Orthopedics-Online

Pain in the legs

introduction

Leg pain can occur in different places and have a variety of causes. Since the leg consists of different bones as well as numerous muscles, nerves and vessels, all of these structures can be diseased or injured and cause pain.
Joint problems in the hip or knee joint, broken bones or circulatory disorders are particularly responsible for the pain. The diagnosis is made through the anamnesis, imaging and laboratory parameters. According to the numerous causes, the therapy is diverse.

Causes of pain in the legs

Causes of pain in the legs can be very diverse. They can arise from any structure that is in the leg (bones, joints, vessels, nerves or muscles). Acute pain in the legs can result from injuries to the ligaments and tendons (see also tendinitis in the leg) or muscle strains. Broken bones or joint injuries also cause acute pain.

Signs of wear and tear or chronic circulatory disorders (PAOD) usually develop over time and slowly but steadily increase the pain in the legs.

Read more about the possible causes under:

Causes of pain in the legs

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In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
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Injuries

Fractures of the femur (Femur) or from shin (Tibia) or fibula (Fibula) usually occur in the context of accidents. Depending on the bone structure, a simple fall can lead to a fracture of the thigh. Injuries to the joints (hip or knee joint) also occur in the context of accidents and lead to severe pain. If the ligaments, tendons or muscles are strongly stretched due to incorrect movement or other causes, they can tear and thus also cause pain and restricted mobility.

Illustration leg pain

Pain in the legs

Hip joint - Articulatio coxae
Femoral neck - Collum femoris
Femoral shaft -
Corpus femoris
Meniscus (inner, outer)
Meniscus medialis, lateralis
Knee joint - Articulatio genus
Ligaments (inner, outer)
Collateral ligament
tibial, fibular
Calf community -
Corpus fibulae
Shin community -
Corpus tibiae
Tarsus - tarsus
Metatarsus - Metatarsus
Upper ankle joint -
Articulatio talocruralis
Femoral vein -
Femoral vein
Large rose vein
= great saphena
(Superficial trunk vein) -
Great saphenous vein
Popliteal vein -
Popliteal vein
Small rose vein
(Superficial trunk vein) -
Vena saphena parva
Phlebitis -
phlebitis
Varicose veins (superficial
Veins that are baggy or
are cylindrically expanded) -
Varices
Leg ulcer (open leg) -
Leg Ulcer

Causes of pain in the legs:
A. - Hip arthrosis
(Arthrosis deformans coxae),
Femoral neck fracture
B - torn ligament
= Ligament rupture (outside, inside),
Meniscus damage, knee osteoarthritis
C - fibula fracture,
Broken tibia
a - Healthy venous valve
(Valvula) opened - blood flows
only one way
b - Healthy venous valve
closed (resting phase) -
Blood does not flow back
c - Defective (leaky) venous valve
closed - leads to varicose veins
(Varices)
d - thrombosis (vascular disease) -
Partially occluded vein
(Restricted blood flow)
e - Thrombosis - vein complete
closed (no more blood flow)
f - embolism - blood clot
(Embolus) comes off

You can find an overview of all Dr-Gumpert images at: medical illustrations

Leg pain from venous disease

Venous diseases can also cause pain in the legs.

The patient often notices that his legs feel tired and heavy. Little exercise, obesity, too little drinking and an unhealthy lifestyle can lead to diseases of the veins. But hereditary factors also play a role. Varicose veins (Varicose veins), Spider veins and leg vein thrombosis can be counted as venous diseases.

In spider veins, it is mainly small skin vessels that are affected, but these usually do not cause any symptoms.

It looks different with varicose veins. Larger, superficial vessels are affected here, which can be seen at first glance. With varicose veins there is an expansion of the vessels for various reasons. The consequence of this expansion is that the so-called venous valves, which are normally supposed to prevent the blood from flowing back against the direction of flow, can no longer close properly.
The blood no longer flows back in its original direction to the heart, but follows gravity and flows back into the legs. This reflux in turn leads to a further expansion of the vessels, so that they become more permeable for fluid and edema forms. These are especially noticeable on the ankles. As a late stage of this disease, in the worst case it can also lead to "open spots" on the legs.

