Cramp in the legs after walking

Cramp in the lower legs after walking a short distance can be caused by arterial insufficiency. This is known as intermittent claudication and is likely to be caused by peripheral arterial insufficiency (PAD).

Assessment of a patient with peripheral arterial disease

You should assess people with suspected peripheral arterial disease by:

  • Asking about the presence and severity of possible symptoms of intermittent claudication and critical limb ischaemia
  • Examining the legs and feet for evidence of critical limb ischaemia, for example ulceration
  • Examining the femoral, popliteal and foot pulses
  • Measuring the ankle brachial pressure index

Measure the ankle brachial pressure index in the following way:

  • Make sure your patient is rested and supine if possible
  • Record systolic blood pressure with an appropriately sized cuff in both arms and in the posterior tibial, dorsalis pedis and, where possible, peroneal arteries
  • Take measurements manually using a Doppler probe of suitable frequency in preference to an automated system

Document the nature of the Doppler ultrasound signals in the foot arteries and calculate the index in each leg by dividing the highest ankle pressure by the highest arm pressure.

Treatment of peripheral arterial disease

You should offer all people with peripheral arterial disease information, advice, support and treatment about the secondary prevention of cardiovascular disease. This is in line with published NICE guidance and includes advice around:

  • Smoking cessation
  • Diet, weight management and exercise
  • Lipid modification and statin therapy
  • The prevention, diagnosis and management of diabetes
  • The prevention, diagnosis and management of high blood pressure
  • Antiplatelet therapy

You should also offer patients access to a supervised exercise programme.

This should include:

  • 2 hours of supervised exercise a week for a 3‑month period
  • Encouraging people to exercise to the point of maximal pain

Make sure you refer your patient to to a vascular centre if:

  • Diagnosis of PAD is unclear
  • A supervised exercise programme has not improved their symptoms

Patient information for peripheral arterial disease

You should talk to people with peripheral arterial disease about their condition and give them written information too. By discussing it with patients, they can share decision‑making, understand the course of the disease and what they can do to help prevent the disease progressing. Make sure you cover:

  • The causes of their symptoms and the severity of their disease
  • The risks of limb loss and/or cardiovascular events associated with peripheral arterial disease
  • The key modifiable risk factors, such as smoking, control of diabetes, hyperlipidaemia, diet, body weight and exercise
  • How to manage pain
  • All relevant treatment options, including the risks and benefits of each
  • How they can access support for dealing with depression and anxiety.

It’s important to tailor information to the individual needs of the person. It’s important that you give patients information when they are diagnosed and throughout the course of their treatment so they can make informed decisions at every stage .

The patients, family and friends section has lots of useful, accessible information for your patients.

Clinical guidelines for peripheral arterial disease

These guidelines give you a useful overview and more detailed information on peripheral arterial disease and diabetic feet:

Peripheral Arterial Disease Diagnosis and management (NICE 2012)  (Web page)

Publications & Evidence for peripheral arterial disease

We’ve carefully curated resources to help in your everyday work.

Read more

Patient information for peripheral arterial disease

The patients, family and friends section has lots of useful, accessible information for your patients.

Read more

Other support

The Circulation Foundation The Circulation Foundation is the UK’s only dedicated vascular charity. They fund and promote research into the causes, treatment and prevention of vascular disease.

Contact details
020 7205 7151
info@circulationfoundation.org.uk
Find out more on The Circulation Foundation website

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