The earliest symptom or complaint is usually pain in the calf or thighs
on exercise (intermittent claudication). As the arteries to the legs are
narrowed or blocked, the blood supply to the muscles during exercise is
impaired. There is an increased demand for blood supply to the muscles
during walking, particularly in the calf muscles and buttock muscles. In
peripheral arterial disease these muscles ache after a certain walking
distance and this symptom is called “intermittent claudication”. Claudication
means limping and is named after the Emperor Claudius who limped. The
patient usually has to stop walking or slow down because of cramp in the
calf or buttock; when he stops the pain gradually passes off and he is able to
walk again. After a similar distance he has to stop again because the
discomfort in the muscle re-occurs. Intermittent claudication may go on for
many years with little change; a patient who has this complaint very seldom
needs surgery if he heeds the advice he is given.
In a more serious form of peripheral arterial disease, pain is continuous
and prevents sleep. This is referred to as ischaemic rest pain, in other
words, pain occurring without walking caused by shortage of blood supply.
This discomfort is usually worst at the tip of the toes but can often be
relieved by hanging the leg down. This encourages blood flow in the
arteries and may relieve the pain but can lead to swelling of the leg. If this
symptom is ignored and not dealt with, gangrene or death of the toes may
occur and amputation becomes necessary.