What Can Cause Leg Pain?

Leg pain is the ache and throbbing felt along the leg. Leg pain is known as unilateral leg pain when felt over one leg and also known as bilateral pain when pain is felt over both legs. Leg pain is caused by inflammatory disease, cancer or injuries of joint, bones or soft tissue. Soft tissue pain originates from skin, subcutaneous tissue, muscles, tendon or ligaments. Leg pain is frequently described as burning, stabbing or squeezing pain. Leg pain is also caused by irritation or pinch of the nerves supplying sensory nerve fibers to entire leg. The leg pain caused by pressure or irritation of nerve is known as radicular pain of leg or sciatica. Intensity of pain in the legs is expressed as mild, moderate, severe and very severe. Leg pain intensity is described as a score zero to 10 also known as visual analogue score (VAS). VAS of zero pain is no pain and 10 is excruciating leg pain. Duration of leg pain may last from hours, days, weeks or months depending on cause of pain. Leg pain duration is also described as intermittent or continuous pain.

1. Leg Pain Caused due to Skin Diseases

   Leg pain when caused by skin disease is localized in the area of skin which is infected by skin diseases like carbuncle, furuncle, boil and skin abscess. Skin lesions are most often seen by individual and often treated with local application of antibiotics and anti-inflammatory medications (NSAIDs). Antibiotics gel and NSAIDs are sold on counter in most pharmacy.

2. Leg Pain Caused by Muscle Pain

   1. Leg Muscle Cramps or Leg Muscle Spasm as a Cause for Pain in the Legs-

      The muscle spasm resulting in leg pain is common among elderly patient. Leg pain caused by muscle spasm is often observed in young athletes because of muscle injury or tear. Muscle spasm is also caused by dehydration, mineral or vitamin deficiency. Muscle spasm resulting in leg pain is in most cases intermittent and moderate to severe in intensity. Intensity of leg pain associated with muscle spasm is in most cases observed to be increased when individual tries to move the painful leg. The leg pain caused by leg muscle spasm restricts the activities and spasm become less severe during rest. Thus during initial phase until medication take effects resting the painful leg helps to reduce intensity of pain in legs.

      Leg muscle spasm is also known as muscle cramp and most often observed in calf, thigh and foot muscles. The Foot muscle spasm causes foot bend and distortion during the muscle contraction. The calf and thigh muscles become extremely tight and feels rigid when ball of contracted muscles are touched. Massage and rest helps to relieve the spasm causing leg pain. Muscles spasm also responds to muscle relaxants which are prescribed as pills. Most common muscle relaxants used are Baclofen or Flexeril. Leg Pain caused due to muscle spasm also responds to anti-inflammatory medications such as Motrin, Naproxen and Celebrex.

   2. Myalgia of Leg Muscles-

      Myalgia is an inflammatory disease of muscle which results in moderate to severe leg pain. Myalgia of leg muscles causes bilateral leg pain and is often observed when individual suffers with viral infection. Viral infection associated with myalgia causes respiratory or stomach infection. Leg pain caused by myalgia in most cases is continuous and moderate to severe in intensity. Myalgic leg pain does respond to anti-inflammatory medication. Activities are restricted because of generalized weakness associated with viral infection. Isolated myalgia of one leg is rare.

   3. Fibromyalgia

      Fibromyalgia is generalized muscle disease resulting in moderate to severe pain in one or both legs. Several muscles of neck, back, arms and legs are simultaneously involved in inflammatory disease resulting in pain. Patient suffering with fibromyalgia often suffers with bilateral leg muscle pain. Leg pain is mostly observed over muscles of buttocks (gluteal muscles) and muscles of back of thigh. Leg pain or generalized pain caused by fibromyalgia does not respond to anti-inflammatory medications or muscles relaxants. Pain in few cases responds to opioids for initial few days. The recommended treatment is anti-inflammatory and muscle relaxant as well as physical therapy. Opioids are avoided since long term treatment causes addiction or dependence.

