Night leg pain is common. Some reasons are urgent and dangerous. Other reasons can cause a great deal of discomfort. While some reasons are chronic, they can still cause much discomfort.
Urgent Night Leg Pain
Several reasons for night leg pain are urgent. They can either result in lasting harm to patients, or they can cause a lot of discomfort.
1. Lack of Blood Flow
Lack of blood flow is an important cause of pain in the legs. And yes, this pain can be more severe at night. Pain from lack of blood flow is usually severe. Patients feel it mostly in the toes, but it can involve the whole foot or even more of the leg. When this happens, we call it rest pain. Rest pain is usually the most severe form of peripheral artery disease. It is one of the types of critical limb ischemia.
We should never ignore rest pain. If we ignore it, the problem will not resolve, and it will progress. Gradually, the lack of blood flow will cause damage to the leg. Eventually, the lack of blood flow might even cause loss of part of the foot or leg.
But why is the pain worse at night?
The reason lack of blood flow hurts more at night is… gravity. When we put our feet up at night, gravity is not helping blood to reach the feet. So, if there is severe artery narrowing, putting the feet up will cause lack of blood flow.
Why is Lack of Blood Flow Urgent?
If not enough blood is reaching the feet, that can cause the skin to break down. Eventually, this can lead to losing a toe or even worse. So, identifying severe lack of blood flow as a cause for night leg pain is important.
How to Diagnose Lack of Blood Flow?
Your doctor will identify lack of blood flow by examining your pulses. Reduced pulses can suggest lack of blood flow. Then, they will order blood flow tests to measure flow to the legs and feet. These tests are done at a dedicated ultrasound laboratory. The usual tests are either an ultrasound or a test called ankle-brachial index. These tests do not involve needles, radiation or dye. They use sound waves and blood pressure cuffs to identify any artery blockages you might have.
Treatment of Lack of Blood Flow
If the lack of blood flow is severe enough to cause nighttime leg pain, we must treat it urgently. The goal of treatment is to restore blood flow to the leg. Because the blockages are usually very significant, treatment is often with a procedure or surgery.
2. Infection
Infection in the leg can be in the toenails, skin or joints. In all cases, the symptoms include heat over the infected area, swelling, redness and pain. When all symptoms are present, the diagnosis is straightforward. But sometimes there is only pain, without the rest of the symptoms. For instance, a person might have cellulitis, and have only nighttime leg pain as a symptom. Making the diagnosis in this case can be challenging.
Still, it is important to diagnose an infection quickly. The treatment for infection is with antibiotics. Delaying treatment can be the difference between an easy recovery and a dangerous disease. As you probably know, severe infection might be deadly.
3. Gout Night Leg Pain
Gout is a form of arthritis. It can cause a great degree of suffering. In fact, gout causes so much pain that in the past people believed that gout attacks were caused by demons.
Gout usually affects the first toe. But, it can affect other joints as well. A very painful, red, swollen, toe might be a sign of gout. Gout attacks can happen at any time, but at night can prevent sleep. People describe severe pain. They often cannot even tolerate a bedsheet over their toe.
To diagnose gout, your doctor might need to obtain fluid from the joint. This is done with a needle and syringe. Examining the fluid will show typical crystals. Then, they can offer you treatment. Treatment will include medications to control the inflammation and medications to prevent more events from happening in the future.
4. Fracture
You might find it surprising, but some people may have a fracture without really knowing it. How is that? Well, either they do not realize that their injury is severe. Or, they may have brittle bones, and not realize that they sustained a severe enough injury. This is most common in elderly people, but can also happen in younger persons. Sometimes, pain is the first and only sign of a fracture. At night, when a person is laying in bed, they might notice the pain more than during the rest of the day.
For this reason, don’t ignore pain that is constant, especially if it happened after an injury or if there is any visible deformity. If you have these symptoms make sure to have them checked. If we suspect a fracture, a simple x-ray can usually make the diagnosis. Sometimes, in more challenging cases, we might need an MRI to make the diagnosis.
5. Sprain
Sprains are different than fractures. A sprain means the ligaments were either stretched or torn. The ankle is probably the most typical location for a sprain. Most people will remember an injury. A sprain might cause swelling and throbbing pain. It can definitely cause night leg pain that might take several days to resolve.
The first treatment for a sprain is to follow the R.I.C.E. principles. These include rest, icing, compression and elevation. If these simple measures do not help, you will need to seek medical attention and you may need more advanced measures.
6. Blood Clot
Blood clots can happen at any time of day. But our body is more at risk for clotting during the night, and especially early in the morning. So sudden onset leg pain at night could be a clot. A leg vein clot is called a deep vein thrombosis or DVT. The chance that the pain is from a clot is even higher if there is also leg swelling.
