A 59-year-old male complains of pain in his right leg for the last few months. He is normally able to walk two miles a day, but has noted pain when he climbs hills, which is relieved with rest or resuming walking on flat ground. He also complains of foot pain at rest. He does not smoke and denies injury to his back. He has been generally healthy with obesity and mildly elevated triglycerides. The most likely cause of the pain in this patient is

• A. Sciatica
• B. Deep vein thrombosis
• C. Intermittent claudication
• D. Diabetic neuropathy

Answer: (C)

Pain in the leg with walking that improves with rest points to intermittent claudication from peripheral arterial disease. When the leg muscles demand more blood during activity, atherosclerotic arteries can’t supply enough oxygen, causing ischemic pain that resolves with rest when demand decreases. This pattern aligns with his age and risk factors like obesity and elevated lipids, and the resting foot pain can occur as PAD progresses.

Sciatica would typically produce nerve-related leg pain that follows a dermatomal pattern and is not specifically triggered by walking or relieved solely by rest. Deep vein thrombosis presents with acute leg swelling, warmth, and tenderness rather than exertional claudication. Diabetic neuropathy causes distal sensory symptoms such as numbness or burning, often symmetric, and not classically described as exertional leg pain relieved by rest.