3. Leg Pain Caused by Diseases of Tendon

   1. Tendonitis-

      Tendonitis of leg is rare and often seen in young individual as well as elderly. Tendonitis is observed in athletes who are repeatedly using same tendon during sporting activities. Severe leg pain caused by tendonitis are observed in football, soccer and tennis player. Tendon gets inflamed when muscle attached to tendon is repeatedly used during sporting activities. The cause of inflammation is micro-injuries of muscle fibers. Rest, massage and anti-inflammatory medication helps to treat the tendon inflammation causing leg pain.

   2. Tendon Injury or Tendon Tear

      Leg pain is also observed when tendon is injured or torn. Tendon tear in lower extremity is partial or complete. Complete tendon tear of leg muscles causes separation of tendon from attached muscles and results in severe leg pain with any movements of leg. Such condition need surgical treatment to attached two separated end of tendon. Auto accident and work injury causes tendon tear in leg following injury caused by accelerated force or direct impact. Leg pain caused due to partial tendon tear or tendon laceration responds to rest and anti-inflammatory medication. Healing of such tendon injury causes scar tissue formation. Scar tissue after healing often causes moderate to severe pain when muscle attached to tendon contracts. In such cases individual should be treated with aggressive physical therapy. Spontaneous injury resulting in partial or complete tendon tear is often observed in elderly patient suffering with rheumatoid arthritis. Multiple tendon tear results in abnormal position and shape of toes and foot. The leg pain caused by tendon tear in patient suffering with rheumatoid arthritis is moderate to severe. Leg pain responds to anti-inflammatory medications.

4. Leg Pain Caused by Disease of Ligament-

   1. Inflammation of Ligament

      Ligaments are band of tough fibrous tissue that lie close to the joint and bones. The ligament links and fastens the two adjacent bone of the joint. Dislocation or repeated use of hip, knee, ankle or foot joint causes inflammation of ligament. The leg pain become severe when joint moves. Leg pain caused by inflammation of ligaments in lower leg responds to anti-inflammatory medication.

   2. Ligament Injury

      Isolated ligamental injury is rare. Most of ligamental tear is observed following hip, knee, ankle or foot joint dislocation and fracture of the bones of lower extremity. Ligament lies adjacent to bone and joint. The pain become excruciating when injured area is touched or pressed. Pain often last for long time once pain in induced. Pain may not respond to muscle relaxants or anti-inflammatory pain medication. Ligamental pain following injury is treated with opioids. Opioid treatment should not be continuing for more than 1 to 3 weeks. Opioid treatment should be closely supervised by treating physician or pain specialist.

5. Leg Pain Caused by Joint Disease

   1. Leg Joint Osteoarthritis

      Osteoarthritis is a degenerative joint disease. The hip, knee and ankle joint is often affected by osteoarthritis. The chronic inflammation of larger joint causes degeneration of cartilage and ends of bone within the joint. The thinning of cartilage within joint eventually leads to bone on bone condition, which follows with severe pain during bending or twisting of joint. Pain eventually become severe and does not respond to anti-inflammatory medications. Pain is localized over the joint and in few cases spread to adjacent tissue. Pain increases with bending or twisting of joint. Patient often feels pain free at rest. Most patient are elderly and restrict their activities. Restriction of activities of painful joint causes weakness of muscles around the joint and eventually individual prefers to use cane, walker or wheel chair. Osteoarthritis is treated with anti-inflammatory medication during the initial phase of disease later several medications like glucosamine, chondroitin, muscle relaxants, anti-inflammatory pills, antidepressants like Duloxetine (Cymbalta) for neuropathic pain and cortisone injection. Osteoarthritis pain is not treated with opioids.

   2. Leg Joint Rheumatoid Arthritis

      Rheumatoid arthritis is predominantly inflammatory joint disease unlike osteoarthritis, which is degenerative joint disease. The inflammation of capsule of joint of leg affects cartilage, joint capsule and synovial membrane. The inflammation causes edema of the capsule and synovial membrane. The chronic inflammation weakens the capsule and synovial membrane, which eventually if not treated appropriately leads to joint dislocation. The small joint like toes and foot joint are deformed because of joint dislocation, which follows weakness of joint capsule and synovial membrane. Inflammation of cartilage causes severe intra joint pain. The leg pain is mild to moderate during initial phase and later pain become moderate to severe. The inflammation does not respond to anti-inflammatory medications. Inflammation does respond to corticosteroids during initial phase, later dose of corticosteroids needed for leg pain relief is higher that results in side effects. Rheumatoid arthritis causing joint pain is also treated with group of medications known as Disease-modifying anti-rheumatic drugs (DMARDs). Medications included in the group of DMARDs are methotrexate (Trexall), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine). Severe joint dislocation is often treatment with corrective surgery. Other treatment options are cortisone injection and physical therapy.

