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Why do I get severe pain in my legs after walking short distances?

Tuesday, 14 March 2006
Answered by: Dr. Mathew Varghese
Consultant Orthopaedic Surgeon and Director,
St. Stephens Hospital,
New Delhi
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Q. I am facing problems in walking. When I walk for a short distance, I get a severe pain and have to stop walking. My doctor said that it could be from smoking. I have stopped smoking for over three weeks and the gripping pain no longer pains me as much as before. I can't even walk half a block without getting tremendous pain on my left side (hip). I tried to walk it off but it gets worse. If I stand for a while, the pain decreases but as soon as I start walking the pain increases and I have to stop again. I walk as little as possible due to this. I also had restless legs for over 4-5 years. This pretty has slowed down though. I used to walk 2 miles thrice a day. But now I can't even go shopping. Please advise.

A.  Your symptom in medical terms is called claudication. However, this could be because of either decreased blood supply to the calf muscles resulting from occlusion of blood vessels (common in smokers) or as a result of narrowing of spinal canal (what is called spinal canal stenosis). The first condition is called vascular claudication and the second is called neurogenic claudication. Clinical examination can differentiate between the two. In vascular claudication, peripheral pulses on the feet would be weaker or absent and test for narrowing of blood vessels using an ultrasound Doppler would show the abnormality. In neurogenic claudication there is no difference in peripheral pulses and Doppler would be normal. However, patient will have difficulty in walking and may at times present with what is called as stoop after walking for about 10 minutes. This is because the patient has relief of pain in bending forward, therefore, to avoid on set of pain these patients stoop. It is also been seen that patients with neurogenic claudication are able to bicycle comfortably while they cannot walk. On the other hand, patients with vascular claudication can neither bicycle nor walk. In neurogenic claudication, what is required is an MRI of the back (spine) with measurement of spinal canal diameters. Treatment will depend on the final diagnosis.

A.  Your symptom in medical terms is called claudication. However, this could be because of either decreased blood supply to the calf muscles resulting from occlusion of blood vessels (common in smokers) or as a result of narrowing of spinal canal (what is called spinal canal stenosis). The first condition is called vascular claudication and the second is called neurogenic claudication. Clinical examination can differentiate between the two. In vascular claudication, peripheral pulses on the feet would be weaker or absent and test for narrowing of blood vessels using an ultrasound Doppler would show the abnormality. In neurogenic claudication there is no difference in peripheral pulses and Doppler would be normal. However, patient will have difficulty in walking and may at times present with what is called as stoop after walking for about 10 minutes. This is because the patient has relief of pain in bending forward, therefore, to avoid on set of pain these patients stoop. It is also been seen that patients with neurogenic claudication are able to bicycle comfortably while they cannot walk. On the other hand, patients with vascular claudication can neither bicycle nor walk. In neurogenic claudication, what is required is an MRI of the back (spine) with measurement of spinal canal diameters. Treatment will depend on the final diagnosis.

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