Table 3.18-6. Differential diagnosis of intermittent claudication

Condition

Location of pain or discomfort

Typical manifestations

Onset of pain in relation to exercise

Relation between rest and pain

Relation between body position and pain

Other features

Claudication (hip, thigh, buttock)

Hip, thigh, buttock

Painful discomfort, weakness

Always after the same defined type/amount of exercise

Resolves rapidly

None

Pain can be induced in repeated manner

 

Osteoarthritis of the hip

Hip, thigh, buttock

Painful discomfort

After exercise of varied intensity

Does not resolve quickly (pain may also be present at rest)

Patient feels better when seated with lower extremities unweighted

Variable pain, may depend on activity level or weather changes

Spinal cord compression

Hip, thigh, buttock (limited to dermatomes)

Weakness dominates over pain

After walking or standing for some time

Resolves on stopping exercise only when accompanied by change in body position

Patient feels relief after flexion of lumbar spine (when seated or leaning forward)

In many patients history of back pain; pain induced by increase in abdominal pressure

Claudication (lower leg/calf)

Muscles of lower leg (calf)

Cramp

Always after the same defined type/amount of exercise

Resolves rapidly

None

Pain can be induced in repeated manner

 

Venous claudicationa

Muscles of lower leg

Severe, expanding

After walking

Resolves slowly

Resolution faster when limb is elevated

History of DVT, features of venous congestion, edema

Radiculopathy (eg, herniated nucleus pulposus)

Referred along lower extremity, usually in posterior aspects

Severe, tearing

Soon or immediately after compression

Not resolving quickly (pain often present at rest)

Resolution may occur upon changing spine position

History of back pain

Symptomatic popliteal (Baker) cyst

In popliteal fossa, referred to lower leg

Edema, pain, tenderness

During exercise

Pain at rest

None

Claudication not intermittent

Claudication (foot)

Foot

Severe deep pain, numbness

Always after the same defined type/amount of exercise

Resolves rapidly

None

Pain can be induced in repeated manner

 

Osteoarthritis or arthritis

Foot

Severe pain

After exercise of varied intensity

Not resolving quickly (pain may also be present at rest)

Pain may be reduced by joint unweighting

Variable pain, may depend on activity level

a Bursting, heavy discomfort in legs with walking as legs become congested with blood due to impaired venous return.

Adapted from Eur J Vasc Endovasc Surg. 2000;19 Suppl A:Si-xxviii, S1-250.

DVT, deep vein thrombosis.