Standing or sitting for long periods of time often makes the situation worse, so the patient is advised to put their legs up as often as possible. In order to counteract and improve the pain and the remaining symptoms, it is advisable to do special vein gymnastics, which serve to promote the blood flow back to the heart. If this is not enough, there is also the option of wearing compression stockings.

Inflammation of the veins can also lead to leg pain. Most often only one leg is affected and the inflammation develops along the course of the veins.
The skin is reddened and warmed up, the pain occurs suddenly and can have a pulling character.

Circulatory disorders

Various disorders of the blood circulation can cause pain or pulling in the legs. Peripheral arterial disease (PAOD) occurs in the context of diabetes. The cause is hardening of the arteries, especially in the leg vessels. As a result, the legs are no longer adequately supplied with blood and lead to pain, especially when exercising. Embolism or thrombosis of the leg vessels, on the other hand, lead to sudden and acute severe pain and must be taken seriously. The sudden interruption of the blood flow leads to an acute insufficient supply of the muscles and thus to pain. In addition, there can be vacancies as part of a circulatory disorder, a so-called leg ulcer.

Inflammation

Inflammation of the muscles, tendons or bones can be caused by chronic stress or germs. Usually, this inflammation is accompanied by other symptoms. The chronic inflammation in the context of arthritis (joint inflammation) often occurs over a long period of time and can usually only be cured by consistent, lengthy therapy.

Neurological causes

Chronic neuropathy associated with diabetes can also lead to severe pain and loss of sensitivity.
A herniated disc in the lumbar spine can also cause pain in the legs if a nerve supplying the leg has been pinched by the disc.
Great importance is attached to the herniated disc in the lumbar spine, but in many cases other causes of the pain can be identified.

If you suspect a herniated disc behind the pain, we recommend our topic:

Herniated disc of the lumbar spine

Polyneuropathies

Polyneuropathies are nerve disorders that affect multiple nerves.

These diseases often lead to abnormal sensations in or on the body. Those affected experience a tingling sensation, pain, numbness or even a loss of sensation, for which there is no corresponding correlate at the perceived area. Rather, the nerves are damaged and therefore tend to convey sensations that don't actually exist. In the case of numbness, it can even happen that a nerve has died completely. Usually an entire leg or foot is affected by this "false sensation".

Risk factors for polyneuropathies are poorly controlled diabetes or smoking.

Leg pain from MS

Leg pain can also be associated with MS (= multiple sclerosis) occur. In a third of patients, the first symptoms of the disease are sensory disturbances, which are mainly expressed as tingling and numbness in the arms and legs. In the course of the disease, muscle spasms often develop, which can also cause severe pain.

Furthermore, patients with multiple sclerosis mainly experience pain in the legs, back and face. It is often not possible to find a cause at the pain point concerned, so that it is assumed that in these cases the pain center in the brain is affected by multiple sclerosis and that this causes the pain. Unfortunately, conventional painkillers such as ibuprofen or aspirin are often ineffective.

Restless Legs Syndrome

Restless Legs Syndrome (RLS for short) is a neurological disease of the legs.

Those affected feel sensitive sensations in their legs. This can range from numbness to tingling sensation to pain. This results in the patient's urge to move, which leads to an improvement in the symptoms. As a rule, the abnormal sensations only occur during rest and appear in the late evening or at night when the person concerned comes to rest or is in bed.

The RLS can be inherited genetically, but is often also caused by psychiatric drugs such as neuroleptics. Even if the cause has not yet been really clarified, the symptoms can be treated quite satisfactorily with painkillers and dopamine preparations. In many cases, however, it is not the sensitive symptoms that are in the foreground, but rather the exhaustion caused by the disturbed night's sleep.

