From health.com
By Taneia Surles, MPH
Leg pain can be an irritating side effect of many different injuries or conditions. More common sources of leg pain include muscle cramps, injury, blood clots, and certain medical conditions that can cause general pain and discomfort. Leg pain can be acute (temporary) or chronic (ongoing).
Depending on the cause, leg pain may be a minor issue you can treat at home or can indicate a more serious health problem affecting your ability to complete daily activities. For example, in more serious cases, leg pain may be a sign of nerve damage, osteomyelitis (bone infection), joint inflammation, or other medical conditions.
If you’re experiencing severe or recurring leg pain, it's important to know the causes and seek medical attention if necessary.
Parts of the Leg
Your leg is comprised of many different parts, including bones, muscles, joints, tendons, ligaments, cartilage, and nerves. Any of these structures can be injured or otherwise affected by a medical condition, so it’s important to be aware of what they are and where you’re feeling pain.
Your thigh, which is the upper half your leg, contains your quadricep, hamstring, abductor, and adductor muscles. Your thigh also contains the largest and strongest bone in your body: the femur.
The lower half of your leg is made up of your shin, calf, and ankle. Your shin, or the front half of your lower leg, contains a bone called the tibia. Your calf is the back part of your lower leg. It contains the gastrocnemius and soleus muscles, which come together to form your Achilles tendon. This tendon connects your calf muscles to your heel bone. The ankle joint connects your leg to your foot.
Your knee joint is in the middle of your upper and lower legs. Your knee joint connects your femur, tibia, and patella (which is more commonly known as the kneecap). Ligaments, tendons, and cartilage help support and stabilize your knee joint.
How Leg Pain Presents
Several factors help differentiate between the many types of leg pain.
Understanding the following characteristics can help you determine what may be causing your pain:
- Location: Pain may occur in one specific area of your leg or the entire leg.
- Time of onset: Leg pain can occur due to normal wear and tear on your limbs or overuse, as well as from injuries or health conditions. More sudden pain can more often be attributed to an injury, whereas pain that sets in over time may be due to wear and tear or overuse.
- Type of pain: There are several types of leg pain, including nociceptive (tissue damage), neuropathic (nerve), and inflammatory (joint and muscle) pain. Each type presents with unique symptoms.
- Pattern: Your leg pain may be ongoing, sporadic, acute (sudden and intense), or a mixture.
- Sensation: The affected area of your leg may ache, cramp, feel hot, be tender to the touch, or feel heavier than usual.
- Intensity: Leg pain can range from mild to severe, potentially even impacting your ability to complete daily activities.
Potential Causes of Leg Pain
Pain in one or both legs can occur due to many causes, including overuse, wear and tear, injuries, certain medications, and various health conditions.
Muscle Cramps
Muscle cramps are a common cause of leg pain. You can experience ongoing, involuntary, and painful muscle contractions or cramps within single or multiple muscle fibres within your leg. These can last for a few seconds or up to several minutes.
Possible risk factors for muscle cramps include:
- Dehydration
- Muscle fatigue, which is especially common during physical activity
- Imbalance of electrolytes
- Compression of nerve roots (the first part of a nerve) or arterial blood vessels (which carry blood from your heart to your other organs)
- Use of certain medicines, including diuretics, beta-blockers, and statins
- Hormonal and metabolic disorders
Injuries
Acute or chronic injuries are another common cause of leg pain. These injuries can cause symptoms like sudden and severe pain (if acute), swelling, bruising, and the inability to move your joint normally. Risk factors for acute leg injuries include playing sports, running, falling, or having an accident. Chronic injuries are more likely to occur when acute injuries aren’t treated properly or cause complications.
The most common acute injuries leading to leg pain include:
- Strain or sprain
- Stress fracture
- Tendinitis
- Shin splints
- Joint dislocation
Peripheral Artery Disease (PAD)
Peripheral artery disease (PAD) is a condition that can cause pain in the legs due to a narrowing or blockage of the blood vessels that carry blood from your heart to your legs. The primary cause of PAD is plaque build-up in the arteries, known as atherosclerosis.
