder due to improper manipulation technique or as a complication during vaccination.
Insufficient calcium in the bones causes the condition of osteoporosis, in which voids appear, and the property of increased bone fragility.
The consequence of impaired blood flow is a symptom such as alopecia. Areas appear on the legs where the skin falls out and no longer grows due to an acute lack of cell nutrition.
Atrophic changes in tissues are manifested by the complete disappearance of muscle tissue and subcutaneous fat. When you apply strong pressure to the toe or heel area, a dent is left that does not straighten out in a short period. This phenomenon is called an “empty” heel or toe.

Diagnostics

To determine the disease, you will need to conduct diagnostic tests prescribed by your doctor. Collecting an anamnesis and listening to complaints is carried out at the first examination. Visualization of the surface of the legs and feet will allow you to preliminarily determine the degree of damage: brittle nails, pale skin, lack of hair on the fingers and shins.

Carrying out specialized tests will help establish the diagnosis:

Opel test: in a lying position, raise both legs to a height of 30 cm and fix the position for 1.5 minutes, bluish areas will appear on the legs;
Burdenko's test: bend and straighten one leg at a fast pace 8 times; with poor blood circulation, the skin will turn pale and unevenly colored;
Palchenkov's test: sit on a chair with your legs crossed, after a quarter of an hour the leg turns blue.

Ultrasound examination of blood vessels will allow us to study changes in the vascular wall from the inside. Angiography is an X-ray examination of blood vessels. Doppler ultrasound evaluates the volume of blood passing through the vessels.

Treatment

How to get rid of intermittent claudication? It is impossible to recover from this condition; the modified vessels remain like this for the rest of your life. Treatment of intermittent claudication involves preventing the condition from progressing in order to prolong work capacity and the ability to move independently.

The process of conservative treatment accompanies a person throughout his life. With the active transition of the disease to the second and third stages, surgical treatment may be prescribed. The stage of formation of necrotic masses leads to their partial removal or amputation of the leg.

Medicines

Disaggregants (Aspirin, Prasugrel, Clopidogrel) prevent the formation of blood clots by thinning the blood.
Lipid-lowering drugs (Atorvastatin, Simvastatin) to regulate lipid metabolism.
You can influence the stabilization of metabolic processes with the help of fortified complexes and with the help of tissue regeneration stimulators Actovegin, Kudesan, Elkar.
Prostaglandins will help relieve inflammation in blood vessels - Alprostat, Thrombo Ass.
To improve immunity, Polyoxidonium, Panavir, Viferon are recommended.

Physiotherapy

Intermittent claudication is amenable to restorative treatment using modern physical therapy methods. In the absence of thrombus formation, massage courses can be carried out. Therapeutic sessions will improve blood circulation, raise the tone of skeletal muscles, and improve sensitivity in the legs.

Magnetic therapy is carried out by applying an electromagnetic field to diseased limbs. The therapeutic effect is achieved by the end of the full course and persists until the next hardware treatment.

Therapeutic gymnastics is carried out under the supervision of a physical therapy instructor. The set of exercises and technique are explained by a specialist. Exact adherence to the instructions and dosing of the therapeutic load will ensure a positive result.

Hydrogen sulfide baths will saturate sore legs with the necessary chemical elements that restore metabolism and trigger the natural course of biochemical reactions.

Operation

Surgical treatment is performed to improve blood flow in areas susceptible to ischemia. Surgical treatment of intermittent claudication is carried out in the following ways:

mechanical cleansing of the inside of the affected vessel to restore optimal lumen;
excision of the damaged segment with replacement with an artificial vessel or transplantation of part of one’s own vein;
creating a bypass section of blood circulation to bypass the damaged area;
stenting – the vessel is forcibly expanded with the introduction of an endoprosthesis.

Traditional methods

Traditional treatment involves using natural ingredients to prepare healing compounds. Before using grandma's recipes, you should consult your doctor to avoid unforeseen conditions that could worsen the condition.

Contrasting foot baths using pine decoction will improve the condition, have an analgesic and anti-inflammatory effect, and strengthen the walls of blood vessels. Brew the pine needles in hot water and let it brew for a couple of hours. Place two containers with hot and cool solution. Immerse your feet in turn in two baths. Keep in cool water for no more than 3 minutes, in warm water - 10 minutes.
Grind the horse chestnut fruits to a powder. Pour two tablespoons into a bowl, add three tablespoons of algae and 4 tablespoons of hop cones. Steam one spoonful of the mixture with a glass of boiling water and drink it throughout the day, dividing it into three doses.

Prevention

lead a healthy lifestyle, avoiding cigarettes and alcoholic beverages;
promptly treat chronic pathologies and infectious diseases;
dose physical activity;
maintain normal body weight;
See a doctor at the first sign of discomfort.

