Leg Pain: Causes, Symptoms and Treatments

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Pain in the leg is a common symptom, particularly if it is caused by painful joints, however, pain in the leg itself can be important and should not be ignored.
 
Contents of this article:
 
What is leg pain?
What causes leg pain?
Signs and symptoms
Tests and diagnosis
Treatments for leg pain
What is leg pain?
Pain in the feet, ankles, knees or hip is typically dealt with individually and separately from ‘leg pain’ in general, for this article, leg pain is said to occur anywhere between the groin and ankle, thus excluding the hip and feet.
 
Pain can be experienced in a number of different ways. Pain in the leg, as in other parts of the body, can be described as sharp, dull, numbing, tingling, burning, aching, and so on.
 
Pain can be acute (short-term) or chronic (long-term), and can be rated on a scale of severity from mild to severe, often rated on a numerical scale.
 
Sensory neurons (nerves) are responsible for our experience of pain, and these are triggered by stimuli such as high levels of pressure, high or low temperatures and chemicals, which can be released by tissue damage.
 
Fast facts on leg pain
Here are some key points about leg pain. More detail and supporting information is in the body of this article.
Leg pain refers to any kind of pain that occurs between the heels and the pelvis.
Many causes of leg pain are obvious, such as injury after an accident.
Leg pain can have less obvious causes, such as peripheral artery disease.
Repetitive, excessive sports, especially in the form on running, can lead to trauma that creates leg pain – E.G: shin splints and stress fractures.
Leg pain with an underlying medical cause may be nerve-related, musculoskeletal or vascular.
Some forms of leg pain resolve with self-help care.
What causes leg pain?
The obvious causes of leg pain are injuries, perhaps sustained during a sports game, or due to an accident – damage that doctors call trauma.
 
Since the causes of trauma pain are obvious, and the treatment is applied accordingly, this article deals with leg pain that is not associated with traumatic injury.
 
Sports can also cause injury in a less immediate way – shin splints, for example, are caused by excessive exercise.
 
Long-distance running is associated with a higher incidence of leg pain of numerous types – bone, musculo-tendinous, and vascular. Around half of people running more than three kilometres, who train steadily and regularly take part in a long-distance run, sustain a running-related injury each year.
 
Three broad areas cover the medical causes of leg pain (follow the links for more MNT detail on individual conditions)
 
Neurological (nervous) causes, including:
 
Neuropathy
Restless legs syndrome
Trapped nerve
Sciatic nerve pain.
Musculoskeletal causes, including:
 
Arthritis, which affects joints – the hip, knee, or ankle
Muscle, tendon or ligament strains – for example, due to sports injury
Night cramps
Exertional/chronic compartment syndrome
Medial tibial stress syndrome
Stress fracture
Vascular causes (relating to blood vessels), including:
 
Intermittent claudication due to peripheral vascular disease (PVD)/peripheral arterial disease (PAD)
Deep vein thrombosis (blood clot).
Signs and symptoms of leg pain
Leg cramps
Leg cramps are transient episodes of pain, usually for several minutes, when muscle – usually the calf at the back of the lower leg – goes into a spasm, which cannot be controlled.
 
Leg pain
If there is no obvious injury, leg pain may have a nerve, musculoskeletal or blood vessel cause.
There is a tightening sensation during cramps, which are more common at night and in older people – an estimated third of people over 60 years of age suffer from this problem.
 
Intermittent claudication
Intermittent claudication is the name given for pain in the leg due to poor circulation, which is known as Peripheral Arterial Disease (PAD).
 
This is common and associated with significant morbidity and mortality.
 
Leg pain caused by atherosclerosis or narrowing of the arteries in the leg has distinguishing features and is known as claudication or intermittent claudication. The word claudication is from the Latin word meaning limp.
 
Other terms for this atherosclerotic disease are:
 
Peripheral arterial disease
Peripheral arterial occlusive disease
Peripheral vascular disease.
It occurs due to a restricted blood supply reaching the leg muscles and as the muscles are not getting enough blood, oxygen and nutrients they start to hurt.
 