People who develop a blood clot in the legs need to receive blood thinners quickly. Missing the diagnosis can cause the clot to grow and even travel to the lungs.
Chronic Nighttime Leg Pain
Some leg pain that people experience at night is chronic. This does not mean it is not severe or that it is not important. It just means that it has been going on for a while.
7. Neuropathy and Nighttime Leg Pain
Neuropathy causes burning, tingling pain. It can be severe. In fact, neuropathy leg pain can prevent people from having a good night’s sleep. Most people notice their neuropathy leg pain more at night. Examples of common causes of neuropathy include diabetes, lack of vitamin B12 and medications. But, there are many other potential causes.
It is not always easy to make the diagnosis of neuropathy. Sometimes, just hearing the story is enough. But sometimes you will need specific knowledge. For instance, you might need to know that a certain medication you are taking can cause neuropathy as a side-effect.
Once the diagnosis of neuropathy is confirmed, the next step is to control symptoms. This is usually done with medications. Examples of such medications include gabapentin and pregabalin.
8. Arthritis
Of course, gout is a form of arthritis. But, there are other forms too. The most common form of arthritis is degenerative joint disease. Plainly, this means overworked joints. Some of the most common locations for arthritis are the ankles, knees and hips. Laying in bed can be quite uncomfortable for some people. These people might experience night leg pain from arthritis.
How to Diagnose Arthritis?
Your doctor will diagnose arthritis by examining you. Then, they will likely get x-rays. Sometimes they will need other types of scans, like CT scans to make the diagnosis.
Sometimes, arthritis is a result of inflammation. If you doctor suspects inflammation, they may need to put a needle in the joint and take out the fluid to send it for tests.
Treatment of arthritis depends on the cause. Some types will respond to medications that reduce inflammation. In other cases, you may need more advanced solutions. People with very advanced wear and tear of the joints may need to control the pain and consider joint replacement.
9. Sciatica Can Cause Night Leg Pain
Sciatica is a term we use to describe a pinched nerve coming out of the lower spine. This nerve travels to the leg. When it is pinched, it causes a deep discomfort in the buttocks and down the leg. In some cases, laying down can be quite uncomfortable. People find it hard to find a comfortable position to sleep. That is why sciatica leg pain is a common cause of leg discomfort that appears mainly at night, in bed.
Remember that other forms of nerve pressure might cause leg pain. Sadly, in some cancer patients experience leg pain because of tumors pressing on nerves. It is important to know the difference between the common sciatica leg pain and the less common cancer leg pain. New onset pain should always either have a clear explanation or you should seek professional help to make the diagnosis.
10. Restless Leg Syndrome
Restless leg syndrome does not cause pain. But, we often mention it as a cause for night leg pain. The reason is, that restless leg syndrome causes leg discomfort. People who suffer from restless leg syndrome will find it hard to lay still in bed. It might prevent them from sleeping. When you listen to their story, you might think that they are suffering from pain. But in fact, they are actually suffering from a completely different condition.
11. Ingrown Toenail
Ingrown toenails can cause quite a bit of pain. This is especially true if there is infection on top of the nail. People tend to notice the pain more when they walk, but it might also cause night leg pain.
To diagnose an ingrown toenail you have to examine the feet. You might notice the toenail digging into the toe. It may be red, warm and tender, and there may be pus coming out. Sometimes soapy soaks will help with ingrown toenails. But sometimes the solution for an ingrown toenail is to cut the piece that is digging into the skin out. Usually a podiatrist will be the doctor to do so.
12. Night Cramps
Night cramps are common. As the name implies, they happen during the night. There are many potential causes for night cramps. Fortunately, there are ways to prevent night cramps and also ways to treat them once they happen. Follow the link to learn more about night cramps.
13. Venous Insufficiency
Veins carry blood from the feet back to the heart. To do this, they have to work against gravity. Valves inside the veins in our legs make sure blood flows in the correct direction. Faulty valves will allow backflow. This is called venous insufficiency. People who have severe venous insufficiency might have heavy legs, especially by the end of the day. Sometimes the heaviness and aches are bad enough that they prevent sleep.
14. Cancer Leg Pain
Sadly, leg pain in cancer is common. Sometimes it is urgent, and other times it is chronic.
There are several potential reasons for this pain. First, some cancers involve the nerves and can cause pain. Other cancers will invade the bone, and that can cause pain.
But sometimes cancer treatment is the cause of the cancer leg pain. Sometimes it is the treatment itself. But other times it is through side effects such as neuropathy. Also, many cancers cause blood clots. Unfortunately, some cancer patients develop leg blood clots which can cause leg pain and swelling.
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