Deformities

Joint deformitieswhich lead to misalignments of the bony structures can lead to chronic pain. Especially Knock knees or If onecaused by a misalignment in the hip and knee joint can put a lot of stress on the joints. The pain often only arises in adulthood, as the joint surfaces are only worn down by prolonged long-term use. In the context of joint wear, a arthrosis, which leads to chronic pain at rest and entails complicated therapy.

diabetes

Diabetes as a disease in itself is not responsible for leg pain. It is the sequelae of diabetes that can cause leg pain.

Badly controlled diabetes with permanently high blood sugar levels can damage blood vessels and nerves. In this case one speaks of a diabetic polyneuropathy. The damaged nerves give the person concerned the feeling of suffering from pain, although there are no corresponding correlates on the body. Often, however, diabetic polyneuropathy occurs more as tingling than pain. However, if the polyneuropathy progresses even further, especially in diabetics, their feet become completely insensitive to sensitive stimuli.

This means that diabetics can no longer really perceive injuries, hypothermia or the like at this stage. Therefore, diabetics should have their feet checked regularly by their family doctor.

Tumors

These are bone tumors of the thigh bone or the two lower leg bones Ewing's sarcoma or that Osteosarcoma. Ewing's sarcoma is the most common tumor disease in children; adults and children are equally affected by osteosarcoma. Overall, bone tumors are a rare disease that often leads to pain late.

Can a vitamin deficiency cause leg pain?

Yes, leg pain can indeed be the result of a vitamin deficiency.

This has not only existed for a few weeks, but for several years, in order to have such serious effects. As a rule, components from the vitamin B series are those that, if deficient, can lead to nerve damage and thus to leg pain. The vitamins have a protective role for the nerves in order to shield them from damage and to manage their correct structure. If these vitamins are missing, the damaged nerve conveys a pain stimulus for which there is actually no correlate on the surface of the leg or within the muscles.

You might be interested in these topics:

Vitamin B12
Folic acid

Pain like sore muscles without exercising?

In this context, two main phenomena come into play. On the one hand, rheumatic muscle complaints can cause muscle soreness-like pain. The cause of the pain, however, is to be seen in an autoimmune reaction of the body against itself. Not every rheumatoid sufferer gets muscle pain in the calf, but unexplained sore muscles-like calf pain could be an indication of the presence of a rheumatic disease.

The second potential factor are so-called statin-associated muscle symptoms, or SAMS for short. Statins are a group of drugs that belong to the lipid-lowering nucleus. They have the effect of synthesizing less cholesterol from the ingested dietary fats, which is why they can be used by people with high cholesterol levels. However, the SAMS are one of the common side effects of statins. Up to five percent of all statin patients complain of the above-mentioned statin-associated muscle symptoms, which often affect the calf muscles. The most extreme form of these symptoms is so-called rhabdomyolysis, which can lead to "muscle breakdown".

Diagnosis

In most cases, leg pain is harmless aching from overload. In this case, a precise diagnosis is unnecessary and the pain disappears after a short time.

However, if the pain persists, is severe, or one or more joints are swollen, a doctor should examine the leg. Also at overheat and Redness the leg should be examined by a doctor as an indication of an inflammatory cause, or in the event of pain as a result of an accident.
Usually the doctor starts with an exact one anamnese. For this, the exact location of the pain, the nature of the pain and the duration of the pain are important.

In addition, comorbidities are like a Diabetes mellitus, an underlying neurological disease or a previous accident of interest for the diagnosis. Other known pre-existing conditions such as a arthrosis, A friend disc prolapse, Varicose veins or Circulatory disorders should be mentioned.

Then the leg is examined and various movements are tested. These give an indication of a bony or muscular cause of the complaint. Inflammation or osteoarthritis of the joint also lead to pain in the affected leg and can be examined in this way. The leg is also examined for varicose veins or shortened muscles.

The Pulse on the legs are found in the groin, the hollow of the knee, on the outer ankle and on the back of the foot and should be palpable everywhere. If the pulse can no longer be felt from a point downwards, this can be an indication of a circulatory disorder and should, under certain circumstances, be accompanied by a Ultrasonic be examined more closely. If a bony or muscular cause is suspected, a X-ray be performed. If inflammatory causes are conceivable, the inflammation parameters are determined in the laboratory.
Neurological exams like that Nerve conduction velocity or that EMG serve to diagnose a neurological disease. If a joint disease is suspected, this can be done using a Jointoscopy (Arthroscopy) to be examined. A joint effusion is detected by an ultrasound (Sonography) and can then be dotted. If there is a suspicion of a herniated disc, the Magnetic resonance imaging (MRI) Means of choice.