Aside from atherosclerosis, other risk factors for PAD include:
- Smoking
- Having hypertension (high blood pressure)
- Having diabetes
- Being older than 60
PAD signs and symptoms may include the following:
- Leg pain, aching, a feeling of heaviness in the leg, and/or cramping
- Leg hair and toenails may stop growing
- Foot or leg becomes pale, discoloured, or blue
- Weakness or numbness in the legs
- The feeling of pins and needles in your leg or foot
- Limb ischemia (severe pain while leg and foot are resting)
- Sores or wounds on your toes, feet, or legs that heal slowly or never heal
Blood Clot (Deep Vein Thrombosis, or DVT)
Leg pain may also result from a blood clot, also known as deep vein thrombosis (DVT). Two to 5% of people will develop DVT in their lifetime. Blood clots more often form within the leg's deep veins but can also develop in the arms.
DVT can develop from:
- Reduced blood flow
- An increase in venous (vein) pressure
- Injury to the vein from trauma, surgery, catheters, previous history of DVT, or intravenous (IV) drug use
- Having obesity
- Being pregnant
- Being older than 60
- Hospital admission for critical care
- Having cancer
Symptoms of DVT include pain, swelling, redness, and warmth on one or both legs. DVT is a life-threatening medical emergency and always requires urgent medical care.
Osteomyelitis (Bone Infection)
Osteomyelitis, or a bone infection, is one of the more serious conditions that can cause leg pain. This medical condition can cause acute or chronic inflammation of your bones and surrounding structures.
Potential risk factors for osteomyelitis include:
- Diabetes
- A weak immune system
- Use of intravenous drugs
- Bacteremia (bacteria in the blood)
- Endocarditis (inflammation of the inner lining of the heart’s chambers and valves)
- Injuries or other physical trauma
- Open fractures (fractured bone is exposed to the outside environment)
Symptoms of a bone infection may include:
- Erythema (skin redness)
- Swelling
- Dull pain with or without moving limbs
- Warmth in the affected area
- Fever or chills
Joint Inflammation
Joint inflammation, also known as arthritis, can be a possible cause of leg pain. Various types of arthritis can affect the lower extremities, such as the legs, hips, knees, and ankles.
Common arthritis symptoms include pain, redness, heat, or joint swelling. In addition, one form of arthritis, osteoarthritis, can lead to leg length discrepancy, or LLD. LLD is a common condition that causes uneven and excessive force applied to knee and hip joints and parts of the spine.
The risk factors for arthritis include:
- Older age
- Being assigned female at birth
- Having obesity
- History of diabetes, cancer, or cardiovascular disease
- Walking disability
Nerve Damage
Nerve damage, or peripheral neuropathy, is a common health condition in which the nerves in your legs don’t function properly due to damage to an individual or multiple nerves. There are several types of nerve damage and causes, but the most common risk factor is diabetes. Over time, having consistently high blood sugar levels can damage your nerves.
A few other risk factors for peripheral neuropathy include:
- Chronic conditions, such as rheumatoid arthritis and lupus
- Infections such as Lyme disease, shingles, hepatitis B and C, and diphtheria
- Low levels of B vitamins (e.g., B1, B2, B12)
- Heavy metal poisoning such as lead or mercury poisoning
- Nerve trauma
- Long-term, heavy alcohol use
Varicose Veins
Varicose veins, or varicosities, are veins underneath your skin that become swollen or twisted. Varicosities typically develop in the legs but can also occur in the rectum and scrotum.
Symptoms of varicose veins in the legs include the following:
- Bluish, bulging veins
- Discomfort around the affected veins
- Changes in skin colour around the veins
- Swelling
- Aches and pain
- A feeling of heaviness in the legs and feet
- Night-time cramps
There are many potential causes and risk factors of varicose veins, including:
- Being of an older age
- Being assigned female at birth
- Occupations that require constant or frequent standing
- Pregnancy
- Family history of varicose veins
- Smoking
- Having obesity
- Low physical activity levels
- Genetics
- High blood pressure
- Lifestyle habits (i.e., sitting or standing for long periods)
Less Common Causes
Less common causes of leg pain include:
- Cellulitis: Cellulitis is a common bacterial infection that can cause swelling, pain, and redness in the affected area of your skin. It more commonly affects the legs or feet, but can affect other areas of your body.
- Cancerous bone tumours: Tumours may metastasize (spread) from the original affected area to other body parts, such as the legs.
- Legg-Calve-Perthes disease (LCP): This is a rare bone disorder that affects one or both hips in children between the ages of 3 and 10.
- Osteoid osteoma: Osteoid osteoma is a benign or noncancerous bone tumour that can cause severe pain at night. It typically develops in the long bones of the body, such as the thigh and shin bones.
- Sciatica: Sciatica is a condition that causes severe pain along the path of the sciatic nerve, the largest nerve in your body. It can cause a pins and needles feeling.
