Intermittent claudication

Walking difficulties, pain in the legs or a shorter walking distance may be signs of intermittent claudication, often caused by reduced blood circulation in the lower limbs or narrowing of the spinal canal. At Aava’s Walking Clinic, specialists in vascular surgery, orthopaedics, neurology and physiotherapy investigate the cause of your symptoms and tailor the treatment to your needs, from walking exercise and medication to procedures that may require surgery. The care pathway begins with an initial assessment by a physiotherapist. Based on this assessment, you are referred to the appropriate specialist. Early assessment significantly improves the prognosis.

Contents

• What is intermittent claudication and why does walking become difficult?
• Causes of intermittent claudication – what causes walking difficulties?
• Symptoms of intermittent claudication – when should you seek help?
• Aava’s Walking Clinic – comprehensive assessment and treatment
• Examination and diagnosis of intermittent claudication
• Treatment options for intermittent claudication
• The role of lifestyle in treating walking difficulties
• Who benefits from the Walking Clinic?
• Frequently asked questions (FAQ)
• How to book an appointment at Aava’s Walking Clinic
• Related services at Aava

What is intermittent claudication and why does walking become difficult?

Have you noticed that when you walk, your calves or thighs start to hurt, feel tight or become so tired that you have to stop and rest? The cause may be intermittent claudication, due to reduced arterial circulation in the lower limbs or spinal stenosis. After resting, the pain usually eases and you can continue walking until the pain returns.

Intermittent claudication is not just an inconvenient symptom. In artery-related disease, it is caused by narrowed or blocked arteries of the lower limbs, preventing the muscles from getting enough oxygen during exertion. In spine-related disease, the cause is spinal stenosis, where narrowing of the spinal canal compresses the spinal nerves and causes pain in the back and/or lower limbs.

These are, however, only a few of the possible causes of walking difficulties, as they can also be caused by osteoarthritis or other musculoskeletal problems, central nervous system disorders or other nerve damage, rheumatic diseases or heart failure. This is why getting the right diagnosis is important, and treatment is always tailored according to the underlying cause. At the Walking Clinic, your individual situation is assessed carefully.

Aava’s Walking Clinic has been created for you: it is a place where the cause of walking difficulties is investigated systematically and comprehensively, so that you receive the right help at the right time.

Causes of intermittent claudication – what causes walking difficulties?

Walking difficulties are common, especially from middle age onwards, but they can have many different causes. One of the key tasks of the Walking Clinic is to distinguish between two common causes: vascular claudication, meaning circulation-related claudication, and neurogenic claudication, meaning nerve-related claudication.

Vascular claudication – narrowing of the arteries

When atherosclerosis builds up in the arteries of the lower limbs, the blood vessels gradually narrow. During exertion, the muscles do not receive enough oxygen, which causes pain or cramp-like symptoms. Risk factors for atherosclerosis include smoking, diabetes, high blood pressure, high cholesterol and ageing.

Neurogenic claudication – narrowing of the spine

As a result of spinal stenosis, the nerves leaving the spinal cord may become compressed. This can cause radiating pain, numbness or weakness in the legs when walking. The symptoms resemble those of vascular claudication, but the mechanism is completely different. Distinguishing between the two is important because the treatment is different.

Other causes of walking difficulties

• Osteoarthritis in the hip, knee or ankle
• Orthopaedic problems, such as foot malalignment
• Rheumatic diseases, such as inflammatory muscle diseases or muscle weakness
• Heart failure
• Diabetic neuropathy and other neuropathies
• Neurodegenerative diseases, including balance disorders

Symptoms of intermittent claudication – when should you seek help?

Walking difficulties can appear in many ways, and the symptoms are not always immediately recognised as being related to an arterial problem in the lower limbs or a back problem. Recognising the symptoms is important because timely treatment significantly improves the prognosis.

Seek assessment at the Walking Clinic if:

• Walking causes pain, tightness or cramp-like symptoms in the calves, lower legs or thighs
• Symptoms force you to stop and ease with rest
• You feel numbness, tingling or weakness in your legs when walking
• The colour or temperature of the skin on your legs has changed – the skin may be pale, bluish or cool
• Wounds or minor injuries on your legs heal poorly
• Your walking distance has clearly shortened over months or years
• You have rest pain in your legs at night

Especially if your walking distance has clearly shortened or you have constant pain in your legs even at rest, it is important to seek assessment quickly. Untreated arterial disease can progress to a severe stage associated with tissue damage and a risk of gangrene in the toes or foot, which often requires amputation.

Aava’s Walking Clinic – comprehensive assessment and treatment

Aava’s Walking Clinic is a multidisciplinary service designed especially for people with walking difficulties. The clinic brings together expertise in vascular surgery, internal medicine and orthopaedics so that you receive a comprehensive overview of your situation in one place.