When can leg pain still occur?

After the sport

It is completely normal and not worrying to experience pain in your legs at one point or another after exercising.
Often that is a Signs of overwork and overexertion.

However, if the pain occurs regularly after exercise and does not go away, this must be observed more closely.

The pain can then possibly be as Signs of improper training be interpreted.

In addition, the pain after exercising can be with too few breaks for relaxation and a too heavy and too intense training be connected.

Leg pain while jogging can be a sign of Muscle fatigue represent.

The body receives too few minerals there can also be pain for his metabolism.
To compensate you should then in addition to the normal diet, minerals such as Calcium, magnesium or ironto take.

To stimulate the regeneration of the body after a strenuous workout, one should after jogging leak.

While walking

Pain in the legs when walking is a common sign of circulatory problems. These affect the arteries of the legs and are therefore PAD (peripheral arterial disease) called.

It arises from a slowly increasing narrowing of the arteries due to growing arteriosclerotic (calcifying) Plaques.
The diameter of the vessel becomes smaller and smaller due to the increasing calcification, so that the blood flow to the subsequent tissues steadily decreases and the tissue is ultimately insufficiently supplied, which then ultimately triggers the symptoms. It is astonishing that symptoms only appear at 75% vascular occlusion. Before that, the body manages to circumvent and compensate for the deficiency in various ways.

The pain in the legs in PAOD initially mainly occurs under stress, i.e. in everyday situations when walking. An increasing distance also worsens the symptoms. Stopping at the onset of the disease will make the symptoms disappear again. Therefore, the PAD is often called "Intermittent claudication“Because a constant alternation between standing and walking is practiced.

In addition to the pain, there are also other symptoms such as paresthesia or a feeling of cold, in higher-grade stages of the disease also skin and nail changes. The narrowing of the artery can occur in many different places in the leg, and therefore the degrees of symptoms can vary.

The PAD is divided into different stages according to Fontaine:

At the Stage 1 there is a narrowing, but there is no pain.

It looks different with Stage 2 out. If a distance of more than 200 meters can be covered painlessly, there is a problem Stage 2a in front.
If the person concerned can no longer cover a distance of over 200 meters without pain, then there is a problem Stage 2b in front.

in the Stage 3 the patient already has pain at rest and when Stage 4 there are also vacancies (Ulcer) or the tissue has already irreversibly died (necrosis). There is a great risk of amputation here.

Aside from a circulatory disorder, leg pain can also be caused by what is known as spinal stenosis of the lumbar spine. This is a narrowing of the spinal canal, which has its origin in wear and tear on the spine. The spinal canal is the space formed by the vertebral bodies in which the spinal cord runs, from which the nerves eventually exit to the outer zones of the body. Similar to PAD, those affected are forced to interrupt walking due to pain.
Activities such as cycling or walking uphill are particularly painful for those affected. The patients also complain of sensory disorders in the legs and in the groin region.

When climbing stairs

Pain in the legs when climbing stairs can indicate two types of illness. For one, it could be an orthopedic problem. Wear and tear of the joints, ligament irritation or, in the worst case, an undetected fracture can be the cause. However, it would be unlikely that the pain would only be felt when climbing stairs. Rather, they would be felt during any kind of sporting activity and also during normal walking.
A circulatory disorder in the legs, on the other hand, seems much more likely. During normal walking, the blood flow is still sufficient; When climbing stairs, however, the muscles of the legs need more blood, but this cannot be provided due to the circulatory disorder.
The most common circulatory disorder of the legs is PAOD (peripheral arterial occlusion disease), as part of arteriosclerosis.