- Slipped capital femoral epiphysis (SCFE): SCFE is a relatively common hip condition that occurs due to a shift at the upper part of the thighbone or femur, leading to a weakened hip joint. This condition is prevalent among teens and pre-teens.
When To See a Healthcare Provider
In some instances, your leg pain may go away on its own. However, depending on the cause of the pain, you may need to seek immediate medical attention to prevent further health complications.
If you have any of the following signs and symptoms, visit a healthcare provider for further evaluation and diagnosis:
- You have severe pain alongside swelling, bruising, or skin discoloration.
- You have pain and swelling that does not disappear after a few days.
- You are trying at-home treatments, such as rest and ice, but they are not improving symptoms.
- You are unable to tolerate any weight on your affected leg.
- Your pain worsens when you exercise and improves when you rest.
- You notice a visible deformity or other physical change to the affected area of your leg.
Depending on your symptoms, your primary care provider may refer you to a variety of specialty doctors. For example, if they think it’s an injury, they may refer you to an orthopaedist (a medical doctor who focuses on the musculoskeletal system).
How Is Leg Pain Diagnosed?
Before receiving treatment, your healthcare provider may ask questions about your leg pain and recommend certain diagnostic tests.
Common diagnostic exams and tests for leg pain include:
- Cardiac examination involving pulse and blood pressure: This is a physical examination that checks for signs of endocarditis and other heart concerns.
- Head and neck examination: This is a physical examination in which a healthcare provider inspects you for signs of head and neck injuries or related conditions.
- Abdominal examination: A healthcare provider examines the shape of your abdomen, looking for any changes in your skin, abdominal masses, and movement of the abdominal wall as you breathe in and out.
- Peripheral pulse and extremity exam: This assesses your pulse to determine if you have an irregular heartbeat, which can be an indicator of peripheral artery disease.
- Non-invasive arterial examination: This examination reviews the blood vessels that support major organs and tissues to detect any underlying problems.
- Computed tomographic angiography (CTA): This non-invasive test uses X-rays to take images of your heart and blood vessels. A computer then combines the images to create a three-dimensional (3D) image of your heart.
- Magnetic resonance imaging (MRI): An MRI is a non-invasive scan that creates detailed pictures of the area of your body being examined. This makes it easier for your healthcare provider to spot any issues in areas like your bones and muscles.
- Magnetic resonance angiography (MRA): This non-invasive test generates images of your arteries to see if any abnormalities (such as build-up) could be contributing to a blood clot.
How Is Leg Pain Treated?
If your leg pain isn’t severe, you may be able to treat it with at-home remedies. Depending on the cause, medical intervention may be needed.
At-Home Treatments
If you have acute leg pain from muscle cramps or overuse, you can the rest, ice, compression, and elevation (RICE) method before resorting to medical care, if necessary. Here are some recommendations:
- Rest: Try to limit or avoid activities that can worsen your leg pain
- Ice therapy: Apply ice to the affected area for up to 15 minutes four times daily
- Compression: Bandage the affected area to reduce swelling and inflammation
- Elevate your leg: Use a pillow or two to elevate your leg to reduce or prevent swelling
- Stretches and massages: Gently stretch and massage your leg muscles to relieve cramps
- Over-the-counter medications: Take non-steroidal anti-inflammatory drugs (NSAIDs) such as Tylenol (acetaminophen) or Advil (ibuprofen) for pain relief
Medical Treatments
For more serious or chronic leg pain, your healthcare provider may suggest one of the following medical treatments to relieve your symptoms:
- Prescription medications: Leg pain due to nerve damage, heart or blood conditions, or arthritis may require prescription drugs.
- Immobilisation: This common treatment method uses movement prevention to encourage blood flow in the affected area. Splints, braces, and casts can support and protect a leg injury.
- Physical therapy: If you have an acute injury, rehabilitation may be necessary before resuming your daily activities. A physical therapist can teach you exercises to rebuild your strength and improve your range of motion.
- Surgery: In some instances, surgery may be necessary to repair connective tissues, bone fractures, or damaged nerves.
A Quick Review
There are many reasons why you might experience leg pain. The most common causes are muscle cramps, injuries, blood clots, and various medical conditions. Leg pain can vary depending on factors such as location, symptoms, severity, and other factors.
If you’re dealing with chronic or long-term pain in one or both legs, visit your healthcare provider to get a diagnosis and start treatment so you can resume your daily activities as soon as possible.
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