About Leg Pain

Some people mistakenly think that leg pain is a natural part of getting older. You might be surprised to learn that leg pain that develops during walking—and then goes away only with rest—can be caused by intermittent claudication (IC), a potentially disabling yet treatable medical condition.

IC affects roughly 3 million people, most of them over age 55. Unfortunately, an estimated 75 percent of all IC sufferers fail to seek medical help, often because they don’t realize that IC is a treatable medical condition.

IC is a symptom of peripheral arterial disease (PAD). PAD—also known as “hardening of the arteries,” or atherosclerosis of the legs—has been estimated to affect approximately 10 percent of people over age 55. PAD occurs when arteries in the legs become clogged with fatty deposits.

It’s not uncommon for people who have PAD to also have atherosclerosis in other parts of the body—especially in the heart and brain. Atherosclerosis is a serious health problem that can lead to heart attack or stroke if left untreated.

The symptoms of IC may be felt in the:

• Calf
• Thigh
• Buttock

And the symptoms may be felt as:

• Aches
• Cramps
• Heaviness
• Numbness

IC symptoms may be felt in one or both legs and may occur during walking or exercising. The pain is characterized by aching, cramping, tiredness, or tightness of the affected muscle group. Once you stop walking or exercising, the symptoms subside within minutes. If you’re experiencing any of these symptoms, see your podiatric physician. He or she can diagnose your condition and suggest treatments that may help you walk farther without leg pain.

Controlling Your Risk

You can decrease the risk of developing leg pain due to intermittent claudication (IC) if you take steps to control its risk factors. Risk factors are conditions that increase your chances of developing IC.

Risk factors and other conditions that may complicate IC include:

• Smoking
• High cholesterol
• High blood pressure
• Physical inactivity
• Obesity
• Diabetes

Smoking

Smoking is one of the most significant  risk factors for IC. If you smoke, your risk of developing peripheral arterial disease is two to seven times greater than nonsmokers. Smoking increases the risk of IC by:
 

• Narrowing blood vessels, which decreases blood flow to the legs.
   
• Reducing the amount of oxygen in your blood, which can increase leg pain.
   
• Irritating the lining of blood vessels, which can speed hardening of the arteries (atherosclerosis).

People with IC who continue to smoke also have a 10-fold greater risk for limb amputation.

Quitting smoking can slow or stop the worsening of IC symptoms and may greatly improve the quality of your life. If you need help quitting, several smoking cessation aids are available; your doctor can help you decide which one is best for you.

Most podiatric physicians include an antismoking component as a routine part of their encounters with all patients regardless of the diagnosis and no matter what age.

High Cholesterol

High blood cholesterol is another risk factor for IC. Cholesterol is a fat-like substance made by the liver, and it also enters the bloodstream from the food you eat. When cholesterol builds up in the walls of the arteries of the legs, blood flow is reduced, causing pain when you walk. Studies suggest that lowering the amount of fat in the blood, including cholesterol, may slow the progression of IC and possibly relieve symptoms.

Some steps you can take to control high blood cholesterol include eating a heart-healthy diet, maintaining a healthy weight, and being physically active. These lifestyle changes are the same as those recommended for people with IC, giving you even more reason to undertake them. When diet and exercise aren’t enough, medication may be needed. Your doctor can determine what treatment is best for you. For more on what you should know about cholesterol, visit the National Cholesterol Education Program on the Web.

High Blood Pressure

High blood pressure is a major risk factor for IC. It contributes to hardening of the arteries (atherosclerosis), which is the basis of peripheral arterial disease and IC.

Although clinical studies have not yet been performed to determine if lowering high blood pressure relieves IC symptoms, it’s wise to take steps to control your blood pressure. For more information on lowering high blood pressure, visit the National Heart, Lung, and Blood Institute Web site.

Physical Inactivity

Doctors have found a link between IC and an inactive lifestyle, which means that people with IC are most likely not getting enough exercise. A sedentary lifestyle can result in muscle loss, lower endurance, and higher blood pressure—all of which complicate IC.

To become more active, people with IC can begin by walking every day for 20 minutes, alternating walking with periods of rest. Your podiatric physician can ensure your feet will be up to the task of starting a walking regimen. The goal is to increase continuous walking to 30 to 45 minutes each day for at least six months. Ask your doctor before you start or significantly increase an exercise program.

Exercise yields many rewards. Research has shown that regular exercise can help control IC risk factors such as high blood pressure, obesity, and diabetes—as well as almost double your pain-free walking distance.

Obesity

Excess weight can make other IC risk factors much harder to control. It raises blood pressure and blood cholesterol,and increases the risk of developing diabetes. A commitment to losing weight and maintaining that weight loss can be challenging, but by losing even 10 to 20 pounds, you can help reduce your risk of developing cardiovascular disease. Your doctor can help you begin a healthy weight loss plan which may include both diet and exercise.

Diabetes

If you suffer from diabetes (high blood sugar), your risk for developing IC is two to three times greater. Steps to help control diabetes include quitting smoking, eating a heart-healthy diet, being physically active, and controlling sugar intake. By controlling diabetes, you may also be able to delay or prevent its complications, such as IC. For more information on controlling diabetes, visit the National Diabetes Education Program Web site.

Patients, especially those with diabetes, should pay extra attention to their foot and nail care and obtain regular foot examinations from their podiatric physician. Call for an appointment at the first sign of any changes in the foot.

Managing the Condition

Dr. Robinson will undertake a careful examination and diagnosis of the condition. Foot care is of critical importance to patients with IC, because seemingly minor injuries to the feet may result in infection, nonhealing wounds, and other complications. Patients, especially those with diabetes, will receive explicit instructions regarding foot and nail care. Smokers need to stop—immediately. Exercise programs, particularly walking, can help the condition, and safe, effective drug therapy may be prescribed by your podiatric physician.