Claudication

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**Intermittent claudication**
*Classification & external resources*
ICD-10	I 73.9
ICD-9	443.9

Claudication, literally 'limping', is used as a medical term in various contexts. It is also used figuratively.

Claudication refers to cramplike pains in the calves caused by poor circulation of the blood to the leg muscles.

Jaw claudication is pain in the jaw or ear while chewing. The most commonly used application of claudication is to describe the pain in the legs on exertion suffered by arteriopaths. The lack of compliance of the arterial tree, usually due to atherosclerosis, means that on exertion the body is unable to compensate and increase blood flow. This causes severe cramping pain, usually in the calf muscles, which will only be relieved by rest.

Spinal claudication is not due to lack of blood supply, but is instead the pain felt on exertion by patients whose leg pain is caused by nerve root compression, usually from a degenerative spine. It may be differentiated from arterial claudication in that it is often only relieved by sitting down, whereas in arterial claudication standing at rest is usually sufficient to relieve the pain.

The ankle-brachial index is a simple, non-invasive test that can be used to assess patients with claudication symptoms. The ankle-brachial index, or ABI, involves obtaining blood pressure measurements in both arms and both legs. The higher of the two arm pressures becomes the denominator, and the individual leg or ankle pressures serve as the numerator in calculating the ABI for each leg. Thus the ABI is a ratio which roughly compares the blood flow in the arms to that in the legs, and can help screen for arterial insufficiency as a source of the claudication symptoms. A normal ABI should be 1.0-1.3, whereas an ABI of less than 0.9 can indicate significant arterial insufficiency. An ABI of less than 0.5-0.6 can correlate with threatened limb loss. An abnormal ABI in correspondence with claudication symptoms usually leads to a more sophisticated imaging work-up to uncover the specific arterial blockages implied by the screening test.