12 Common Causes of Leg Pain and How to Feel Better Today
Many of my patients come to me with leg pain and it is my job to help determine the source of that pain. Sometimes, it can be difficult, even for a medical provider, to help make this determination.
Below are some of the most common reasons for leg pain, and some strategies for feeling better.
Please note, however, that some of these conditions are serious and require immediate medical attention. Don’t put off seeking medical attention for new or worsening leg symptoms, and make sure you speak to a healthcare provider before starting any new regimen.
Reason #1 - Sprains and Strains
A sprain is a stretch or tear in a ligament. Ligaments are bands of fibrous tissue that connect bones to bones at joints.
A strain is also a stretch or tear, but it happens in a muscle or a tendon. Tendons link muscles to the bones.
- Strains occur when there is a stretch or a tear in a muscle or tendons. Tendons connect muscle to bone.
- Sprains occur when there is a stretch or a tear in a ligament. Ligaments connect bones to other bones.
- This type of pain is the result of an accident or overuse and tends to be worse near a joint.
- A diagnosis can be made without testing, but an x-ray or MRI may be ordered.
- Occasionally, swelling or bruising may be present.
- Typically, only one leg is affected at a time.
How to feel better?
- Ice, elevation, and OTC pain relievers can help relieve pain.
- Avoid bearing weight or doing other activities that make the pain worse.
- Severe strains may require a brace, a cast, physical therapy, or surgery.
Reason #2 - Arthritis
- Joint pain can sometimes radiate into the legs themselves causing an aching sensation.
- Pain is often worse upon awakening or upon standing/walking from a seated position.
- Pain may improve as a patient continues to walk and feels “less stiff". Joints may swell.
- Treatment typically consists of medications to manage the pain, but some types of arthritis also require medications to prevent joint damage, and severe cases may lead to surgery
Reason #3 - Bursitis
- Small, fluid-filled structures called bursa help to ease the movement of joints. These structures can become damaged or inflamed, causing stiffness of the joint and pain with flexing the knee or pressure on the knee.
- Pain typically resolves without stress on the joint.
- Diagnostic tests are not always needed to make a diagnosis but an MRI might be ordered for confirmation.
- Treatment usually consists of rest and/or ice, but may also include physical therapy or steroid injection into the joint.
Reason #4 - Tendonitis
- Overuse or repetitive use of the calves can lead to inflammation of the Achilles tendon
- Pain is often described as burning in the back of the calves with exercise, and it may be accompanied by stiffness. The pain improves with rest.
- Tendonitis can be diagnosed without any special tests, but sometimes imaging tests are ordered to rule-out other causes of pain.
- New, or acute, tendonitis is treated with ice, anti-inflammatories, and compression of the calf. Chronic tendonitis may also be treated with physical therapy or bracing, and occasionally steroid injections are recommended.
Reason #5 - Nighttime Leg Cramps
Nighttime leg cramping is extremely common and often has no identifiable cause. Some cases, however, may be the result of the following condition.
- Dehydration - Make sure to drink adequate amounts of water and electrolytes.
- Vitamin or Mineral Deficiency - Eat plenty of fresh fruits and vegetables, especially leafy greens, to keep up potassium levels.
- Pregnancy - Ask your OB/Gyn if you need magnesium supplements.
- Medication Reaction - Some medicines that can cause leg cramping include certain diuretics (also called “water pills”), blood pressure medications, and cancer drugs.
- Ask your healthcare provider if your cramping could be improved with a medication adjustment.
- Underlying Disease - Diabetes, hypothyroidism, Parkinson’s, and anemia. Appropriate treatment of the disease can improve or resolve leg cramping.
- Leg cramping due to vascular disease will be covered later in this article.
- No identifiable cause - A daily exercise and stretching routine may help alleviate cramping in the legs. Sitting for prolonged periods of time during the day can make nighttime cramping worse.
- Some patients report improvement in leg cramping when they consume a glass of tonic water before bed. Tonic water contains small amounts of quinine, the agent thought to help with cramping.
Reason #6 - Diabetic Neuropathy
- Poorly controlled diabetes can lead to nerve damage which can present as pain, numbness, or tingling of the legs or feet. Risk factors for the development of diabetic neuropathy go behind just blood sugar levels and include obesity, cholesterol levels, age, and smoking.
- No testing is needed to diagnose diabetic neuropathy.
- Treatment consists of medications that help to reduce pain. OTC pain relievers, like Capsaicin, may help but many patients require prescribed medications.
- Sometimes, even non-diabetics can also develop neuropathy due to nerve irritation or unknown causes.
Reason #7 - Spinal nerve disorder
- Damaged, inflamed, or “pinched” nerves of the lower back can cause pain that radiates into the legs. Examples include spinal stenosis and sciatica. Pain may start in the back or hips and radiate down the leg. Pain is often sharp, shooting, or burning and may worsen with prolonged sitting or standing in one position.
- Testing is not always needed for diagnosis, but imaging studies or nerve conduction tests may be ordered.
- Treatment of spinal disease via physical therapy or surgery may improve leg pain.
Reason #8 - Peripheral Arterial Disease
- Blockages, called plaque, in the arteries of the legs and feet can result in decreased blood and oxygen to the muscles and skin.
- This is plaque created by the build-up of fat and blood particles within the arteries. Things like elevated cholesterol and smoking can cause or worsen this process.
