For patients
Leg symptoms and circulation
Cramping that comes on when you walk and stops when you stand still is one of the few symptoms in medicine with a straightforward 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. Blood flow falls, usually to the legs first, and if the process continues far enough it can cause tissue loss.
The classic symptom is intermittent claudication: a cramping, aching or tired feeling in the calves, thighs or buttocks that appears at a fairly predictable walking distance and goes away within a few minutes of stopping. It is reproducible, which is what distinguishes it from most other causes of leg pain.
The symptoms that matter
| What you notice | What it may indicate |
|---|---|
| Cramping on walking that stops with rest | Claudication from reduced arterial flow |
| A shorter walking distance than a year ago | Progression, often unnoticed because people adapt |
| One foot colder than the other | Asymmetric arterial disease |
| Pain in the foot at night, relieved by hanging it out of bed | More advanced ischemia — this needs prompt assessment |
| A sore or ulcer on the foot that will not heal | Impaired perfusion, often with neuropathy — needs prompt assessment |
| Burning or tingling rather than cramping | More likely nerve than artery — see neuropathy symptoms |
Why many people have it and do not know
Peripheral artery disease is frequently silent, and the reason is behavioral: people reduce how far they walk without noticing they are doing it. 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. Smoking carried the strongest association, followed by diabetes, hypertension and high cholesterol.
How it is measured
The ankle-brachial index compares systolic pressure at the ankle with the arm. It is non-invasive, takes minutes, and is the standard first measurement. 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.
Nerve or artery
Artery disease and autonomic nerve damage are both frequent complications of diabetes, kidney disease, hepatitis, thyroid failure and aging, and their symptoms imitate each other closely. Distinguishing between them matters, because the treatments are quite different. Measuring both in the same appointment is the reliable way to tell them apart.
If you are a clinician: the same subject written for the person ordering the test is at the full test description.
Talk to someone about testing
Tell us what you are trying to find out and we will explain which Measura assessments answer that question, what each one involves, and how the results are reviewed with a clinician.
4477 Woodson Rd, Suite 201, St. Louis, MO 63134. Monday to Friday, 9:00 a.m. to 5:00 p.m. Please do not send symptoms, diagnoses or images through a web form — a website form is not a secure medical channel. Call us with clinical detail.
Common questions
How far should I be able to walk?
What matters is the change, not the absolute distance — a reproducible drop in walking distance is the useful signal. Claudication explained.
My index was normal. Does that settle it?
Not if the arteries are calcified, which is common in diabetes and kidney disease. Why a normal index can mislead.
Is it varicose veins?
Vein problems and artery problems produce different patterns — veins tend to ache after standing still, arteries after walking. The measurement separates them. What the vascular study measures.
Can walking make it better?
Supervised walking is one of the best-established treatments for claudication, which is another reason to have an objective baseline first. Tracking change over time.
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
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, medical director of Measura. Last reviewed .