1. Eleven men with claudication and ten control subjects had calf muscle metabolism studied at rest and during exercise and the subsequent recovery period by 31P nuclear magnetic resonance (n.m.r.) spectroscopy.
2. The muscle of patients with severe claudication had a significantly greater depletion of phosphocreatine and fall in pH during exercise and a slower recovery of phosphocreatine and pH after exercise.
3. The muscle of patients with both mild and severe disease had slower rates of ADP recovery after exercise than that of control subjects.
4. Surgical correction of the associated arterial stenosis abolished claudication and led to correction of the metabolic abnormalities in two patients.
5. Claudication pain was not related to intracellular pH or concentration of phosphorus-containing metabolites.
6. Energy production via oxidative metabolism is impaired but glycolysis may be increased in the calf muscle of patients with intermittent claudication.