Claudication: leg pain when walking

What is claudication, and how common is it?

Intermittent claudication (usually just called claudication) is cramp-like pain, aching or tiredness in the leg muscles, most often the calf. It comes on when you walk and eases when you rest¹. A typical pattern is walking a certain distance, resting for a few minutes, then walking a similar distance again². It can also affect the thigh or buttock², and some people feel it in the feet³.

It's usually caused by peripheral arterial disease (PAD), where fatty deposits narrow the arteries that supply your leg muscles⁴. PAD is common: up to 20% of adults over 55 have detectable PAD, but only a small proportion of them have claudication⁵. About one-third of people with PAD have typical claudication⁶. It appears more common in men⁷.

Leg pain on walking has many possible causes, so it's worth having it assessed rather than assuming it's ageing or an ordinary cramp.

What can cause leg pain when walking?

The most common cause is PAD from atherosclerosis (a build-up of fatty plaques in the artery walls). Narrowed arteries can't deliver the extra blood your leg muscles need when you walk, so pain sets in¹. Smoking is the strongest risk factor, followed by diabetes, high blood pressure and high cholesterol⁸. Older age and a family history of cardiovascular disease also raise the risk⁹.

Where it hurts depends on where the narrowing is. Calf pain is the most common; thigh or buttock pain can mean narrowing higher up².

Other conditions can cause similar pain on walking, including spinal or nerve problems⁶. Where the pain is, what brings it on and what eases it all help tell them apart. But the pain pattern alone isn't enough, so your clinician will also check your circulation¹⁰.

How is the cause found?

A podiatrist or GP will ask about your leg pain: where it is, how far you can walk, what eases it and whether it's changing. They'll also ask about smoking, diabetes, blood pressure and cholesterol⁶. They'll check the pulses, skin colour and temperature of your legs¹.

The usual test compares the blood pressure in your arm and your ankle (the ankle brachial pressure index)⁴. If you have diabetes or chronic kidney disease, the ankle result can be unreliable because the vessels may be stiff. A test using the pressure in your toe can be more reliable⁶¹¹. A normal-looking ankle result shouldn't be used to dismiss symptoms that fit⁶.

What can I do first?

Guidelines strongly recommend stopping smoking, structured exercise, and medicines to lower cholesterol and reduce clots as first-line care¹². Surgery isn't the starting point.

• Stop smoking. Ask your GP for stopping-smoking support.
• Follow a structured exercise programme. In people fit for exercise, these improve how far you can walk before pain starts and your maximum walking distance¹³. Supervised programmes improve walking distance more than home-based programmes or walking advice¹⁴. If a supervised one isn't available, structured community or home programmes are also supported⁶. General advice to "go out and walk" hasn't been shown to work⁶. Ask your GP what's available locally.
• Ask about medicines. A GP or pharmacist can explain them. Don't start or stop any without medical advice.

Stop exercising and speak to a healthcare practitioner before restarting if you get new or worse chest pain, dizziness, palpitations or breathlessness¹⁵. A heart check before starting an unsupervised programme may be sensible¹⁶. Home exercise advice doesn't apply if you have pain at rest or a foot sore; see the warning signs below¹⁶.

What if that isn't enough?

If walking is still severely limited after risk-factor changes and exercise, and it affects your daily life, your GP may refer you to a vascular (blood vessel) team¹⁷. Referral suits people who are medically fit and would consider a procedure to restore blood flow¹⁷. Most people with claudication are best managed without a procedure, because the risks usually outweigh the benefits². If you're considering one, ask the vascular team about its risks and benefits compared with continuing exercise and medical care.

Does it get better, and how do I stop it coming back?

Walking distance usually improves with weight loss, regular exercise and stopping smoking². But claudication also suggests the arteries to your heart and brain may be narrowed, so a heart attack or stroke is more likely¹. PAD can lead to rest pain, wounds, gangrene and amputation¹¹.

The main risk factors you can change are smoking, diabetes, high blood pressure and high cholesterol⁸. Work with your GP on each of them, and have your overall heart risk reviewed regularly, even when your walking improves. These steps lower risk; they can't guarantee symptoms won't return.