Pain in the legs when lying down

A particularly feared cause of leg pain is so-called leg vein thrombosis, which can occur suddenly, for example, when lying in bed for a long time. When lying down, it is harder for the blood to flow back to the heart, so that the blood builds up in the vessels and leads to the formation of clots (thrombus) can come.

The clot now clogs the vein and the blood builds up in front of the closure and suddenly leads to severe pain, reddening, overheating and swelling in the area of the leg. There is a great risk that part of the thrombus or the thrombus itself will tear off and migrate into the lungs. In the lungs, the clot, in which it blocks a pulmonary vessel, can then cause a dreaded pulmonary embolism, which is accompanied by shortness of breath, a racing heart and severe chest pain and great fear.

If you suspect a leg vein thrombosis, you should consult a doctor immediately.

Pain at night

Pain in the legs at night is caused, for example, by the so-called Restless Legs Syndrome. This leads to pain in the legs and abnormal sensations when resting, i.e. when lying down and especially at night.

The abnormal sensations can be very different and from tingle, over Pull, Sting, itch up to severe pain pass.

The sensory disturbances in the legs also go with one strong urge to move hand in hand. The patients often suffer from this sleep disorders, both when falling asleep and when sleeping through the night.
Standing up and walking around may alleviate symptoms for the moment.

For the restless legs syndrome usually no cause is found that the doctor calls "idiopathic" designated. The therapy takes place with medication. First choice means are that Levodopa and Dopaminergics represent.

With alcohol consumption

Leg pain after a one-off intoxication rarely has anything to do with the alcohol itself, but with the magnesium deficiency that results from it and increases the tendency of the muscles to cramp. It is mostly a sore muscles or leg cramps.

But even with alcoholics, it is not just alcohol, but also malnutrition, which is often associated with it, that leads to nerve damage. Alcohol itself is cell-toxic and, in addition to the liver and pancreas, also likes to attack nerve tissue. This then gives those affected a feeling of pain in their legs. Due to the malnutrition that is often associated with this, there is a lack of vitamin B types, which are important for the body to maintain the body's own nerves.

After chemotherapy

Chemotherapy drugs are, roughly speaking, cell toxins. Depending on the specification of the chemotherapeutic agent, this poison not only attacks cancer cells, but also healthy, normal body cells. It is therefore possible that the chemotherapeutic agent is also directed against neural structures in the body, which results in nerve damage.

When there are not enough protective factors in the body that can dampen the effect of chemotherapy, the body's own structures are affected. In this case, the damage to the nerves can lead to a sensation of pain as the pain-mediating fibers of the nervous system are overexcited.

You may also be interested in this topic:

Chemotherapy side effects

During menopause

Leg pain is also a phenomenon that can occur more frequently during menopause.

Compared to, for example, hot flashes, it is rarely discussed. The exact mechanisms that lead to leg pain are not yet fully understood. However, here, too, a connection with the changed hormone balance is considered likely. Those affected indicate that the pain can also move within the body, so it does not always have to affect the same area.

With children

Leg pain can also have very different causes in children. Inflammations, infections, broken bones or rheumatic diseases as well as tumors can cause pain.

But children also often have so-called growing pains in their legs.
These only occur at night or in the early evening, but not during the day and also not during exercise.
One possible explanation for the pain is tension pain caused by an acceleration in bone growth.
Children in the growth phases are particularly affected, by which especially children in toddler age and during puberty are meant.

Another cause of leg pain in children can be called hip rhinitis (Coxitis fugax) be. This is a short-term inflammation of the hip joint, which heals completely after a few days to weeks and usually without any consequences.

The hip runny nose is often preceded by an infection of the respiratory tract or the gastrointestinal tract.
Treatment of the disease includes rest for a few days and symptomatic treatment of the pain with painkillers.

Localization of the pain

Calf pain

Calf pain is arguably the most prominent example of "leg pain". As a rule, it is the areas of our extremities that are furthest away from the trunk that are plagued by pain. The causes of calf pain can be obvious, for example as a result of sore muscles, excessive exercise or other injuries to the calf muscles, or the cause can be based on an endogenous, so to speak, endogenous cause. Examples of this would be nerve damage in the area of the legs, which convey pain, or an insufficient supply or insufficient blood supply to the legs.

