There are many causes for leg pain. Some are urgent but others are chronic. So to understand leg pain you have to understand how to describe it. Only after you are able to describe your leg pain, you will be able to diagnose the cause, and think about treatment.
Describing Leg Pain: The First Step in the Diagnosis
Leg pain is a complicated symptom. To make the diagnosis you have to be able to describe exactly what is bothering you. Here are a few questions to think about:
1. How Long have you had the pain for?
Pain that you had for a long time is different than pain that just started. It is hard to draw the line between new-onset and chronic symptoms. Sometimes chronic means more than 6 weeks and other times it means more than 3 months. But the idea is to be able to know if the symptoms just started or if they have been around for a while.
Examples of chronic leg pain causes include arthritis (“wear and tear”), a pinched nerve (such as sciatica leg pain), venous insufficiency (“faulty leg vein valves”), growing pains, and more rare conditions such as muscle inflammation and certain types of cancer. On the other hand, examples of acute leg pain include a blood clot in the leg veins or arteries, an injury such as a fracture or a sprain and an infection such as cellulitis.
2. Where exactly is the pain located?
Knowing the location of pain is important. For instance, generalized pain is different from localized pain. A painful joint might hurt because of arthritis or an inflammation. On the other hand, a shin might hurt because of anything from growing pain, to shin-splints and even a tumor.
3. Can you see anything wrong with your leg?
Looking at your leg can really help make the diagnosis. Is any part of the leg swollen? Has the color of the skin changed? Can you identify a foot wound?
Swelling might be a sign of arthritis, infection or a blood clot (DVT). A change in the shape of your toes or foot might mean you have arthritis. Skin color changes are often clues for problems with blood flow or an infection.
4. Do you know what caused the pain?
I think it was the great Sir William Osler who said: “Listen to your patient; they are telling you the diagnosis.”. Well, you are the patient. Tell yourself what the diagnosis is. In other words, even though it may sound silly, ask yourself if you know what caused the leg pain. Often, the answer will be “yes”. Perhaps you know that you suffer from arthritis and you are experiencing a flare-up. Or maybe you can remember an injury that you had.
5. What makes the pain worse?
Some types of leg pain are just constant. But other types change with things we do. Here are a few common things we do that can make certain types of leg pain worse:
- Walking – Leg pain with walking can be a sign of blocked arteries. But it can also be a sign of a problem in the joints, too much pressure in the muscles or of spinal stenosis. Still, if you understand that the pain is worse with walking, it is very useful information.
- Standing – Sometimes you will have pain in the legs especially when you stand. If your veins are not working properly, then when you stand, pressure will build up in your ankles and calves. That will cause discomfort. Another example is arthritis. Standing can increase the pressure on the joints, and that can cause pain.
- Lying down – Pain when lying down usually means there is some sort of compression that is going on. It could be a problem with a joint that is grinding when you change position. Or it could be a pinched nerve, like sciatica.
- Touching the painful spot – No one wants to touch a spot that hurts. We all know touching can make the pain worse. But there is a difference between a specific spot that hurts and a whole area that hurts. For instance, pain over a specific joint can mean there is joint inflammation. But if the whole leg hurts, the cause is usually something else.
6. What makes the pain better?
The same way certain things make the pain worse, there are usually things you can do to feel better. Here are a few examples:
- Putting your feet up
- Stopping to rest when you walk
- Wearing compression stockings
- Icing a painful spot
All of these are useful hints. If you have calf pain with walking that goes away after you stop walking for a couple of minutes, then the problem is probably blocked arteries. Or if your legs feel heavy at the end of the day, but compression stockings help, then think about a problem with the leg veins.
7. How severe is the leg pain?
This is a tricky question. Different people have a different tolerance for pain. One person might call pain “mild” but another person will call the same pain “severe”. Still, understanding the degree of pain can help. Sudden severe pain in a swollen calf might mean there is a ruptured Baker’s cyst, a blood clot in a vein or an infection. On the other hand, achy pain in the buttocks that changes with position is a clue for a pinched nerve. Or for instance, very severe pain in the toes that happens at night when your feet are up, may be rest pain, which is a clue for severely blocked arteries.
8. How would you describe the pain?
We use different words to describe pain. And the words we use can help us understand the cause. For instance, heavy legs at the end of the day are different from night muscle cramps. Both happen toward the end of the day, but they feel very different. We use different words to describe them (“heavy” versus “cramping”). Also, we usually think of the cramps as “severe”, and the heaviness as “annoying” or “aching”. These differences matter. Pay attention to them and you will know the diagnosis.
Testing for Leg Pain
Once you are able to describe the pain, the next step is to get a few tests to prove your diagnosis. The test you choose depends on the condition you are thinking of. Here are a few examples:
- Testing for blood flow in the arteries – There are simple, non-invasive, tests that can assess the blood flow in the arteries. A common test is called the ankle-brachial index. A more comprehensive version is called pulse volume recordings. Both involve simple blood pressure cuffs over your legs. These cuffs will measure blood flow to the legs.
- Ultrasound to look at the veins – An ultrasound uses sound wave to show structures in the body. It is a great test to show the blood flow in the veins. An ultrasound will be the first test we will choose if we suspect a blood clot in a vein or a problem with how the veins are functioning.
- Blood work to test for inflammation
- X-rays
Obviously, there are also more sophisticated tests. If the simple tests do not reveal the cause for leg pain, more complicated tests might.
Treatment
There is no simple way to write about the leg pain treatment. The bottom line is that the treatment depends on the cause. And the treatments can be very different from one another. For instance, a person might need a procedure to improve blood flow to the legs if they have blocked arteries. But if they have a blocked vein from a vein blood clot, the correct treatment is actually a blood thinner. Usually a procedure is not the best treatment.
If you want to learn more about the treatment of any particular cause, you will need to read about that cause in more detail.
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