Neurology-Online

Leg tingles - what's behind it?

What is a tingling leg?

A tingling leg is a typical example of a sensory or emotional disorder.

In technical terms, this is known as a sensory disorder, more precisely as paresthesia. Such a discomfort arises on the body surface, there are nerve endings in the skin. These are actually there to transmit certain stimuli (for example touch) along the associated nerve path into the brain. If this nerve pathway (= nerve) is damaged somewhere, this tingling sensation can be triggered. It is often described very differently by the patients, some report ants running on their legs. Others speak of a burning or electrifying sensation.

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causes

The cause of a tingling leg is a nerve disorder. The nerve that supplies the skin on the leg becomes irritated. Usually this can happen along its entire course (e.g. through a herniated disc at the spinal cord level).

Another underlying disease that can lead to this is circulatory disorders. If the blood supply to the legs is reduced due to a vascular disease, the nerves are not supplied with enough blood either. This often leads to a burning sensation and other painful sensory disturbances.

Restless legs syndrome can also cause tingling in the leg. In this condition, the symptom occurs primarily at night. Fibromyalgia, an autoimmune disease, can also cause pain and tingling in the lower extremities. Chronic alcohol consumption or a vitamin B12 deficiency lead to such complaints due to faulty regeneration of the nerves and their protective structures.

Last but not least, one should think of secondary diseases of diabetes mellitus and diseases of the central nervous system (multiple sclerosis, stroke, Parkinson's disease).

Herniated disc of the lumbar spine

Problems in the spine area very often lead to tingling in the legs.

On the one hand, already harmless muscle tension in the thoracic and lumbar spine can lead to these abnormal sensations. A narrowing of the bony canal through which the spinal nerve emerges from the spine (spinal canal stenosis) also leads to these complaints.

A herniated disc in the lumbar spine does not always have to be the cause. However, if you have back pain in addition to a tingling leg, you should urgently consult a doctor. The protruding parts of the intervertebral disc put pressure on the nerves emerging from the spinal cord. This leads to a tingling sensation in your legs. On the other hand, it can also lead to restricted mobility and paralysis. In this case, surgery is usually carried out in the course of the process. The bulging disc tissue is removed. This relieves the pressure on the nerve fibers.

Can that be a thrombosis?

A thrombosis is an occlusion of a blood vessel with a blood clot. This is very common in the deep leg veins. One then speaks of a deep vein thrombosis (DVT).

A thrombosis usually leads to swelling of the affected extremity. Often the leg is also reddened and slightly overheated. There is also pain. Some patients describe this as just a feeling of tension. A tingling sensation can therefore certainly occur. So it can be said that a tingling leg is not a classic symptom of a thrombosis. However, one should know that these classic signs of thrombosis are only applicable in around 50% of patients.

multiple sclerosis

A tingling leg could also be an initial symptom of multiple sclerosis. With this disease, those affected often complain of tingling and numbness in the face and limbs.

The disease can manifest itself with numerous symptoms, depending on which part of the central nervous system is affected by the breakdown of the myelin sheaths. In addition to sensory disturbances, visual disturbances are the second most common symptom in these patients. In order to be able to make a diagnosis of multiple sclerosis, one has to assess symptoms, course and an imaging examination of the brain together.

diagnosis

A detailed anamnesis is always the basis for making a diagnosis. When do the complaints occur? Are these only temporary or permanent? Are there any accompanying symptoms?

After the anamnesis, a physical examination follows. The doctor will look at the leg, examine the spine, and perform a brief neurological examination. Depending on the suspected diagnosis after these two steps, further measures are taken. If a central nervous system disease is suspected, an MRI is performed by the brain. If the doctor suspects a herniated disc, an imaging representation of the spine is carried out.

Concomitant symptoms

Depending on the cause of the nerve disorder, the tingling sensation in the leg is accompanied by numerous other symptoms. On the one hand, this can be pain. These are also caused by the nerve irritation along the limbs.

If the cause is a herniated disc in the lumbar spine, back pain occurs as an accompanying symptom. Extensive herniated discs can always lead to paralysis or disorders of the bladder and rectum function.

If a disease of the central nervous system, for example multiple sclerosis, is hidden behind the tingling leg, the patient will suffer from other neurological symptoms such as visual disturbances, paralysis or sensory disorders in other areas of the body. Pain in the musculoskeletal system is another symptom of fibromyalgia. A polyneuropathy in the legs, e.g. Alcohol or vitamin B12 deficiency often leads to tingling legs and gait disorders.

Pain

Patients who report a tingling sensation in the leg also report pain as an accompanying symptom. This often cannot be precisely differentiated.

The tingling sensation in the leg is usually caused by nerve damage. This can only be temporary. Nevertheless, nerve damage usually leads to pain. However, nerve pain is often not perceived as classic back pain or headache. Most patients experience them as much more uncomfortable than a burning and stabbing feeling. Such nerve pain is also difficult to treat with regular pain relievers (such as ibuprofen or paracetamol). Therefore, one should first research the cause of the complaints. If these cannot be treated or only inadequately treated, special nerve pain relievers (mostly antidepressants or neuroleptics) are used.

