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Hi all,

I have a patient who exhibits intermittent claudication-like symptoms. However, I very much doubt it's intermittent claudication. This is due to her age, health status and triphasic pedal waveforms.

To properly assess exertional leg pain I believe you need to exert (ie: walk) until pain develops and retest.

My question is, can this be done in an averge podiatry clinic with a doppler and treadmill? And if so, what change in the waveforms constitutes pathology?

Thanks in advance.

Rebecca

 

Re: Intermittent claudication

Hi Rebecca,

I've crudely tested haemodynamics in clinic in the past - not with any level of accuracy or scientific rigor, but just to clarify in my mind what I may have been dealing with and to gather as much information as possible for the potential vascular referral.

From memory with one chap (cyclist) we tested his ankle-brachial pressure index pre and post exercise --> you gotta be quick once they jump off the turbo-trainer though! Another guy we didn't even bother with the ABPI - post exercise his foot was pale, cold and pulses difficult to palpate (none of which was observed pre-exercise). Not used a doppler as part of the testing personally.

If its the sort of exercise induced leg pain which looks and smells more like compartment syndrome than anything vascular then those are the ones I refer off for more specialist testing immediately.

 

Re: Intermittent claudication

In my humble non-scientific experience, the vast majority of claudicators smoke. Stop them smoking and some recede. I have seen this more than once. Rob

 

Re: Intermittent claudication

Is she a continual high heel wearer? If so then that might be your answer, otherwise I go along with Ian's probability of compartment syndrome (of course, the two things are not necessarily mutually exclusive).

Bill Liggins

 

Re: Intermittent claudication

Could it be pseudo-claudication?Ask about his spinal situation;any back surgeries or pain?

 

Re: Intermittent claudication

I would suggest you rule out compartment syndrome.
Steve

 

Re: Intermittent claudication

Consider venous issues (Calf pain in runners may be caused by venous insufficiency) or popliteal artery entrapment syndrome.

 

Re: Intermittent claudication

Compartment syndrome is plausible.Where is the pain?Anterior or posterior?

 

Thanks everyone,

Posterior compartment syndrome is very much on the radar and the physio will be referring on for this.

I was talking to him recently about using doppler to assess arterial supply during diabetic assessment. Following this, he asked me to rule out intermittent claudication in this patient before he refers on, which I have not done before and was a bit stumped.

Thanks again.