Definition Intermittent claudication: A symptom of peripheral arterial disease (PAD) characterised by muscle pain (often calf pain) that occurs during physical activity and is relieved by rest. Etiology & Pathophysiology Caused by reduced blood flow to the leg muscles due to atherosclerosis in the peripheral arteries. Insufficient oxygen supply (ischaemia) to the muscles during activity. Risk Factors Smoking. Diabetes mellitus. Hyperlipidaemia. Hypertension. Age over 50. Family history of cardiovascular diseases. Clinical Presentation Pain, cramping, or fatigue in the leg muscles (often calves) during walking or exercise. Relief of symptoms with rest. Decreased or absent pulses in the affected limb. Atrophic skin changes, hair loss on the leg. Delayed wound healing, especially on feet. Investigations Ankle-brachial index (ABI): Ratio of blood pressure at the ankle to the arm. A decreased ratio indicates PAD. Doppler ultrasound: Evaluates blood flow and identifies blockages or narrowing. Angiography (either magnetic resonance angiography or contrast angiography). Treadmill exercise test to reproduce symptoms and measure severity. Management Conservative: Supervised exercise programmes to improve walking distance. Medical: Antiplatelet agents (e.g., aspirin or clopidogrel) and statins to reduce cardiovascular risk. Interventional: Angioplasty with or without stent placement, bypass grafting. Complications Progression to critical limb ischaemia. Increased risk of myocardial infarction and stroke due to systemic atherosclerosis. Prevention Smoking cessation. Regular exercise. Control of blood sugar, cholesterol, and blood pressure. Maintaining a healthy weight and diet.
