WHAT IS LEG CLAUDICATION?
Lower extremity pain, numbness and difficulty walking all are symptoms of claudication. Claudication causes tightness in the legs when standing or walking, and often is relieved with rest. It is most commonly felt in the calves, but also can affect the feet, thighs, hips, or buttocks. Claudication can limit the performance of many activities, including walking, climbing stairs, exercising, etc. In fact, claudication comes from the Latin work claudicare or “to limp.”
WHAT ARE THE CAUSES OF LEG CLAUDICATION?
The most common cause of leg claudication is poor blood flow to the distal lower extremities (vascular claudication). Hardening of the arteries is the most common cause. Risk factors are smoking, cholesterol problems, diabetes, obesity, age > 70, and a positive family history. Narrowing of the spinal canal can cause neurogenic claudication, mostly associated with age, congenital or acquired deformities of the spine (stenosis), or adjacent to a lumbar fusion (transitional changes).
HOW IS LEG CLAUDICATION DIAGNOSED?
In addition to complaints weakness, diminished or absent distal leg pulses and sensory loss, other tests may be necessary. For vascular claudication, ultrasound, or CT / MRI angiograms of the legs may be ordered. For neurogenic claudication, imaging of the spine is necessary, along with possible electrical testing of the nerves in the legs.
WHAT IS THE INITIAL TREATMENT FOR LEG CLAUDICATION?
The best treatment for vascular claudication is prevention… avoid smoking, exercise regularly and control your weight. If you are diabetic, manage that also. Ask you doctor about treating atherosclerosis of the legs. Neurogenic claudication is more difficult to manage. Anti-inflammatory medications, physical and chiropractic treatments, and weight control are primary treatments. OPIOIDS ARE TO BE AVOIDED! Home treatment including stretching, muscle conditioning and aerobic exercise are also recommended.
SO…WHAT IF INITIAL TREATMENT FOR LEG CLAUDICATION DOESN’T WORK?
Despite medical treatment or lifestyle changes, arterial or lumbar spinal canal narrowing (stenosis) may progress to a critical level. At that point, a procedure or surgery may be necessary.
The most direct way to improve blood flow to a leg is to either widen the narrowed artery or bypass it. This may require an arteriogram (vascular dye injection) to better understand where the narrowing is. Options to improve blood flow include angioplasty (dilating the vessel), placing a stent, or opening the vessel and clearing the atherosclerosis. A graft may also be used to bypass the narrowing.
Symptoms from a narrowed lumbar spinal canal, can only be treated by decompressing (enlarging) the canal itself. The bone in the back of the lumbar spine can be removed to widen the canal (laminectomy). A fusion is placing bone or bone matrix adjacent to the spine to eliminate abnormal motion, and is used to supplement a laminectomy. Metal plates and screws are generally used to hold the bones in place to make sure the fusion occurs.
Another option is a minimally invasive lumbar decompression (MILD). This procedure is done as an outpatient, and completed well under an hour. Essentially a laminectomy is done through a tube inserted next to the lumbar spine. Various bone and tissue sculpting instruments are placed through the tube to remove bone and ligament at the level of the lumbar narrowing. The MILD procedure is done completely through an incision less than an inch.
IF YOU POSSIBLY HAVE LEG CLAUDICATION… TALK TO OUR PROVIDERS ABOUT OPTIONS
THE TRISTATE PAIN INSTITUTE