Leg pain is a very common health problem, but did you know that it may sometimes be related to arterial blockage?

Mr. Chow, who was over sixty and had a history of smoking, noticed some time ago that when he walked, his legs often felt numb and weak. After only a short distance he would begin to limp because of pain. The problem was especially obvious when climbing stairs or walking uphill. He would have to stop and rest repeatedly before he could continue.

At first, it seemed natural to treat the pain as a local problem in the leg, but despite various tests and treatments, the condition did not improve and the root cause remained unclear. Fortunately, one doctor noticed that the pulses in his lower limbs were very weak and referred him on. After consultation and vascular assessment, it became clear that he had intermittent claudication. His leg pain was not caused by bones or nerves, but by fat deposits building up in the artery walls, which narrowed or blocked the vessels and prevented oxygenated blood from flowing freely to the legs.

The most typical symptom is that the patient feels normal at rest, but after walking a certain distance, the muscles in the lower limb begin to ache and may become so painful that the patient must stop. After a short rest, the pain gradually settles, but once the person walks another certain distance, the pain returns. The calf muscles are the most common site of pain.

The original article notes that some patients may deteriorate over time, with shorter and shorter walking distance, and a smaller proportion may progress to ulcers, gangrene, or even require amputation. It is important to remember, however, that leg pain can have many different causes, including skin, musculoskeletal, or nerve problems. Narrowed arteries are only one possible explanation, and proper assessment is needed.

When leg pain is caused by arterial blockage, appropriate aerobic exercise may help improve the condition. Exercise can encourage the smaller surrounding vessels to dilate and may promote collateral blood flow, improving delivery of blood to the lower limbs. If exercise and medication are not enough, minimally invasive endovascular treatment may then be considered. A small opening is made in the leg, and a long catheter is inserted to widen the narrowed or blocked artery. A stent may also be used when needed to help maintain blood flow. In more severe disease, bypass surgery using an artificial graft may sometimes be required to route blood around the blocked segment.

Mr. Chow underwent a minimally invasive endovascular procedure under local anaesthesia. He was able to move about normally two days later, and after one month he had returned to morning exercise and was no longer limping. One key step still remained: he needed to stop smoking immediately to help prevent further damage to his blood vessels.

Author: Honorary Clinical Associate Professor, Department of Surgery, The University of Hong Kong; President, Vascular Health Foundation