There are many causes for leg pain in seniors. The main sources for pain are the joints, the arteries, the veins, the nerves and the muscles of the legs. Each type of problem is more common in older people than it is in younger people. Sometimes leg pain in seniors is a sign of something urgent. But usually it turns out to be a chronic condition.
Leg Pain in Seniors from Artery Blockages
Leg Pain in Seniors from a Blood Clot
Blood clots in the veins are an urgent reason for leg pain. Usually there will also be swelling. But some people will just have pain. The pain can be in the calf but it can also be higher in the leg. Older people are at higher risk for clots than younger people. So if you are an older person, and you are experiencing sudden pain and swelling in your leg, you have to make sure this is not a blood clot.
Diagnosis and Treatment of Blood Clots
The way to diagnose a blood clot is with an ultrasound. Once you have the diagnosis of a blood clot, you have to start taking a blood thinner very quickly. Any delay in treatment can result in problems including more extensive clots or even clots breaking off and going to the lungs.
Leg Pain from Blocked Arteries
Blocked arteries in the legs can lead to two types of leg pain. The first, is called intermittent claudication. This is basically leg pain with walking. Basically, our muscles need blood flow to function the way they are supposed to. If there is not enough blood flow because of blocked arteries, then the muscles will ache when we walk.
The second type of leg pain from blocked arteries is rest pain. Rest pain is a very severe form of nighttime leg pain. It is the result of very severe blocked arteries. When a person has such blockages, and they raise their legs, they will feel very severe pain in their toes and feet.
Importantly, night cramps are usually not because of blocked arteries.
Diagnosis and Treatment of Blocked Arteries
The diagnosis of blocked arteries is with blood flow testing. The first tests you will need do not involve radiation or dye (contrast). The first is called pulse volume recordings. Basically, blood pressure cuffs measure blood flow along the leg. The second test is an ultrasound.
People who have symptoms because of blocked arteries should discuss treatment options with their vascular doctor. Treatment must include medications and an exercise program. Some people will need procedures. These can be “minimally invasive” or open surgery.
Joint Pain
Joint pain is very common in older people. The most common cause of joint pain in seniors is “degenerative joint disease” or “wear and tear” of the joints. Another name for this is osteoarthritis. Most people simply say “arthritis”. Arthritis can affect most joints of the legs.
Many older people will complain of joint pain when lying down. Usually, this pain will be in the hips. It is sometimes hard to know if this pain is from the joints or from the nerves in the back. When the nerves are the cause this is called sciatica leg pain.
Diagnosis and Treatment of Joint Pain
The best way to make the diagnosis is with an X-ray, CT scan or MRI scan.
There is no simple solution for joint leg pain in seniors. One approach is to stop doing whatever it is that is causing the pain. But for many people that will mean slowing down, when they don’t want to slow down. Physical therapy is actually a better solution. In my opinion people should use physical therapy much more to help with joint pain.
Controlling the pain is also important. But acetaminophen (Tylenol) may not be enough. And it can also be risky to take medications such as NSAIDs for a long time. So, some people will need injections to their joints. Others might benefit from joint replacement.
Nerve Leg Pain
Another name for nerve pain is neuropathy. Like other conditions, neuropathy is more common in older people. It can cause lack of sensation but it can also cause pain. In fact, neuropathy leg pain is a common cause for night leg pain in elderly people.
Diagnosis and Treatment of Neuropathy
The diagnosis of neuropathy is usually clinical. This means that your doctor will hear the story and examine you to make the diagnosis. Some people need more sophisticated testing such as nerve conduction testing or even skin biopsy. Other times, people need blood tests to look for the cause of the nerve damage.
Once you have the diagnosis, neuropathy treatment is with medication. There are several groups of medicines that may have some benefit to improve the symptoms in most people. Of course, part of the treatment is also to remove whatever the cause was. For this reason, proper evaluation by an experienced doctor is important.
Vein Valve Disease in Seniors
Blood clots are not the only reason for leg pain in seniors from the veins. This is because our veins do not work as well as we age, compared to younger people.
In the legs, our veins carry blood from the feet back to the body. So the veins work against gravity. To make that work, veins have valves inside them that prevent blood from going the wrong way. But these valves are very delicate. So with time more people develop some vein valve disease. Another name for this is venous insufficiency. When these valves are not working properly, some blood flow can go the wrong way. This will increase the pressure in the ankles and feet. People who have this problem with experience achiness and heavy legs. Symptoms are worse if you stand for a long period of time. Also, symptoms tend to be worse at the end of the day. This is why vein valve disease is a reason for night leg pain in seniors.
Diagnosis and Treatment of Vein Valve Disease
The diagnosis of vein valve disease is with ultrasound. Here is a video clip showing what the valve looks like and how blood flows in the wrong direction:
There are several treatments for vein valve disease. One option is compression stockings. Of course, these stockings are tight. Some older people will not be able to get them on properly. Another option is a procedure to fix the veins. Naturally, many older people will want to avoid procedures. For many people, the practical treatment ends up being leg elevation.
Still, there is one important thing to remember. A possible complication of vein valve disease are wounds around the ankles. If you develop such a wound, seek medical attention. These wounds will probably not close on their own.
Tight Muscles
No one stretches as much as they should. No one. And muscle become tighter with age. This means that most older people will suffer from tight muscles. While this does not sound like a very “medical” diagnosis, tight muscles can lead to cramps, aches and pains. Regular stretching can be important for balance and to reduce the amount of leg pain in older people. Tai Chi is one way of achieving this. In fact, Tai Chi may even be beneficial for knee joint pain. It may also have other health benefits.
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