Leg pain when you walk
Cramping that appears at a predictable distance and disappears within minutes of stopping is one of the few symptoms in medicine with a simple, objective test behind it.
What claudication is
Peripheral artery disease is the narrowing of arteries by atherosclerotic plaque along the vessel lining. As plaque accumulates the artery narrows, stiffens and loses function, and blood flow falls — usually to the legs first.
Muscle that is working needs more blood than muscle at rest. When the supply cannot rise to meet demand, the muscle produces a cramping, aching or tired sensation that stops when the demand stops. Hence the pattern: predictable onset distance, relief within minutes of standing still, and reproducibility from one day to the next.
What it is not
| Pattern | More likely |
|---|---|
| Cramping at a predictable walking distance, relieved by standing still | Arterial claudication |
| Aching and heaviness after standing still for a long time, relieved by elevation | Venous |
| Pain radiating from the back down the leg, worse with certain positions, relieved by leaning forward | Spinal or nerve root |
| Burning or tingling at rest, worse at night | Small-fiber neuropathy — see burning feet at night |
| Pain in the foot at night relieved by hanging it out of bed | More advanced ischemia — needs prompt assessment |
Why so many people have it and do not know
Because people adapt. Walking distance shortens quietly, a hill gets avoided, a parking space closer to the door gets chosen, and the symptom never becomes a complaint. Peripheral artery disease is the third leading cause of atherosclerotic cardiovascular morbidity after coronary disease and stroke, and an estimated 202 million people were living with it worldwide in 2010.
Prevalence rises steeply with age — from roughly 5% of adults in their late forties to roughly 18% by the late eighties in the wealthier countries surveyed. The strongest associations were current smoking, then diabetes, hypertension and high cholesterol.
How it is measured
The ankle-brachial index compares systolic pressure at the ankle with the arm and takes minutes. Because a calcified artery can make that index falsely reassuring, it is paired with the pulse volume waveform and the toe-brachial index, neither of which depends on the vessel being compressible. Why that matters.
The reason to find it early
Not primarily because of the legs. The same process is happening in the coronary and cerebral circulation, and a measurable abnormality in an accessible artery is information about all of them. It is also one of the areas where the interventions — stopping smoking, supervised walking, treating blood pressure and glucose — are well established and measurable.
References
- Fowkes FGR, Rudan D, Rudan I, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382(9901):1329–1340. doi:10.1016/S0140-6736(13)61249-0
- Aboyans V, Criqui MH, Abraham P, et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation. 2012;126(24):2890–2909. doi:10.1161/CIR.0b013e318276fbcb
Related reading
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, medical director of Measura. Last reviewed .