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Leg pain

Definition

Leg pain is a common symptom and complaint.

Alternative Names

Pain - leg; Aches - leg; Cramps - leg

Considerations

Common Causes

Leg pain can be due to a muscle cramp (also called a charley horse). Common causes of cramps include:

• Dehydration or low amounts of potassium, sodium, calcium, or magnesium in the blood
• Medications such as:
  • Diuretics, which can cause you to lose too much fluid or minerals
  • Statins, which lower cholesterol and can cause muscle injury
• Muscle fatigue or strain from overuse, too much exercise, or holding a muscle in the same position for a long time

An injury can also cause leg pain from:

• A torn or overstretched muscle (strain)
• Hairline crack in the bone (stress fracture)
• Inflamed tendon (tendinitis)
• Shin splints -- pain in the front of your leg related to overuse or repetitive pounding

Other common causes of leg pain include:

• Atherosclerosis that blocks blood flow in the arteries (this type of pain, called claudication, is generally felt when exercising or walking and relieved by rest)
• Blood clot (deep vein thrombosis) from prolonged bed rest
• Infection of the bone (osteomyelitis) or skin and soft tissue (cellulitis)
• Inflammation of the leg joints by arthritis or gout
• Nerve damage -- common in diabetics, smokers, and alcoholics (symptoms include numbness, tingling, or a sensation of pins-and-needles)
• Varicose veins

Home Care

If you have leg pain from cramps or overuse, take these steps first:

• Rest as much as possible.
• Elevate your leg.
• Apply ice for up to 15 minutes. Do this 4 times per day, more often for the first few days.
• Gently stretch and massage cramping muscles.
• Take over-the-counter pain medications like acetaminophen or ibuprofen.

For leg pain caused by varicose veins, leg elevation and compression with elastic bandages or support hose can help.

For leg pain caused by nerve disorders or claudication, control diabetes, eliminate alcohol and tobacco, and avoid ill-fitting shoes.

Call your health care provider if

Call your doctor if:

• The painful leg is swollen or red
• You have a fever
• Your pain worsens when walking or exercising and improves with rest
• The leg is black and blue
• The leg is cold and pale
• You are on medications that may be causing leg pain. DO NOT stop or change any of your usual medications without talking to your doctor
• Self-care steps do not help

What to expect at your health care provider's office

Your health care provider will perform a physical examination, with careful attention to your legs, feet, thighs, hips, back, knees, and ankles.

To help diagnose the cause of the problem, your doctor will ask medical history questions, such as:

• Where exactly is your pain?
• Do you have pain in one or both legs?
• How would you describe the pain? Dull and aching? Sharp and stabbing? Do you consider it to be severe?
• Is the pain worse at any particular time of day, like in the morning or at night?
• What makes the pain feel worse? For example, does exercise or long periods of standing worsen your pain?
• Does anything make your pain feel better like elevating your legs?
• Do you have any other symptoms like numbness or tingling? Back pain? A fever? Weakness?

The following diagnostic tests may be performed:

• Arteriogram to check blood flow
• Blood tests for specific diseases
• Bone biopsy if tumor is seen on MRI which may be malignant
• Bone scan
• Duplex Doppler/ultrasound exam to look for a blood clot
• MRI if a malignant tumor is suspected
• X-ray of your back or legs

Treatment depends on the cause. Medications may include pain medicines, anti-inflammatory drugs (NSAIDs), anticoagulants (blood thinners) such as Coumadin if there is a blood clot, and others. Cellulitis and osteomyelitis are each treated with antibiotics. Osteomyelitis will require extended use of antibiotics.

For some causes of leg pain, physical therapy may be recommended by your doctor. If you have a blocked artery, inserting a balloon catheter into the artery to improve blood flow may be advised.

Prevention

To prevent claudication and nerve damage:

• Don't smoke or use tobacco.
• Limit how much alcohol you drink.
• Keep your blood sugars under good control if you have diabetes.
• Reduce other heart disease risk factors, including high cholesterol and high blood pressure.

To prevent overuse injuries, like shin splints, muscle cramps, and other causes of leg pain:

• Warm up before physical activity and cool down afterward. Be sure to stretch.
• Drink plenty of fluids throughout the day, especially before, during, and after exercise.

References

Huddleston JI, Goodman SB. Hip and knee pain. In: Harris ED, Budd RC, Genovese MC, Firestein GS, Sargent JS, Sledge CB, eds. Kelley's Textbook of Rheumatology. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2005:chap 42.

Nagaraju K, Lundberg IE. In: Harris ED, Budd RC, Genovese MC, Firestein GS, Sargent JS, Sledge CB, eds. Kelley's Textbook of Rheumatology. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2005:chap 78.

Andrish JT. The leg. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2003:chap 29.

Ginsberg J. Peripheral venous disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 81.

Shy ME. Peripheral neuropathies. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 446.