At the Walking Clinic, you may be supported by:

• A vascular surgeon, who assesses the condition of the arteries in the lower limbs and the need for treatment
• A spine orthopaedist or neurosurgeon, if a spine-related cause is suspected
• An orthopaedist, if joint damage in the hip, knee or ankle is suspected as the cause of the walking problem
• A neurologist, who investigates and treats central nervous system disorders underlying balance problems
• A specialist in internal medicine or a cardiologist, who assesses the broader arterial disease risk profile and the treatment of cardiovascular diseases
• A rheumatologist, if an inflammatory muscle disease or another rheumatic disease is suspected as the cause of the walking problem
• A physiotherapist, who guides exercise and supports the restoration of functional capacity

The most important thing about Aava’s Walking Clinic is that you do not need to explain your symptoms in several different places. We bring the information together and create a clear treatment plan tailored to you.

Examination and diagnosis of intermittent claudication

The right diagnosis is the basis for treating walking difficulties. At the Walking Clinic, examinations proceed systematically, and we use modern imaging and measurement methods.

Initial interview and clinical examination

The physiotherapist maps your symptoms, their duration, your walking distance and other health information. During the clinical examination, the circulation in your legs, skin changes, pulses and neurological findings are checked.

ABI measurement, or ankle-brachial index

ABI measurement, or ankle-brachial index, is a simple and painless screening method in which blood pressure is measured at the ankle and upper arm. The ratio of the results shows how well blood flows to the lower limbs. A low ABI value suggests narrowing of the arteries.

Ultrasound and duplex ultrasound

An arterial ultrasound examination shows the location and size of arterial narrowings and their effect on blood circulation without radiation. Duplex ultrasound combines imaging of the vessel structure with measurement of blood flow.

Magnetic resonance imaging

To confirm spinal canal stenosis, magnetic resonance imaging of the lumbar spine is carried out. If needed, magnetic resonance angiography may also be used as a further examination for artery-related claudication. It provides a detailed picture of the anatomical situation in the arteries and helps guide the planning of invasive treatment in particular.

Blood tests

Laboratory tests are used to assess cholesterol, blood sugar, kidney function and inflammatory markers. These provide information about overall risk and guide the planning of medication.

Treatment options for intermittent claudication

Treatment of walking difficulties is always individual and depends entirely on their cause and severity. The aim of treatment is to restore functional capacity, relieve symptoms and prevent the disease from progressing.

1. Lifestyle changes – the cornerstone of treatment

Lifestyle changes are an essential part of treatment alongside every other treatment option. Stopping smoking is the single most important action a patient can take. It significantly slows the progression of the disease.

2. Medication

The aim of medication is to manage the risk factors for arterial disease and improve blood circulation. A doctor may prescribe medicines to lower blood pressure, cholesterol and blood sugar, among others.

3. Supervised Exercise Therapy – an effective and often underestimated treatment

Walking exercise is the first-line treatment for artery-related, or vascular, intermittent claudication. Regular, supervised walking exercise develops collateral circulation in the arteries and can significantly increase pain-free walking distance and improve quality of life. Training must be regular and progressive, and physiotherapists play a key role in guiding it.

4. Invasive procedures

If atherosclerotic disease progresses, an invasive procedure may be considered. Depending on the location and nature of the narrowings, treatment may involve percutaneous angioplasty or open surgery.

In an endovascular procedure, a thin catheter with a balloon is inserted through a puncture in the groin and guided through the narrowed area. The balloon is then inflated, opening the blood vessel. This is called balloon angioplasty or PTA, meaning percutaneous transluminal angioplasty. The procedure is often performed under local anaesthesia. If needed, a stent, a small metal mesh tube, is also placed at the narrowed area to keep the vessel open.

In open surgery, an endarterectomy may be performed. This means removing the atherosclerotic inner layer of the artery. Another option is bypass surgery, where a new route for blood flow is created around the blockage using either the patient’s own vein or a synthetic vascular graft.

Sometimes these two methods may be combined in a hybrid procedure, where both open surgery and an endovascular PTA procedure are carried out during the same operation.

In Finland, invasive procedures for atherosclerotic disease are carried out in public hospitals.

The role of lifestyle in treating walking difficulties

Lifestyle plays a central role in the treatment and prevention of walking difficulties, especially those caused by arterial circulation problems. Healthy lifestyle choices do not only slow the progression of the disease but may also significantly improve the situation.

The most important lifestyle recommendations are:

• Stop smoking: Smoking is the strongest single risk factor for the development and progression of lower limb arterial disease. Quitting significantly slows the course of the disease.
• Regular physical activity: Supervised walking exercise in particular is a central part of treatment.
• Blood pressure control: Reducing salt, increasing physical activity and using medication when needed.
• Managing cholesterol levels: A healthy diet and medication when needed.
• Good control of diabetes: Managing blood sugar levels protects the blood vessels.
• Weight management: Maintaining a healthy weight reduces the risk of cardiovascular disease.
• Good foot care: Especially for people with diabetes, monitoring and hygiene of the feet are important for preventing tissue damage.

Who benefits from the Walking Clinic?