Situation-dependent tingling on the leg

Leg tingles only at night

Tingling in the legs combined with an obsessive urge to move and restless legs are indications of restless legs syndrome (RLS). The symptoms typically occur at night and get better with movement. The causes of the disease have not yet been fully researched; the most likely assumption is a disturbed dopamine metabolism in the brain. In rare cases, there are other causes that favor the development of restless legs syndrome, such as pernicious anemia, terminal kidney failure, Parkinson's disease, rheumatoid arthritis, special medications such as antidepressants or neuroleptics or pregnancy.

The diagnosis can usually be made based on the typical symptoms. A therapy attempt with L-Dopa is also often started. The symptoms usually improve quickly below this. But the cause of a leg tingling sensation at night can also be far more harmless. A skin nerve is irritated by an incorrect sleeping position. This hypersensitivity reaction is reported back to the brain and perceived by the patient as a tingling sensation.

Leg tingles when lying down

The cause of tingling in one leg when lying down is a nerve disorder. In meralgia paraesthetica, the external cutaneous nerve on the thigh is narrowed under the inguinal ligament. This is favored by tight clothing, pregnancy and excess weight. Seat belts that are too tight in the car are also responsible for this.

Symptoms are abnormal sensations on the front outside of the thigh. These usually occur at the beginning while lying down or with the hip joint extended. If the hip flexes, the symptoms usually improve immediately. Surgical decompression of the nerve is possible. However, one should first eliminate triggering factors. The symptoms often resolve spontaneously. Before thinking about an operation, there is also the option of injecting painkillers (local anesthetics) or cortisone with a thin needle into the vicinity of the nerve. General pain therapy with non-steroidal anti-inflammatory drugs (e.g. ibuprofen) is also possible.

Leg tingles while sitting

If the leg tickles while sitting, the cause is usually nerve damage from mechanical pressure. If you sit in an awkward sitting position for a particularly long time, your legs begin to tingle. This is a fairly common symptom. It's mostly harmless. If you change your sitting position or get up and move around, the tingling disappears quickly because the pressure on the nerve subsides. Nevertheless, if the symptoms occur more often, it is advisable to see your doctor.

Leg tingles when falling asleep

When falling asleep, the legs may occasionally tingle.

In most cases it is a short-term disturbed nerve conduction. This is often due to an unfavorable sleeping position. If you change your movement, the symptoms will quickly disappear. However, more serious illnesses can also be behind it. Warning signs are, for example, an increased occurrence and other accompanying symptoms. Even if the leg tingling does not resolve spontaneously, you should consult a doctor.

Leg tingles after exercise

Tingling in the legs after exercising can be caused by a lack of magnesium or potassium. But it can also be a harbinger of sore muscles. So in most cases it is harmless. However, if it occurs more frequently or no longer regresses, it makes sense to see your doctor. There can always be other causes, e.g. there is a nerve conduction disorder. However, after a detailed medical history and physical examination, the family doctor can usually give the all-clear.

therapy

There are numerous causes for a tingling leg. Ultimately, it is mostly caused by a nerve disorder. The first thing to do is to determine where the nerve disorder is coming from. If the nerve is only temporarily damaged by an incorrect position, the symptoms quickly disappear again after a change in position. In this case, no specific treatment is necessary.

However, if it is a bulging disc that is pressing on the nerve or parts of the spinal cord, the patient may even need an operation. The nerve is only relieved by removing the protruding intervertebral disc tissue. Sensory disorders in the leg are often the first harbingers of a disease of the central nervous system. If multiple sclerosis is the cause of the nerve disorder, it would be treated with cortisone. If a stroke is suspected, the patient would be admitted to hospital immediately. Blood-thinning therapy would be initiated. If the cause of the symptoms is the diagnosis of restless legs syndrome, drug treatment with L-Dopa is necessary. After all, there are no one-size-fits-all principles for treating a tingling leg. It is important to find the cause and treat it accordingly.

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Therapy of herniated disc

Duration

Most leg tingling is a temporary feeling that disappears after a certain time. Actually, the tingling of the nerve shows us that it is in an awkward position and that it would like to be freed. In most cases the nerve is damaged by mechanical pressure. If you change your position, the problem is usually resolved. However, if the pressure is not taken off the nerve, numbness will develop in the leg over time.

forecast

The prognosis of tingling legs depends on the cause and is therefore very different. In most cases, leg tingling is a harmless nerve disorder that goes away on its own after a short period of time. However, if the nerve disorder is a symptom of a herniated disc or multiple sclerosis, the prognosis is significantly different. Restless legs syndrome can also cause tingling legs. The disease can be treated well, but there is no cure.