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 severe pain in the legs both when walking and in a calm state, which is why the person begins to limp.

Approximately one and a half million residents of Russia suffer from PH syndrome, among whom about one hundred thousand are diagnosed with ischemic leg disease. The number of limb amputation operations annually exceeds 40 thousand.

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

Most often, the anomaly develops in adults, mainly older people. Men are especially susceptible to the disease, as they are more prone to atherosclerosis. And the presence of bad habits, an irregular daily routine and rare visits to specialists in medical institutions only increase the risk of developing PC.

The main causes of the syndrome include the following pathologies:

Atherosclerosis. In approximately nine out of ten patients, the anomaly is a consequence of atherosclerotic vascular damage. Damage to the aorta, iliac and femoral arteries leads to a decrease in the amount of oxygen 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 significantly already during the first stage 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 extremities is insufficient. One of the representatives of vasospastic diseases is Raynaud's syndrome.
Obliterating vascular diseases. and obliterating endarteritis are a consequence of the inflammatory process in the wall of the vessel, reducing its lumen. These pathologies are characterized by symmetry of damage to the limbs.
Occlusive thrombosis. In its advanced form, the anomaly causes vascular obstruction due to the almost complete closure of their lumen in a certain area.

Other factors that provoke venous intermittent claudication syndrome include:

severe intoxication;
long-term infections;
frequent;
hereditary predisposition;
injuries;
regular hypothermia;
obesity;
physical inactivity;
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 roots of the cauda equina, usually with narrowing of the spinal canal at the level of the lumbar spine. Lameness can be either congenital or acquired. In the second case, caudal syndrome occurs against the background of exacerbation of osteochondrosis or spondylopathy.
Vascular (vascular). This form is characterized by damage to the walls of blood vessels and disruption of their structure. As a result, tissues do not receive enough 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 disease development, which help determine further treatment tactics:

Stage 1. The patient has already identified various abnormalities in the functioning of the circulatory system, but he does not yet experience pain while walking. The main symptom of PH here is the discomfort that occurs in the legs after a long walk or when climbing stairs. Quite often the stage goes unnoticed, so the disease actively progresses. It can be observed only on one leg - left or right, or maybe on both.
Stage 2. 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 requires conservative treatment.
Stage 3. Is critical. Discomfort in the lower extremities does not disappear even at rest, while the skin acquires a bluish tint and signs of blood stagnation develop. Urgent surgery is necessary to save the limb.
Stage 4. Leads to tissue necrosis of the affected area and gangrene. It is impossible to do without surgical intervention, as the risk of patient death 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 discomfort, typical symptoms include decreased skin sensitivity and mild weakness, which is often confused with ordinary fatigue. We recommend that you watch the video on the topic:

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

Pain in the foot and 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 occlusion of the abdominal aorta.

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

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

paleness of the skin;
reducing the temperature of the feet;
the appearance of trophic ulcers on the legs;
absence of pulse in the arteries of the lower extremities.

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

How to diagnose?

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

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

Then the following types of examination 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 disturbances;
transcutaneous oximetry, aimed at calculating 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 PC is carried out with pseudo-intermittent claudication. About 90% of all cases of the syndrome are caused by canal obliterating endarteritis.

How to treat the disease?

Treatment of patients with PC from the point of view of modern ideas about the pathogenesis of COZANK 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 surgery to correct blood flow, conservative therapy should still continue.

Among the areas of medicinal influence there are:

Prevention of thrombosis and thromboembolism. It is necessary to take Aspirin Cardio or Thrombo Ass tablets.
Taking medications that dilate blood vessels. “Sulodexide” and “Pentoxifylline” - such drugs improve microcirculation in the arteries and reduce blood viscosity.
Increased metabolism in affected tissues. The drug "Naftidrofuril" stimulates metabolism, which helps to walk long distances painlessly.
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 drugs.
Correction of blood pressure. To do this, you need to take Enalapril and Enalacor. Such medications not only normalize blood pressure, but also prevent the risk of heart pathologies and hemorrhages.

If the patient requires surgery, but it is not yet possible, he 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 of limb amputation.

Along with medication, 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, and observe good foot hygiene. Patients with diabetes need to take care of their diet and strict control of sugar levels.

Special therapeutic walking is also recommended, since movement stimulates blood circulation in the lower extremities. Walking should continue until your legs begin to hurt. Afterwards, you should rest and continue walking again. Walking in the fresh air should be done 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 effect is 12 weeks. The complex of therapeutic measures includes physical therapy exercises. They should range from strength training to walking with poles 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 final stages of development. Most often, the operation is performed 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 operations are recommended to create a bypass path for blood flow using one’s own blood vessels or artificial prostheses.