The Walking Clinic is suitable for anyone who has challenges with walking ability, regardless of whether the underlying cause is circulation-related, a cardiovascular disease, a musculoskeletal problem or a neurological cause.

The Walking Clinic is especially for you if:

• Walking causes pain or tiredness in your legs
• Your walking distance has clearly shortened
• You have diabetes, high blood pressure or high cholesterol combined with leg problems
• You smoke or used to smoke and have leg-related symptoms
• You have already been diagnosed with arterial disease or have had a coronary artery procedure
• Age-related changes have reduced your walking ability
• You want to find out what is causing your walking difficulties and what can be done about them

At Aava’s Walking Clinic, you meet specialists who listen to you and approach your situation comprehensively. You do not need to know in advance what is causing your symptoms. We will find out together.

Frequently asked questions (FAQ)

What does intermittent claudication mean?

Intermittent claudication is a symptom in which walking causes pain, tightness or cramps in the lower limbs, usually in the calves or lower legs, forcing the person to stop and rest. The pain eases with rest but returns when walking continues. Intermittent claudication may be caused by reduced arterial circulation in the lower limbs, known as vascular claudication, or by narrowing of the spinal canal, known as neurogenic claudication.

How far is it normal to walk before pain starts?

Normally, a person can walk several kilometres without pain in the lower limbs. In intermittent claudication, the distance before pain starts varies from around one hundred metres to several kilometres, depending on the extent of arterial blockages. When symptoms start after only a few dozen metres, assessment for invasive procedures becomes relevant.

How is intermittent claudication diagnosed?

The diagnosis is based on the symptom history, a clinical examination and different measurements. The most important screening method is ABI measurement, or ankle-brachial index. If artery-related disease is suspected, the first-line examination is duplex ultrasound. If a spine-related cause is suspected, the first-line examination is magnetic resonance imaging.

Can intermittent claudication be treated without surgery?

Yes, in many cases. In artery-related claudication, supervised walking exercise is a highly effective treatment that can significantly improve quality of life and symptom-free walking distance. Medication is used to manage risk factors. In mild or moderate cases, conservative treatment is often sufficient. In more severe cases, balloon angioplasty, open surgery or a combination of the two may be needed. In spine-related claudication, symptoms can also improve with walking exercise and invasive surgery is not always needed.

What is the difference between vascular claudication and spine-related claudication?

In vascular claudication, pain begins when walking or climbing stairs and eases quickly after stopping. In spine-related, or neurogenic, claudication, symptoms may ease more slowly and often require leaning forward. For example, walking uphill or cycling is often tolerated better than walking on level ground. Differential diagnosis is important because the treatment is different.

Is intermittent claudication dangerous?

Intermittent claudication is an important warning sign. If untreated, lower limb peripheral arterial disease can progress to a severe stage involving rest pain, skin ulcers or tissue damage, and even a risk of amputation. Arterial disease is also generally associated with an increased risk of heart attack and stroke. This is why it is important to investigate symptoms and start treatment. By contrast, progression of spinal canal stenosis can also, in very rare cases, lead to permanent paralysis.

When should I seek care for walking difficulties?

Book an appointment with a physiotherapist or doctor if you repeatedly experience leg pain when walking, your walking distance has shortened, you have rest pain in your legs, wounds heal poorly or there are changes in the colour or temperature of the skin on your feet. Urgent assessment is needed if the pain is sudden and severe, or if the leg is cold, pale and painful.

What happens at the first visit to the Walking Clinic?

At the first visit, the physiotherapist interviews you carefully and performs a clinical examination. In addition, a nurse carries out an ABI measurement and the necessary blood tests are taken. Based on these examinations, an appointment is booked with a specialist, who will also arrange or perform any imaging examination needed as a further investigation of your symptoms.

How to book an appointment at Aava’s Walking Clinic

Walking difficulties should always be investigated, because early assessment and treatment significantly improve the prognosis. You can access Aava’s Walking Clinic easily:

Book online: Visit aava.fi and book an appointment with the Walking Clinic physiotherapist. Tell us about your walking difficulty when booking, so that you can be directed to the right specialist.

Call our booking service: You can also call Aava’s booking number on 010 380 3838. We will help you find the most suitable time and the right specialist.

Occupational health: If Aava is your occupational health provider, you can also book an appointment through an occupational health doctor or nurse. They will assess your situation and, if needed, refer you to the Walking Clinic care pathway.

Remember: you do not need to know in advance what is causing your symptoms. Contact us and we will help guide you in the right direction. You are important, and your walking difficulties deserve expert assessment.

Related services at Aava

The Walking Clinic is connected to several Aava services. You may also want to explore:

• Vascular surgery
• Internal medicine
• Orthopaedics and traumatology
• Physiotherapy
• Neurology services
• Cardiovascular examinations
• Rheumatic diseases
• Laboratory tests
• Imaging examinations – ultrasound and magnetic resonance imaging
• Diabetes care
• Occupational health