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Recently I was diagnosed as having diabetes Type 2. I was told that along with the diabetic diet that I had to follow, that I should try to walk at least 1/4 to 1/2 mile a day, to help with my diabetes. I noticed that when I first started walking, that it did not take long for my legs and upper thighs to start hurting. When I asked my doctor about it, he said that I have intermittent claudication, and that was why my feet and legs would hurt when I would take my walks.

After doing research on intermittent claudication, the following is some of the information I found.

Intermittent claudication is a symptom of Peripheral Vascular Disease (PVD), which is a narrowing of the arteries in the legs or arms caused by the build up of  atherosclerotic plaque (fatty plaque), which in 70% of patients it is the only symptom.  Ironically, the treatment for intermittent claudication (muscle pain in the legs that is brought on by walking) is, usually more walking.

Those patients with PVD are encouraged to exercise but that same exercise brings on pain because the blood flow through the narrowed arteries is insufficient to provide their muscles with enough oxygen to meet the increased demands due to exercise.  The oxygen deficit's effects are muscle pain and muscle cramping.  For some people the pain may begin after only walking a block, and for others it might be a mile, but for anyone who has intermittent claudication, the pain consistently starts at the same distance.  Usually, taking just a minute or two to rest brings relief to their pain.  The pain is usually found in the calf muscle, but can also occur in the thighs, feet, hips, and buttocks, depending on where the artery is narrowed. 

It is suggested that an increase in exercise will help by enlarging the collateral vessels that are around the main blocked artery.  Other evidence says exercising may actually reduce some of the plaque build up in the artery and may lead to having better muscle coordination

Atherosclerosis is a process that affects the whole body:  the same narrowing that causes intermittent claudication also causes angina (heart pain) that is brought on by exercise and relieved by rest.  Angina is the primary symptom of narrow coronary arteries, and 60% of those with intermittent claudication also have coronary artery disease.  However, unlike angina, intermittent claudication is not usually dangerous in and of itself.  Patients are often afraid that their problem may lead to a loss of a limb.  This is highly unlikely and very rarely does it happen.  If you exclude diabetics and smokers who are a higher risk for progression of this condition, only about 9% ever require surgery and only about 2% will actually need amputation, and with proper care these rates can be greatly reduced.

Doctor Bruce Perler, Vascular Surgeon, from Johns Hopkins University says,

"Intermittent claudication is a fairly benign symptom that poses no long term threat, or immediate danger.  Patients should be cautious if surgery or other treatment such as, angioplasty or laser angioplasty are recommended for symptoms that only appear with exercise.  In the vast majority, lifestyle changes are the only treatment required."
Smokers are encouraged to quit, since tobacco causes constriction of peripheral veins in arteries and all patients are advised to start a walking program. If the patients are morbidly obese, to lose weight through proper diet, and walking which will help speed up the weight loss.

In the Journal of Vascular Surgery, one study documented a significant difference that a walking program can make.  Over 56 patients with varying degrees of intermittent claudication were enrolled in a six month walking training program, which consisted of three, one hour sessions a week, walking on an indoor track.  Patients were instructed to walk at speeds that caused them some discomfort but not to the point of it being severe pain, and to slow down or completely stop as soon as the pain would become severe.  By the end of the six month period, the patient's average more than doubled the distance they could walk without stopping.  This was a marked improvement.  Around 84% of the patients who completed the program were able to walk a little over a mile after only three months training; over 70% could walk over two miles or more with an average speed around three miles an hour.  Results show that 20 out of the 22 patients who came back for re-testing a year later had maintained or improved their walking ability.

Suggested methods to help walk away the pain:

  • Spend several minutes stretching before you start your walk and try to walk on level ground.
  • While walking, keep track of how far you go before the pain first starts, then continue from there until the pain is severe enough that you have to stop and make note of that distance.
  • Relax for a few minutes until the pain is gone and resume your walk.
  • Continue this pattern for 40 to 60 minutes.
  • Do this at least three times a week.  If the weather doesn't permit this, try walking at your local mall.
  • Keep track of how far the distances are from first signs of pain to severe signs of pain on every walk.  Both of these distances should start increasing in the second or third week.
  • If you have a heart disease or any other health condition, be sure to contact your doctor about how far you should walk.  Even if you don't have a history of heart disease but you do experience shortness of breath, chest pains, or rapid heart beat while walking, you should notify your physician to make sure this is nothing serious.

Source: Perler, Dr. Bruce. The Johns Hopkins Medical Handbook. : Rebus, Inc., 2000.

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