To improve blood supply to the lower extremities and reduce the number of trophic ulcers, lumbar sympathectomy can be performed. The operation is necessary when it is impossible to perform vascular bypass. But the prognosis of the procedure is often unpredictable, so the intervention is considered a backup option for a limited number of patients.

Traditional medicine

Folk remedies for treating the syndrome include:

mud lotions on feet;
mustard baths;
applications from various types of clay;
bee therapy;
rubbing ointment made 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 traditional medicine alone. Medication is also necessary. Before starting to use traditional medicine advice, you should definitely consult with your doctor.

Preventive actions

To prevent the development of an anomaly, you should:

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 amputation of a limb.

Intermittent claudication (IC, intermittent claudication) is a common and very dangerous pathology, which, however, is not always given due attention by doctors. According to various sources, About one and a half million Russians suffer from PC, approximately one hundred thousand are diagnosed with critical illness, and the number of amputations due to the disease reaches 40 thousand per year.

The main cause of PC is considered to be PH, which in most patients also has another location - the heart, blood vessels of the brain, and kidneys. While paying close attention to these forms of atherosclerosis, doctors often do not concentrate on diagnosing and treating intermittent claudication, which progresses, leading to severe disability and even death.

Pain in the legs when walking bothers many, but at best, half of patients see a doctor with this symptom. Meanwhile, their risk of myocardial infarction increases to 60%, and the likelihood of dying from heart disease is six times higher than for other people who do not suffer from vascular disease in the legs.

Intermittent claudication syndrome requires active medical and surgical tactics. When diagnosing PC in the stage of critical ischemia in the first six months from the moment of its establishment, the limb can be saved in only 40% of patients, the same number of patients will undergo amputation, and the remaining fifth of patients will die, therefore early detection of pathology is the primary task of practicing doctors.

Causes of PC syndrome

atherosclerosis: the main cause of PC syndrome

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

Diabetic macro- and without concomitant atherosclerosis.
Autoimmune vascular damage ().

In nine out of ten patients, intermittent claudication is a consequence of atherosclerotic artery disease. At the same time, it is very likely that there are other forms of atherosclerosis. Diabetic angiopathy considered as a cause of PC syndrome if it is isolated and not associated with atherosclerosis. At the same time, diabetes increases the likelihood of lipid disorders and fatty deposits in the arteries.

Other causes of the disease include endarteritis, trauma, infection and intoxication, hypothermia, gout, although these conditions are much less common among the “provocateurs” of PC.

Elderly people, mainly men, are more susceptible to pathology. Actually, atherosclerosis of other localizations is also diagnosed more often in them than in women. In addition, men are more prone to violating the regime, bad habits and rare visits to specialists.

The main mechanism provoking PC syndrome is considered to be vascular spasm. The narrowed lumens of the already damaged arteries cannot deliver the required volume of blood to the limb; the tissues experience hypoxia, which worsens with increased load (walking). Hypoxia has a negative effect on nerve endings, as a result of which the spasm intensifies even more.

Features of symptoms

The main symptom of intermittent claudication syndrome is pain in the legs when walking. Before its appearance, problems with blood vessels are indicated by weakness and rapid fatigue, a feeling of crawling and decreased skin sensitivity. Over time, arterial blood deficiency increases, and fatigue gives way to pain.

Typically, pain occurs when the patient walks. The gait changes, the patient limps, and is forced to stop and rest. During the stop, the pain decreases somewhat, but in severe stages, even rest does not bring relief - the pain becomes constant. Usually the disease is unilateral, but it can affect both legs at once.

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

Decreased skin temperature, pallor and cyanosis;
Disappearance of the pulse in the arteries of the foot.

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

Depending on the cause of PH syndrome, two forms of pathology are distinguished:

Peripheral.
Spinal.

Peripheral PC 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, and the pulse in the arteries disappears. In the severe stage, trophic ulcers appear.

Spinal shape develops when small vessels supplying the gray matter of the spinal cord are damaged. It is characteristic of some chronic diseases (myelitis, syphilis) and may be their early symptom.

Video: lameness and its causes at different ages, “Live Healthy” program

Diagnosis and treatment

To correctly diagnose intermittent claudication, an examination and conversation with the patient is usually sufficient. Characteristic signs of pathology immediately prompt the doctor to think about obliteration of the arteries of the legs.

To confirm his assumptions, the specialist will palpate the pulse and examine the limbs, as well as a series of instrumental tests:

Determination of pressure on the ankle and shoulder (normally the same);
Angiography;
CT, MRI;
Ultrasound examination with Dopplerography.

Treatment of intermittent claudication is carried out in two directions: drug support And surgical care. Conservative treatment is indicated for all patients without exception, regardless of the stage, extent of the disease, degree of vascular damage, and it is prescribed for life.

If the patient has undergone surgery to correct blood flow, this does not mean that conservative treatment is no longer necessary; it must continue. Isolated therapeutic care for intermittent claudication is permissible only if surgery is impossible for some reason.

