Intermittent claudicationBMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39036.624306.68 (Published 05 April 2007) Cite this as: BMJ 2007;334:746
- Roger W Simon, resident1,
- Andr Simon-Schulthess, general practitioner2,
- Beatrice R Amann-Vesti, head of angiology1
- 1Angiology Division, Department of Internal Medicine, University Hospital Zürich, CH-8091 Zurich, Switzerland
- 2Eisfeldstrasse 22, CH-8050 Zurich
- Correspondence to: R Simon
A 58 year old smoker presented with a six month history of pain in the left calf during walking.
What issues you should cover
Is this really intermittent claudication?
Ask about key symptoms of peripheral arterial disease, including walking distance before onset. In peripheral arterial disease, pain in the hip, thigh, and calf (rarely foot) is not present at rest, on weight bearing, or when starting to walk but occurs after a distance that is predictable (and shorter going uphill). The pain is felt in the muscle, not the bone or joint, and is relieved rapidly with rest or reduction of walking pace. Pain occurring before 200 m reflects Fontaine stage Ia peripheral arterial disease; pain at or beyond 200 m reflects stage IIa.
Main differential diagnoses
Spinal claudication manifests as weakness not pain and starts soon after standing up, with relief on sitting or bending (lumbar spine flexion). Radiculopathy …