Excessive exercise in the calf area, for example, can lead to irritation of the Achilles tendon. Another possibility would be muscle strains or muscle fiber tears, which manifest themselves in the form of severe calf pain. On the side of the insufficient supply, it is primarily the peripheral arterial occlusive disease that causes ischemic pain in the legs due to the reduced blood flow. This occurs mainly on longer walking distances and can be improved again briefly by lingering for a short time.

You might be interested in these topics:

Inflammation of the Achilles tendon
Strained calf

Radiating pain from the back

Pain in the legs can not only come from the legs themselves, but can very often come from the back. If the pain has its origin in the supply area of the so-called sciatic nerve and in the lumbar spine, then it is called lumbar disorder or ischalgia (more popularly sciatic pain).

The sciatic nerve, which is responsible for the pain, starts from several nerve roots from the spinal cord in the lumbar spine area and extends into the leg, where it then divides into several branches that even extend to the feet. The cause of the pain is irritation or compression of the nerve or the nerve root. This can have various reasons, for example muscle tension, inflammation caused by a virus called herpes zoster, blockages in the vertebral bodies or masses in this area.

The most common reason for lumbar disease is a herniated disc in the lumbar spine or a bulging disc in the lumbar spine that squeezes the nerve. The "Sciatic pain“Mainly affect the leg, but the buttocks can also hurt. The pain usually only affects one leg and is extremely uncomfortable. Patients describe them as shooting, pulling or burning. There may be an additional feeling of numbness or tingling.

You may also be interested in this topic:

Therapy of lumbar sciatica

therapy

Therapy follows the diagnosis. This usually only makes sense if an exact diagnosis has been made and the symptoms persist. With minor muscular injuries are often Ointment dressings or Bandages sufficient. If there are more serious injuries such as broken bones, a Plaster treatment respectively. In some cases, surgical correction of the hernia is necessary beforehand.

Circulatory disorders need in some cases through a Catheter examination accurately diagnosed and then treated. This can be done by stretching or inserting a Stents into the affected vessel. In some cases a bypass which leads the blood around the damaged vessel and thus again ensures the blood supply to the muscles and skin.
In some cases, too Move, a good Blood sugar control, Diet change and Weight reduction sufficient to improve the blood circulation situation. In the case of an acute circulatory disorder, such as a thrombosis with sudden undersupply of the leg, the thrombus must be surgically or medically removed as quickly as possible.

Treatment of painful varicose veins can go through Venous medication or Compression stockings, but also by means of a Desolation or surgical removal. If there is a suspicion of joint damage, it is often Arthroscopy necessary. The joint can be examined closely and therapeutic intervention can be made. For inflammation, drugs such as Diclofenac or Acetylsalicylic acid inhibit pain and inflammation.

If there are severe joint problems, are Joint injections or one Joint irrigation With Cortisone or local narcotics (Local anesthetics) advisable. Can be supportive for most forms of leg pain physiotherapy (physical therapy), Heat or cold treatments, Muscle and movement training or orthopedic aids are used. Since the exact therapy depends very much on the diagnosis and pain in the legs is a non-specific symptom, a doctor should decide on the therapy.

Summary

Leg pain is a very non-specific symptom with many causes. These range from harmless aching after overloading over Torn muscles or Broken bones as a result of an accident up to chronic diseases of the joints, Circulatory disorders or Tumor diseases.

Due to the numerous causes, the Diagnosis is often not easy. For this reason, the anamnesis with the severity, location and duration of the pain is particularly important. Also Comorbidities can be important and should be mentioned. The physical examination as well as imaging procedures in the sense of a Ultrasound, one Magnetic resonance imaging or one X-ray. Laboratory parameters, one Jointoscopy or a biopsy confirm the diagnosis.

The therapy the pain is just as varied and consists partly in simple ointment dressings and bandages. Operations, plaster casts or vascular surgery may also be necessary. Because of this variety, one should have a long-standing pain in the legs Consulted a doctor become.