The goals of treatment for PC are to improve the quality of life of patients and reduce the risk of developing severe cardiovascular complications, such as myocardial infarction and stroke. Conservative therapy includes not only the prescription of medications, but the elimination of risk factors for the disease, primarily smoking.

In parallel with quitting smoking, all patients without exception are prescribed physical activity in the form of measured walking. Despite its apparent simplicity and accessibility, this method of treatment shows high effectiveness even with severe degrees of arterial blood flow impairment in the legs.

Walking promotes muscle development, improves blood circulation and the condition of vascular walls. It is prescribed at least three times a week with sessions lasting up to 45 minutes. The patient walks as long as the pain is bearable, and only when maximum pain is reached does it stop.

When prescribing dosed walking, the patient should be patient and hope for improvement. The minimum duration of such treatment is 12 weeks, improvement occurs by the end of the first month of training, and the maximum positive effect lasts three or more months. It is important not only the attention of the doctor, but also the desire of the patient himself to fight the disease, following all the instructions and changing his lifestyle.

Conservative treatment

Directions of drug therapy:

Prevention of complications associated with and (heart attack, stroke);
Correction of blood glucose levels;
Normalization of blood pressure;
Improving trophism and metabolism in damaged tissues.

The lipid spectrum can be normalized using drugs from the group (simvastatin, lovastatin, etc.). They are indicated for all patients with PC, but it is worth noting that the degree of arterial damage is not always proportional to lipid metabolism disorders.

Glycated hemoglobin formed during atherosclerosis and other metabolic disorders greatly contributes to damage to the vascular endothelium, so maintenance is an extremely important component of treatment. In the absence of diabetes, it is enough to control glucose levels, but in case of diabetes, therapy is necessary hypolipidemic drugs and insulin until normoglycemia is achieved.

Since patients with pathology of carbohydrate metabolism are very susceptible, they should carefully monitor the condition of the skin of the lower half of the legs, observing hygiene procedures and motor regimen.

An equally important component of treatment is the normalization of blood pressure. If, in addition to PC, there is no concomitant pathology, then the pressure should not exceed 140/90 mm Hg. Art. In case of hypertension, cardiac ischemia, diabetes, chronic heart or renal failure, the recommended maximum pressure is 130/80 mmHg. Art.

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

To improve the rheological parameters of blood are indicated. The most popular are drugs based on acetylsalicylic acid (thrombo Ass, aspirin cardio). Oral anticoagulants are not prescribed to patients with PC, as there is a high risk of cardiovascular complications.

In order to correct metabolic disorders in tissues, it is used pentoxifylline 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 pain appears.

Improves blood flow, reduces blood viscosity, normalizes the condition of the endothelium. sulodexide. Previously, it was prescribed only for critical tissue ischemia, but today it is also recommended for PC. It has been shown that when administered orally and intravenously, the distance that the patient travels before the onset of pain almost doubles.

Endothelial function can be improved by angiotensin-converting enzyme inhibitors (perindopril), beta-blockers (nebivolol), and angiotensin II receptor blockers (losartan). Considering the presence of hypertension and cardiac pathology in many patients, they are all the more appropriate and not contraindicated in the case of PC syndrome.

New and promising methods currently in clinical trials include the use of gene therapy drugs and stimulation of nitric oxide production with the help of its precursors. The research is bearing fruit: the gene therapy drug neovasculgen has already been registered for use in Russia, the effectiveness and safety of which have already been proven. The use of neovasculgen leads to an increase in pain-free walking distance by one and a half times after a year.

If surgical treatment is not possible, then the treatment regimen must include drugs based on prostaglandins (beraprost, iloprost) and prostacyclins, which help reduce pain, regenerate trophic ulcers, and even make it possible to postpone leg amputation for some time.

Operation

Surgery- a radical method, but does not eliminate the need to take medications. The extent of the operation depends on the stage of the disease and the degree of blood flow disturbance. In severe cases, when ischemia reaches a critical level, ulcers and gangrene develop, and amputation is performed.

Stenting is considered minimally invasive. Angioplasty involves inserting a balloon into the vessel, which inflates and increases the lumen. Often the operation is complemented by the installation of a stent. During endarterectomy, part of the inner lining of the artery is removed in the place where the atherosclerotic process is most pronounced.

If it is impossible to carry out surgical treatment, but there is a prospect of saving the limb, bypass operations are indicated, when a bypass path of blood flow is created using artificial prostheses or one’s own vessels.

Intermittent claudication syndrome is an incurable pathology, but can be treated with medication, which can slow the progression of vascular damage. Early diagnosis and the patient’s compliance with all recommendations give a chance to save the limb, therefore, even if the doctor himself did not ask about pain when walking, you must inform him about this sign of a serious disease.