- Leg pain from PAD often starts with pain in the calves, thighs, or buttocks when walking or exercising. Pain is often predictable, occurring at a specific time or distance intervals. Rest often relieves pain. Severe cases of PAD can cause pain in the toes and feet at rest or with elevation. Feet may feel cold, tingling, and numb. One leg or foot is typically more symptomatic.
- Severe PAD can cause the skin to become hard, dry, darkened (red, brown, blue, or black), and painful wounds, slow-healing wounds may develop.
- PAD is diagnosed via the use of imaging like ultrasound or cat scans. An arterial Doppler with ABI’s is often the first test ordered.
- An angiogram is a minimally invasive procedure that may also be used to diagnose PAD. This test is essentially an x-ray of the arteries. Treatment of the arteries can sometimes be performed at the same time the angiogram is done.
- Treatment for PAD depends on the severity and location of the blockage. Exercise- walking and other forms of low-impact exercise help to improve circulation by opening blockages and forming bypasses around the plaque.
- Medication - many patients are benefitted from medications meant to slow the development of and stabilize, plaque in the arteries. Medications include blood thinners and cholesterol medication.
- Intervention. Significant PAD requires procedures to open arteries or re-establish blood flow to certain areas of the feet or legs.
Interventional vascular specialists use minimally invasive techniques, usually via an IV in the ankle, groin, or arm, to repair the arteries. Complicated cases of PAD may not be able to be repaired without surgery, as below.
Vascular Surgeons perform more invasive procedures that require hospitalization and general anesthesia. Sometimes, a patient’s own veins, or a synthetic alternative, is used to create a bypass around large blockages.
Severe PAD can lead to severe complications including gangrene and amputation of limbs. Seek medical evaluation ASAP if you suspect PAD from Physicians at the Center for Vascular Medicine.
Please visit a vascular specialist if you are suffering from leg pain during exertion and when the pain immediately subsides with rest.
Reason #9: Blood Clot
An acute, or new, blood clot in the leg can be the result of an injury, or it may be spontaneous. Risk factors for blood clots in the legs include the following:
- Injury or Surgery
- Prolonged periods of inactivity. (ex) Travel, convalescence
- Medication (ex) Hormonal birth control
Acute blood clots can cause a deep, aching sensation in the leg. Many patients also experience swelling and redness. One leg is typically more symptomatic. Sometimes, clots can travel to the lungs (pulmonary embolus) which may cause chest pain or difficulty breathing.
An acute blood clot in the leg can be a medical emergency so don’t delay medical evaluation
Diagnosis of a blood clot in the leg most often consists of an ultrasound of the leg called a venous Doppler, but other tests, like a venogram can be ordered, too.
Sometimes, a scan of the lungs is ordered to look for evidence of a pulmonary embolism.
Treatment often involves a course prescription blood thinners, either orally or IV. Severe clots may require hospitalization.
You may require additional testing to determine the cause of the clot and how best to avoid recurrence.
A blood specialist called a hematologist may be brought into your care, but otherwise, blood clots can be managed by primary doctors and vascular specialists.
Reason #10: Post-Thrombotic Syndrome
A history of blood clots in the legs can result in long-term discomfort and swelling, even after the clot is resolved.
Treatment begins with compression socks, regularly low-impact exercise, and leg elevation at rest.
To avoid post-thrombotic syndrome, seek early care if you think you have a blood clot.
Reason #11: Chronic venous insufficiency
Venous insufficiency, or superficial venous insufficiency, is a condition wherein veins become weak and allow the backward flow and stagnation of blood in the legs. This is called reflux.
Pain caused by venous insufficiency is most often described as achiness, sometimes accompanied by a sense of heaviness and fatigue of the legs. Swelling and skin discoloration may also develop. Varicose or spider veins may or may not be present.
Venous insufficiency is diagnosed via a special type of vein ultrasound called a “reflux study.” This is different than a basic venous Doppler which looks only for blood clots. Treatment begins with compression socks, regularly low-impact exercise, and leg elevation at rest. Many patients benefit from an evaluation with a vascular specialist to determine if vein treatment would improve their symptoms. Vein treatment for chronic venous insufficiency most often consists of minimally invasive, outpatient procedures to close or remove refluxing veins in order to redirect circulation to healthier veins.
Reason #12: Vein disease of the pelvis
Pelvic congestion syndrome or pelvic vein compression can cause leg pain, with out without pelvic pain or heaviness.
Pelvic vein disease is caused by varicose, defective, or compressed veins within the pelvis. This results in the inefficient circulation of blood as it travels up the leg and returns to the heart.
- Pain is described as an aching sensation, sometimes accompanied by leg heaviness, fatigue, pressure, burning, or swelling.
- Varicose veins of the genital area, groins, or legs may be present.
- Patients may experience pain during and after sexual intercourse.
- Some patients may be at an increased risk for blood clots.
Pelvic vein disease is diagnosed by an ultrasound of the pelvic veins and/or a test called a venogram.
Treatment begins with compression socks, regularly low-impact exercise, and leg elevation at rest.
Many patients benefit from an evaluation with a vascular specialist to determine if vein treatment would improve their symptoms. Vein treatment for pelvic vein disease often consists of closing defective veins or opening compressed veins in the pelvis via minimally invasive outpatient procedures.
Please visit a vascular specialist for your leg pain by going to the location page.