Synopsis
Recognise intermittent claudication, confirm peripheral arterial disease safely, distinguish mimics, and identify limbs needing urgent vascular assessment.
- Claudication is reproducible exertional muscle discomfort relieved within minutes by rest.
- Ask about distance, terrain, muscle group, recovery, progression and daily-life limitation.
- Sudden symptoms, rest pain, tissue loss or neurological deficit are not stable claudication.
Key red flags
Sudden onset severe limb pain with new sensory or motor loss requires immediate vascular assessment.
Persistent forefoot pain at rest, especially at night or relieved by dependency, suggests chronic limb-threatening ischaemia.
Non-healing ulceration, gangrene, spreading foot infection or sepsis requires urgent limb and infection assessment.
A painful blue or mottled toe with palpable proximal pulses can represent embolisation and still needs urgent specialist discussion.
Forefoot rest pain, night pain eased by dependency, ulceration or gangrene signals limb threat rather than uncomplicated claudication.
Abrupt severe pain, coldness, pallor, absent pulses, sensory loss or weakness is an acute vascular emergency even if claudication preceded it.
Investigation priorities
Confirm a physiological arterial deficit and document baseline lower-limb perfusion.
Management branches
Chronic exertional leg discomfort resolves with rest and no limb-threat feature is present.
- Characterise onset, reproducibility, muscle distribution, recovery time and the walking activities that symptoms prevent.
- Examine cardiovascular status and both lower limbs from groin to toes, comparing skin, temperature, ulcers, capillary refill and femoral, popliteal and pedal pulses.