Claudication produces a leg pain that, in classic cases, is.
 
A cramp-like muscle pain during exercise or exertion
Pain occurs in the buttocks, thighs, calves and feet
Symptoms usually ease on resting
Pain when walking or climbing stairs
The cramps consistently occur after the same walking distances
The pain, usually in the calf, eases with rest, and is relieved after 10 minutes.
Many cases of claudication are not classic in this way, many show no symptoms, or produce a pain that is not typical, perhaps in the thigh or buttock.
 
Some people with severe arterial disease experience terrible pains in the leg at night, causing them to have to hang their leg over the side of the bed to gain relief.
 
How leg pain saved David Dow’s life
Medical News Today covered the story of David Dow – see ‘Leg pain can mean heart danger, expert says’ – showing that unresolved leg pain is worth taking noting of.
Deep vein thrombosis (DVT)
This is a blood clot in the deep veins of the leg (rather than the superficial varicose type veins.) It typically causes a one-sided swollen, hot, painful leg.
 
Sports injuries
Musculoskeletal injuries sustained by sporting activity fall into four broad groups, and this applies for leg injuries, too.
 
Overuse injuries from excessive sport
Blunt trauma
Fractures and dislocations
Acute soft-tissue sprains and strains.
Sports injuries to the leg within these broad groups would run into a long list, so we will deal with selected causes of leg pain.
 
Shin splints are an example of an overuse injury. The shin pain cannot be explained by an obvious cause such as a fracture.
 
Activities like jogging, running and hiking create repetitive impact forces that overload muscles and tendons. Shin splints produce severe localized tenderness in the muscles, and sometimes bone pain.10
 
Stress fractures also result from repetitive insults sustained during sports, but typically when the intensity has changed – occurring, for example, in the feet of runners who have changed the intensity or timing of their workouts too quickly.
 
These bone fractures do not result from a one-off injury, and the fractures are small. The pain is felt during the exercise, and its onset is increasingly earlier in a workout, possibly reaching a point that makes the exercise unbearable.
 
Popliteus tendinitis is another overuse injury. It produces knee pain during downhill running, and is caused by inflammation to the popliteus tendon, which is important to knee stability.10
 
Hamstring strain is yet another overuse injury, often associated with running. It gives rise to an acutely painful area in the rear of the thigh muscle, due to a partial tear. This usually develops because of inadequate flexibility training, or poor warm up and stretching exercises before an activity.
 
Compartment syndrome
Injuries to the leg – usually the back of the lower leg – that result in fractures or severe bruising can lead to compartment syndrome, in which the pain is usually disproportionate to the injury.
 
Compartment syndrome is caused by a swelling brought on by the injury, but within a confined volume, within a closed fascial compartment, where there is little room for expansion, and pressure increases.
 
This edema can continue to a serious extent, cutting off blood supply to the tissue (ischemia). In these cases, the early pain may be followed by paresthesias, paralysis, pallor and a lack of pulse at the area affected.
 
On the next page we look at tests and diagnosis for leg pain, how to prevent suffering with the condition and the treatment options for sufferers of leg pain.
 
Leg Pain: Treatments and Diagnosis
Tests and diagnosis
The American Academy of Family Physicians (AAFP) has produced a triage chart for leg problems, flowing through a number of questions that help you to narrow down a potential diagnosis, and offering a prompt if medical attention is called for.
 
The AAFP algorithm begins by ruling out strains and broken bones, and differentiating the two, before dealing with other types of injury and finally teasing out potential medical problems.
 
Doctors work in a similar way during their process of diagnosis – they may develop a ‘differential diagnosis’ after a series of questions and answers to rule out obvious problems.
 
The doctor will want to take a history (ask questions) of the pain and then examine the leg(s) and locate the pain. They will want to feel for pulses, test for edema and swelling, and detect temperature changes.
 
