Pain in the leg is a common symptom, particularly if it is caused by painful joints, however, pain in the leg itself can be important and should not be ignored.
Contents of this article:
What is leg pain?
Pain in the feet, ankles, knees or hip is typically dealt with individually and separately from 'leg pain' in general, for this article, leg pain is said to occur anywhere between the groin and ankle, thus excluding the hip and feet.1
Pain can be experienced in a number of different ways. Pain in the leg, as in other parts of the body, can be described as sharp, dull, numbing, tingling, burning, aching, and so on.
Pain can be acute (short-term) or chronic (long-term), and can be rated on a scale of severity from mild to severe, often rated on a numerical scale.
Sensory neurons (nerves) are responsible for our experience of pain, and these are triggered by stimuli such as high levels of pressure, high or low temperatures and chemicals, which can be released by tissue damage.2
Fast facts on leg pain
Here are some key points about leg pain. More detail and supporting information is in the body of this article.
- Leg pain refers to any kind of pain that occurs between the heels and the pelvis.
- Many causes of leg pain are obvious, such as injury after an accident.
- Leg pain can have less obvious causes, such as peripheral artery disease.
- Repetitive, excessive sports, especially in the form on running, can lead to trauma that creates leg pain - E.G: shin splints and stress fractures.
- Leg pain with an underlying medical cause may be nerve-related, musculoskeletal or vascular.
- Some forms of leg pain resolve with self-help care.
What causes leg pain?
The obvious causes of leg pain are injuries, perhaps sustained during a sports game, or due to an accident - damage that doctors call trauma.
Since the causes of trauma pain are obvious, and the treatment is applied accordingly, this article deals with leg pain that is not associated with traumatic injury.
Sports can also cause injury in a less immediate way - shin splints, for example, are caused by excessive exercise.3
Long-distance running is associated with a higher incidence of leg pain of numerous types - bone, musculo-tendinous, and vascular.4 Around half of people running more than three kilometres, who train steadily and regularly take part in a long-distance run, sustain a running-related injury each year.4
Three broad areas cover the medical causes of leg pain (follow the links for more MNT detail on individual conditions):3,5
Neurological (nervous) causes, including:
Musculoskeletal causes, including:
- Arthritis, which affects joints - the hip, knee, or ankle
- Muscle, tendon or ligament strains - for example, due to sports injury
- Night cramps
- Exertional/chronic compartment syndrome
- Medial tibial stress syndrome
- Stress fracture
Vascular causes (relating to blood vessels), including:
- Intermittent claudication due to peripheral vascular disease (PVD)/peripheral arterial disease (PAD)
- Deep vein thrombosis (blood clot).
Signs and symptoms of leg pain
Leg cramps are transient episodes of pain, usually for several minutes, when muscle - usually the calf at the back of the lower leg - goes into a spasm, which cannot be controlled.1,6,7
If there is no obvious injury, leg pain may have a nerve, musculoskeletal or blood vessel cause.
There is a tightening sensation during cramps, which are more common at night and in older people - an estimated third of people over 60 years of age suffer from this problem.7
Intermittent claudication is the name given for pain in the leg due to poor circulation, which is known as Peripheral Arterial Disease (PAD).8
This is common and associated with significant morbidity and mortality.13
Leg pain caused by atherosclerosis or narrowing of the arteries in the leg has distinguishing features and is known as claudication or intermittent claudication. The word claudication is from the Latin word meaning limp.8
Other terms for this atherosclerotic disease are:
- Peripheral arterial disease
- Peripheral arterial occlusive disease
- Peripheral vascular disease.
It occurs due to a restricted blood supply reaching the leg muscles and as the muscles are not getting enough blood, oxygen and nutrients they start to hurt.9
Claudication produces a leg pain that, in classic cases, is:8,9,14
- A cramp-like muscle pain during exercise or exertion
- Pain occurs in the buttocks, thighs, calves and feet
- Symptoms usually ease on resting
- Pain when walking or climbing stairs
- The cramps consistently occur after the same walking distances
- The pain, usually in the calf, eases with rest, and is relieved after 10 minutes.
Many cases of claudication are not classic in this way, many show no symptoms, or produce a pain that is not typical, perhaps in the thigh or buttock.8,9
Some people with severe arterial disease experience terrible pains in the leg at night, causing them to have to hang their leg over the side of the bed to gain relief.
How leg pain saved David Dow's life
Medical News Today covered the story of David Dow - see 'Leg pain can mean heart danger, expert says' - showing that unresolved leg pain is worth taking noting of.
Deep vein thrombosis (DVT)
This is a blood clot in the deep veins of the leg (rather than the superficial varicose type veins.) It typically causes a one-sided swollen, hot, painful leg.
Musculoskeletal injuries sustained by sporting activity fall into four broad groups, and this applies for leg injuries, too:10
- Overuse injuries from excessive sport
- Blunt trauma
- Fractures and dislocations
- Acute soft-tissue sprains and strains.
Sports injuries to the leg within these broad groups would run into a long list, so we will deal with selected causes of leg pain.
Shin splints are an example of an overuse injury. The shin pain cannot be explained by an obvious cause such as a fracture.
Activities like jogging, running and hiking create repetitive impact forces that overload muscles and tendons. Shin splints produce severe localized tenderness in the muscles, and sometimes bone pain.10
Stress fractures also result from repetitive insults sustained during sports, but typically when the intensity has changed - occurring, for example, in the feet of runners who have changed the intensity or timing of their workouts too quickly.10
These bone fractures do not result from a one-off injury, and the fractures are small. The pain is felt during the exercise, and its onset is increasingly earlier in a workout, possibly reaching a point that makes the exercise unbearable.
Popliteus tendinitis is another overuse injury. It produces knee pain during downhill running, and is caused by inflammation to the popliteus tendon, which is important to knee stability.10
Hamstring strain is yet another overuse injury, often associated with running. It gives rise to an acutely painful area in the rear of the thigh muscle, due to a partial tear. This usually develops because of inadequate flexibility training, or poor warm up and stretching exercises before an activity.10
Injuries to the leg - usually the back of the lower leg - that result in fractures or severe bruising can lead to compartment syndrome, in which the pain is usually disproportionate to the injury.10
Compartment syndrome is caused by a swelling brought on by the injury, but within a confined volume, within a closed fascial compartment, where there is little room for expansion, and pressure increases.
This edema can continue to a serious extent, cutting off blood supply to the tissue (ischemia). In these cases, the early pain may be followed by paresthesias, paralysis, pallor and a lack of pulse at the area affected.10
On the next page we look at tests and diagnosis for leg pain, how to prevent suffering with the condition and the treatment options for sufferers of leg pain.