Patient assessment - examination
Examination starts with a general impression of the patient - if they are short of breath at rest or on minimal exertion, the claudication will assume less of a significance.
The abdomen is examined for an aortic aneurysm - will present as a pulsatile mass. Patients with intermittent claudication have more aneurysms than the normal population.
The legs are inspected for differences in colour - the leg with arterial disease will be paler. Elevating the leg makes it even more pale. Putting the foot onto the floor then allows blood to flow back causing the foot to become redder than the normal side for a short while (this is called 'reactive hyperaemia').
The pulses in the leg will be felt for:
 | Femoral - in the groin |
| Popliteal - behind the knee |
| Dorsalis pedis - in the foot (this may be missing in 10% of the normal population) |
| Posterior tibial - behind the inner ankle |
The distribution of missing pulses will give an indication of the part of the arterial tree of the leg that is diseased.
To give a more accurate picture the blood pressure at the ankle is measured using a hand-held doppler and a blood pressure cuff:
The highest pressure at the ankle is compared to the highest arm pressure to give an index, the Ankle Brachial Pressure Index (ABPI). This is used to give an estimate of disease severity.
Sometimes a patient with a typical history of intermittent claudication has normal pulses and ABPI at rest. This may indicate a narrowing in the arterial tree which becomes significant only during exercise. The pressure measurements may, therefore, be carried out before and after exercise.