Intermittent claudication

Intermittent claudication - syndrome is caused by disturbance of blood supply to the lower limbs and manifested passing pains in the legs that occur during the walk.
The causes of disease (disease), infections, intoxications (for example, manganese), injury, diabetes , etc. Due to spasm of peripheral vessels comes insufficient blood supply to the muscles and nerves of the lower extremities (rarely - top).
Patients first feel fatigue, parestesia (see Sensitivity) in the legs, then pain while walking; patients have to stay for some time, after which the pain disappear and patients may continue to go. In subsequent pain take more persistent. When intermittent claudication disappears pulse on foot, less often in the popliteal fossa, discoloration of the skin (pales in later periods appears cyanosis). In the foot and toes temperature decreases, sensitivity, stop getting cold, pain in the calf muscles and pain when pressure on the nerve trunks on his feet. May appear trophic ulcers on the feet. For intermittent claudication with chronic remissions.
Treatment of the underlying disease; prohibition of alcohol and Smoking; contraindicated dragging of the feet (socks with elastic, elastic stockings, etc.,), air cooling. Appoint pahikarpin 0.05-0.1 g 2 times a day during a month, after the break - second course; nicotinic acid 0.025 g 3 times a day (after a meal); the diathermy, UHF, hydrogen sulfide, radon baths.

Intermittent claudication (claudicatio intermittens, claudicatio ischaemica) - a syndrome that occurs during ischemia of the lower extremities caused by impaired blood supply (often obliterating endarteritis or arteriosclerosis) and characterized by the emergence while walking pain or feeling of tension, the severity, paresthesia in one or (rarely) in both legs (see obliterating Endarteritis). If the patient stops the pain pass, when walking resume. The disease occurs more often in men older and middle age, at a young age is rare. Described family cases of intermittent claudication.
Etiology: acute (typhoid, influenza) and chronic (syphilis) infection, intoxication (alcohol, Smoking is especially), cooling, physical and mental traumas, gout, diabetes and so on, Some of these moments (infection, intoxication), apparently, are complicated by disease of the endocrine and autonomic system.
The pathogenesis is to ischemic events due to spasm of the blood vessels. The last is caused by dysfunction of the adrenal system adrenal (humoral theory), which morfofiziologicheskie connected sympathetic nervous system (neurogenic theory). This leads to inadequate supply of blood to the nerves and muscles of the limbs, especially if their activity (walking), and the defeat of nerve endings, which in turn strengthens vasospasm. In the result of pathological chain of all these factors is developing degenerative neuro-vascular process. The disease is usually chronic, but is described and acute.
The clinical picture. Described peripheral [sharko (J. Charcot)] and spinal [Degerin (J. Dejerine)] types of intermittent claudication. When intermittent claudication-peripheral type often until pain when walking patients feel fatigue, weight or paraesthesia in the legs. Objective research opens the weakening or disappearance of the pulse in the foot, at least in the hollow of the knee, in chronic cases in the femoral artery. In the study of skin temperature of the foot and toes detected first periodic, then a steady decline it. Skin color changes. If the patient outweighs the affected leg, appears pale, bluish coloration of the skin of this leg and the pain. The characteristic symptom of "white spots". The pain gradually become more frequent and intensified. Over time may appear trophic sores, wasting of the muscles of the lower leg. With the development of dystrophic and proliferative processes in the vessels can develop a picture of obliterating endarteritis. In this period when arteriography sometimes detect changes of vascular walls, the narrowing of the clearance. Celebrated the power phase currents of intermittent claudication. Spinal form intermittent claudication usually appears in the prodromal period of chronic processes (myelitis, syphilis) with the defeat of arterioles, feeding gray matter of the spinal cord.
Diagnosis of P. H. usually not difficult, given the typical appearance of pain in the legs when walking, stopping them at the bus stops, the weakening or disappearance of the pulse of the main arteries of the legs, and the subjective and objective temperature violations. Sometimes alternating lameness have to differentiate with polymyositis, ishialgia, platypodia, Raynaud's disease. The prognosis is poor in cases obliteration receptacles limbs, but in the course of the disease can be remission.
Treatment. It is necessary to prohibit Smoking, drinking alcohol. You can not wear tight shoes, to avoid humidity cooling legs, dragging his feet rubber. Intravenous recommended 5-10% NaCl solution 10 ml 10-15 injections, subcutaneously to 1% solution pilokarpina, insulin 10-12 IU (№ 10), Putin, better depot Putin (№ 15-20) 1 ampoule injection, in 2-4 weeks to repeat, 1% solution of nicotinic acid into 1 table. L. within a month or intravenously for 1%-1 ml (№ 10-15), courses repeat; pahikarpin 0.1 g 3 times a day for 2 months., be repeated periodically. Favorable results perinephral novocaine blockade. Sometimes applied with success intraarterial introduction of banked blood vessels in the affected limb.
Of physiotherapeutic methods - diathermy, UHF, mud therapy, steam chamber, hydrosulphuric baths, radon, 2-3 course, alternating. When syphilis, atherosclerosis - appropriate treatment and diet. Surgical methods proposed periarterial sympathectomy (see), epinefrinom; in gangrenous phase - amputation.