Intermittent claudication is a tight, aching, or squeezing pain in the calf, foot, thigh, or buttock that occurs during exercise, such as walking up a steep hill or a flight of stairs. This pain usually occurs after the same amount of exercise and is relieved by rest.

How does peripheral arterial disease cause intermittent claudication?

Many people who have peripheral arterial disease do not have any symptoms. But if you do have symptoms, you may have intermittent claudication.

People with intermittent claudication usually describe the pain as a deep aching that gradually gets worse until they rest. Sometimes, the leg may also cramp or feel weak.

Your speed and whether you are walking uphill or downhill are all things that affect how far you can walk before you feel pain. If you have severe arterial blockage and poor circulation, you will find walking long distances to be a greater challenge. The average person with blockage of one major arterial segment in a leg can walk 90 to 180 meters (a football field or two) before pain starts. As more blockages develop, the pain can appear earlier and earlier. In severe cases a person can only walk a few feet before needing to stop.

Pain at rest, without exercise, means that arterial blockage is advanced. If effective treatment is not started, tissue death can happen. The pain is often noticed at night and is relieved by hanging the leg off a bed or couch. The pain also may improve with walking, because gravity helps blood to reach the foot. As PAD gets worse, the pain may interrupt sleep, cause a lack of appetite, and make the leg sensitive to the touch.

What other problems cause leg pain?

Many problems can cause leg pain that is similar to intermittent claudication but is not related to peripheral arterial disease. These problems include:

• Spinal stenosis.
• Tendinitis.
• Stress fractures.
• Arthritis.
• Nerve damage in the legs (peripheral neuropathy) caused by diabetes or heavy use of alcohol.
• A pulled muscle.

Other conditions can also cut off blood flow to the leg and cause leg pain. But these are conditions that can happen suddenly. They include:

• A blood clot (embolism) in the leg.
• Swelling of muscle tissue that cuts off blood flow (compartment syndrome).