Intermittent claudication occurred in 16 patients (22 legs) despite the presence of a pedal pulse at rest. Exercise, by walking or toe-stands, sufficient to induce claudication resulted in disappearance of the pedal pulse until the claudication subsided (one to three minutes) when the pulse was again palpable. Blood pressure at the ankle normally declines with exercise due to dilatation of the muscular vascular bed. Proximal occlusive disease results in a profound fall in distal blood pressure with concomitant loss of the pedal pulse. There was atherosclerotic occlusive disease at the aorto-iliac level in nine legs and at the femoro-popliteal level in nine legs. Traumatic or congenital arterial disease occurred in four legs. There were persistent pedal pulses after arterial reconstruction in 19 legs, and three have not been treated. Claudication in the presence of resting pedal pulses is usually associated with major artery disease that is amenable to reconstruction.
Barner HB, Kaiser GC, Willman VL, Hanlon CR. Intermittent Claudication With Pedal Pulses. JAMA. 1968;204(11):958-962. doi:10.1001/jama.1968.03140240014005