Specific injuries, such as those caused by sports injuries, may be investigated further, with tests including ultrasound imaging, X-ray, CT scans, MRI, and bone scans.
 
In cases of claudication – leg pain caused by peripheral arterial disease – the diagnostic process may include:
 
Ankle-brachial BP index – measurements of blood pressure in the arm and ankle during rest and after walking
Ultrasonography – scans to test the characteristics of the circulation in the leg
CT/MRI – scans are done after injecting contrast into the blood stream to show up the arteries and veins
Angiography – again contrast is injected and watched as it flow through the arterio-venous system, looking for blockages and narrowing.
 
Treatments for leg pain
 
Self-help for muscle crampsA runner helps another runner with leg cramps by stretching their leg
For calf cramps, straightening the leg and pulling the foot up towards you may help (even better if you have someone to help you).
Leg cramp, often called charley horse in the US, is a type of leg pain that, if other causes have been ruled out, does not call for further investigation, and treatment is limited to self-help measures.7
 
Stretching and massaging the muscle may help, but painkillers will not – since they are too slow to take effect. However, if tenderness persists after cramps, painkillers may be helpful then.7 No drugs are recommended for the treatment of simple leg cramps.
 
For cramps affecting the calf, in addition to massage, the following can help:
 
Pull the foot up toward you while straightening the leg, or
Walk around on heels until the cramp eases off.
Charley horse can be prevented through these measures.
 
Stretching before exercising
Avoiding dehydration by drinking 8-12 glasses of water a day
Stretching and massaging your legs.
Claudication therapy
Treatment for people experiencing claudication leg pain is important since they at a higher risk of heart attack or stroke.9
 
Peripheral arterial disease often coexists with other atherosclerotic conditions, such as coronary artery disease (which narrows the arteries to the heart and raises the risk of a myocardial infarction) and cerebrovascular disease (which can result in a stroke).9
 
A treatment program for claudication involves aggressively tackling cardiovascular risk factors through:
 
Smoking cessation
Management of diabetes
Control of hypertension
Reduction in cholesterol and lipids
Antiplatelet (anticlotting) therapy
Walking exercise programs
Some patients may be suitable for surgery to reconstruct the arteries in the leg.
In a review in 2015, exercise programs have been shown to be a relatively inexpensive, low-risk option compared with other more invasive therapies for leg pain on walking (intermittent claudication).
 
Further studies need to be done to see if drugs such as Sildenafil (usually used for erectile dysfunction) could be useful in the treatment of intermittent claudication.16
 
Recent development in claudication treatment
 
Ramipril improves walking for people with peripheral artery disease. This paper, published in February 2013 in the Journal of the American Medical Association, concluded, “24-week treatment with ramipril resulted in significant increases in pain-free and maximum treadmill walking times compared with placebo.”
Sports injury treatment
An easy acronym is used in the approach to treating minor sports injuries in the form of leg sprains and strains: RICE, which stands for the following four elements:
 
 
People running
 
Running is a common cause of simple sprains and strains, but also of ‘overuse injuries.’
Rest – to prevent further injury and allow healing time to reduce swelling
Ice (or a cold pack available commercially) – to reduce swelling, inflammation and pain
 
Compression – with an elastic bandage to reduce swelling and pain
Elevation – lifting the leg above the level of the heart so that gravity assists with draining and reduces swelling and pain.
Ice should not be applied directly to the skin (and so should be wrapped in plastic or a towel), and should be applied for 20 minutes at the most. Elastic bandages should not be wrapped too tightly, lest a swelling is caused further along.10
 
Pain can be treated with drugs such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs). If their use for an apparently minor injury is needed beyond 72 hours, specialist medical advice should be sought to investigate the injury.10
 
Periods of rest to avoid the same activity that caused the injury need not mean a loss of condition, since alternative exercise that does not affect the leg injury can be pursued. A return to the original activity should be graduated in its intensity so that flexibility, strength and endurance are gradually restored.

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