   3. Gout

      Gout is inflammatory joint disease and can cause severe pain in the legs. Mostly affects joint of toes and ankle. In few cases gout is also inflammation of knee joint. The joint inflammation is triggered by deposits of monosodium urate (MSU) crystals also known as uric acid or urate crystals. The crystal particles are deposited over the synovial membrane and capsule of joint. The MSU crystals are also found in joint inflammatory secretions. The non-infectious acute inflammation of major joints in foot, ankle and knee joint causes severe leg pain at rest and during activities. Pain often does not respond to anti-inflammatory medications. Alternative treatment is colchicine, allopurinol and corticosteroids. Colchicine helps to reduce immune response, which results in inflammation. Colchicine does not cause immediate pain relief. Colchicine is either used for long term treatment in low dosage or short term with moderate to high dosage. The side effects caused by colchicine restricts the short and long term use of colchicine. The common side effects observed are nausea, vomiting, stomach cramps and diarrhea. The allopurinol restricts the formation of uric acid and helps to reduce the leg pain if prescribed as a prophylactic. Allopurinol also helps to reduced kidney stone formation.

   4. Lupus

      Leg pain is a common symptom among patient suffering with systemic lupus erythematosus disease commonly known as Lupus. Lupus is an inflammatory autoimmune disease. The inflammation of leg joint synovium and capsule causes joint swelling and pain, similarly inflammation of leg muscles also causes moderate to severe leg pain. Lupus is most often observed in middle aged females. The disease is rare and affects less than 0.1% population. The smaller joints like toes and foot are mostly affected. Treatment for leg pain due to lupus includes physical therapy, anti-inflammatory medications and oral corticosteroid pills.

   5. Leg Joint Septic Arthritis

      Leg pain is also caused by infection of hip, knee, ankle or foot joints. The infection of joint is a rare condition. The joint is swollen because of abscess within the joint and inflammation of soft tissue surrounding the joint. Joint looks red, extremely painful to touch and feels warm when touched. The leg pain and joint swelling restricts the joint movements. The treatment includes pain medication, antibiotics and physical therapy. In few cases abscess is removed by needle insertion and aspiration. Severe joint deterioration is treated with surgery after antibiotic therapy to remove all infection. The surgical treatment may include total knee or hip replacement.

   6. Leg Joint Dislocation

      Leg pain caused by joint dislocation is very rare. The joint dislocation is seen following motor vehicle accident or work injury. The direct impact during contact sport also causes dislocation of knee and ankle joint. Ankle and knee joint dislocation is more common than hip joint dislocation. The dislocation is suspected when rapid abnormal swelling develops over the joint of associated with severe leg pain. Treatment includes pain medications and surgery. Following surgery, physical therapy and pain medications are necessary before resuming normal activities.

6. Leg Pain Caused Due to Bone Trauma and Disease

   1. Leg Bone Fracture

      Leg pain is extremely severe following fracture of any bones on leg. Fracture of femur, tibia, fibula and ankle bones are less common than metatarsal (bones of foot) and phalanges (bones of toes). Fracture of leg bones is observed following car accident, work injury or direct impact caused during the contact sports like football, soccer and rugby. The pain associated with abnormal swelling of hard consistency over fracture site. Patient is unable to move the part of the leg below the fracture site. Treatment includes surgery, cast, braces, opioids, antibiotics and anti-inflammatory medications. Patient is advised physical therapy and rehab after the fracture site is healed.

   2. Leg Bone and Cartilage Tumor

      The cancer of leg is a very rare disease. Mild to moderate leg pain follows bone and muscle cancer during the initial phase. Leg pain becomes very severe if conservative treatment fails to shrink the tumor mass on bone. The cartilage tumor such as chondrosarcoma is a malignant tumor and grows within the joint cartilage. The types of bone tumor that results in leg pain are osteoma a slow growing benign tumor and osteosarcoma a malignant rapid growing tumor. The treatment depends on type of tumor. Malignant tumor is treated with surgery, chemotherapy and radiation. The benign tumor is also treated with surgery and chemotherapy.

