Intermittent claudication is cramping limb pain brought on by exercise and relieved by 1 to 2 minutes of rest.
This pain may be acute or chronic; when acute, it may signal acute arterial occlusion.
Epidemiology:
Intermittent claudication is most common in men ages 50 to 60 with a history of diabetes mellitus, hyperlipidemia, hypertension, or tobacco use. Without treatment, it may progress to pain at rest. With chronic arterial occlusion, limb loss is uncommon because collateral circulation usually develops.
Pathogenesis:
With occlusive artery disease, intermittent claudication results from an inadequate blood supply. Pain in the calf the most common area or foot indicates disease of the femoral or popliteal arteries; pain in the buttocks and upper thigh, disease of the aorto iliac arteries. During exercise, the pain typically results from the release of lactic acid due to anaerobic metabolism in the ischemic segment, secondary to obstruction. When exercise stops, the lactic acid clears and the pain subsides.
Causes:
Aortic arteriosclerotic occlusive disease:
With this disorder, intermittent claudication occurs in the buttock, hip, thigh, and calf, along with absent or diminished femoral pulses.
Arterial occlusion (acute):
This disorder produces intense intermittent claudication. A saddle embolus may affect both legs. Associated findings include paresthesia, paresis, and a sensation of cold in the affected limb. The limb is cool, pale, and cyanotic with absent pulses below the occlusion. Capillary refill time is increased.
Arteriosclerosis obliterans:
This disorder usually affects the femoral and popliteal arteries, causing intermittent claudication (the most common symptom) in the calf. Typical associated findings include diminished or absent popliteal and pedal pulses, coolness in the affected limb, pallor on elevation, and profound limb weakness with continuing exercise. Other possible findings include numbness, paresthesia and, in severe disease, pain in the toes or foot while at rest, ulceration, and gangrene.
Buerger's disease:
This disorder typically produces intermittent claudication of the instep. Men are affected more than women; most of the affected men smoke and are between ages 20 and 40. Early signs include migratory superficial nodules and erythema along extremity blood vessels (nodular phlebitis) as well as migratory venous phlebitis. With exposure to cold, the feet initially become cold, cyanotic, and numb; later, they redden, become hot, and tingle. Occasionally, Buerger's disease also affects the hands and can cause painful ulcerations on the fingertips. Other characteristic findings include impaired peripheral pulses, paresthesia of the hands and feet, and migratory superficial thrombophlebitis.
Cauda equina syndrome:
Spinal stenosis causes pressure on nerve roots resulting in symptoms of claudication from the hip down as with Leriche's syndrome.
Neurogenic claudication:
Neurospinal disease causes pain from neurogenic intermittent claudication that requires a longer rest time than the 2 to 3 minutes needed in vascular claudication. Associated findings include paresthesia, weakness and clumsiness when walking
Investigations:
• Blood tests
• Urinalysis
• Electrocardiography
• Chest X-rays
• Lower-extremity Doppler studies
• Angiography
• CT Scan of spine
• MRI Scan of spine
Homoeopathic approach:
Aconite:
It is almost a specific for neuralgias of congestive form. It seems to have an elective action on the various nerve, producing painful sensations.
It corresponds to recent cases in young subjects traceable to cold drafts, exposure to dry, cold winds, etc.
Colocynth:
This is also a remedy for recent cases traceable to emotions,
catarrh, or exposure, the characteristic being tearing pressive
pains worse from motion and touch and relieved by rest and
external warmth.
The attacks are paroxysmal,mostly on left side, though the sciatica is right-sided.
The pains of Colocynth are better from rest and pressure, but return as soon as pressure is removed.
Arsenicum:
The more purely nervous the affection the more effective is
Arsenicum.
It has the well-known intermitting burning, stinging, hot needle-pain, the distressed countenance, the restlessness and the periodicity.
Mezereum:
This remedy is indicated by the spreading character of the pains, and the aggravation from warmth; they are accompanied with chilliness and sensitiveness.
There is a stupefying pressure and the pains are worse at the midnight hours.
Especially useful in mercurial and syphilitic subjects. After the attack there is a numbness remaining.
Calcarea carbonica :
It is especially adapted to neuralgias in those of a leuco-phlegmatic temperament.
It has pain with frequent urination, and relieved by warm applications.
Scrofulous constitution, disposition to grow fat, flabby muscles, aversion to cold air, the least cold air goes through fat, flabby muscles, aversion to cold air, the least cold air goes through and through, feet are always damp and cold.