   3. Leg Bone Infection: Osteomyelitis

      Leg pain is rarely caused by infection of bone known as osteomyelitis. Osteomyelitis is rare and caused by infected blood (blood born infection) or migration of local infection from skin and muscles. Bone infection is also observed in few cases following compound or open fracture and dislocation of leg bone or joint. Osteomyelitis is aggressively treated with intravenous antibiotics and anti-inflammatory medications.

   4. Paget’s Disease of Bone

      Leg pain is moderate to severe in intensity during the initial phase of the disease, later pain become severe following fracture of bones of pelvis and leg. The normal wear and tear of bones are replaced by new bone. In Paget’s disease affected bone does not heal to become normal texture and becomes porous. Such a porous bone often gets fractured followed by severe leg pain.

      The treatment includes adjustment of diet to increase calcium and vitamin D intake. Diet such as cheese and milk provides calcium, similarly vitamin D is supplemented by green vegetables and exposure to sunlight. Fracture is treated by surgery and pain caused by activities is treated with anti-inflammatory medication as well as use of cane or walker. The bone growth is improved by taking pills classified as bisphosphonates. The pills available are risedronate, zolendronate and pamidronate. Opioids are avoided because of long term need of pain medications and possible addition if opioids are used for long term. Physical therapy as well as transcutaneous electrical nerve stimulator helps to reduced pain.

7. Leg Pain Caused by Sensory Nerve Disease

   1. Radicular Pain

      Irritation or pinch of sensory nerve fibers of lumbar or sacral spinal nerve within spinal canal causes exclusive leg pain, which is spreads along the neural dermatome of lower leg. Radicular leg pain is unilateral or bilateral. The radicular leg pain travels along the pathway of sensory nerve. There are 5 lumbar and 2 sacral sensory nerves that supply sensory fibers to entire leg from groin to toes. Pain is known as radicular pain when pain is distributed along any one or more than one sensory nerve fibers. Radicular leg pain is observed following irritation or pinched sensory nerve, which is caused by disc bulge or herniation. The radicular leg pain is also observed when sensory nerve is irritated by epidural abscess or hematoma, fracture of vertebra and cancer of vertebral bone.

   2. Sciatica Pain

      Sciatica pain is observed in one or two legs. Radicular leg pain travelling along the back of the leg is often diagnosed as sciatica pain. Sciatica leg pain is in most cases associated with motor weakness in muscles of lower leg. Sciatica leg pain is caused by pinch or irritation of lower lumbar and upper sciatic nerve. The treatment includes physical therapy, pain medication and surgery to remove the cause of the pain. Sciatica leg pain is often caused by disc bulge, disc herniation, spinal tumor, fracture of lumbar vertebra and epidural abscess.

   3. Charcot Marie Tooth Disease

      Sensory neuropathy resulting from Charcot Marie Tooth Disease causes mild to severe pain in one or both legs. The inherited neurological disorder is named after 3 researchers. Charcot Marie Tooth Disease affects sensory and motor nerve, also known as sensory and motor peripheral neuropathy. The disease affects 1 in 2500 people in the United States. Motor neuropathy results in weaknesses of several muscles, which later follows with mild to severe atrophy. Weakness of muscles of mouth and tongue causes difficulties in speech and swallowing. Weakness in chest and abdominal muscles causes difficulties in breathing. Muscle atrophy of muscles of hand and foot causes deformities in hands and foot. The treatment includes physical and occupational therapy. The deformities are treated with surgery, braces and advanced orthopedic devices. Leg pain is treated with anti-inflammatory pain medications or opioids.

      Most common cause of leg pain in young individual is injuries to muscles and tendon or joint sprain. In middle aged people, leg pain is caused by muscle spasm and occasional inflammatory diseases of tendon and muscles. The common cause of leg pain in elderly is osteoarthritis or rheumatoid arthritis.

      Leg pain lasting more than a week should be evaluated by specialist and may be investigated with radiological studies and blood test to rule out most of the rare conditions, which are mentioned in this article.

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