Common causes of leg pain

What is leg pain?

Leg pain is any pain in our lower limbs, better known as our legs.

Leg pain can affect any part of our legs and the pain itself may vary according to how it feels, which part of the leg is affected and how bad the pain is.

You may have leg pain all the time, it may come and go, or it may get worse when you do certain activities.

Leg pain may be acute, which means it gets better in a short space of time, or chronic, meaning it can last for several months, or even years.

Leg pain may be described as:

• Aching
• Burning
• Cramping
• Sharp
• Shooting

Sometimes leg pain happens on its own, but you may also have other symptoms, such as:

• Swelling
• Redness
• Bruising
• Heat — the area may feel warm when you touch it
• Tenderness — the area may hurt when you touch it
• A visible wound or injury
• Changes in the colour of your skin
• Fever (a temperature above 38C), or feeling generally unwell
• Large, visible veins (varicose veins)
• Difficulty standing or walking
• Muscle weakness
• Tingling, or numbness

Can I treat my leg pain at home?

In many cases, leg pain can be treated at home using RICE therapy. This involves:

• Rest — Rest the affected muscle or joint until pain and swelling improve
• Ice — Apply an ice pack, or a bag of frozen peas wrapped in a cloth to the affected area for around 10 minutes. Repeat this a few times a day. This will help to reduce swelling
• Compression — Apply a compression bandage to the affected joint or muscle. The bandage should be tight enough to provide support, but not so tight that it restricts blood flow to your lower leg and feet
• Elevation — Keep your leg elevated to, or above, the level of your heart to reduce swelling

Other home treatments include:

• Over-the-counter painkillers, for example paracetamol
• Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
• Heat packs, and warm baths
• Gentle stretching exercises
• Massage

How our legs work

Until something goes wrong, we probably just think of our legs as a way of getting from A to B. But what are our legs made of? And how do they work?

Leg anatomy

Our legs support our upper bodies and help us to balance. They also allow us to perform a variety of movements such as standing, walking, running, kicking, and jumping.

Each leg is made up of 5 parts:

• Upper leg (thigh)
• Knee
• Lower leg (calf)
• Ankle
• Foot

Upper leg

The upper leg consists of the thigh bone (femur) which is the longest bone in the body and runs from the hips to the knees. There are three types of muscles in the thigh: the hamstrings, which are located at the back of the thigh, the quadriceps at the front of the thigh and the adductors on the inside of the thigh. The sciatic nerve, the main nerve that supplies the legs, runs down each thigh from the hips to just below the knee.

Knee

The knee is the joint that joins the upper leg and the lower leg. It is the largest joint in the body and takes the weight of the upper body. It also allows us to perform activities like walking, running, kicking, and jumping.

The knee is made up of the patella (kneecap) which is attached to various ligaments and tendons. These are types of connective tissue that join our muscles, bones and joints and keep our joints stable.

Other important structures in the knee include the bursae, fluid-filled sacs that cushion the knee joint and reduce friction, and the meniscus, discs of cartilage that help stabilise the knee joint and act as shock absorbers.

Lower leg

The lower leg has two bones, the fibula and the tibia (shin bone), and a variety of muscles. Together these allow us to perform different movements. Fibula nerves allow movement of the muscles on the front of the lower leg. Tibial nerves are branches of the sciatic nerve, the main nerve that runs from your hips to your knees. Tibial nerves control the muscles at the back of the lower leg.

Ankle

The ankle is a joint that connects the lower leg to the foot. It is made up of bones and ligaments that allow movement of the ankle and help to keep the ankle joint stable.

Foot

The foot is a complex structure that has multiple small bones (almost a quarter of the bones in the body are located in the feet). Bones in the feet include the tarsals, metatarsals, and phalanges (toes). Each foot contains over 20 muscles and various ligaments to support the foot and allow a range of movements.

What could be causing my leg pain?

As we have seen, the legs are complex structures made up of bones, soft tissues, blood vessels, muscles, joints, nerves, ligaments, and tendons. Leg pain can be the result of a problem with any of these and may have several causes.

Problems with the muscles, bones, joints, ligaments, tendons, or soft tissues

Cramps

Leg cramps are a common type of leg pain and, though very painful, they are normally harmless and short lasting. A cramp occurs when the muscle contracts (tightens) suddenly, causing sharp pain and making movement difficult. They are most common in the lower legs but can also affect the feet or upper legs.

Sometimes, leg cramps have no obvious cause, but they may be caused by:

• Not drinking enough fluids (dehydration)
• Straining muscles during exercise, especially in hot or humid weather
• Alcohol-related liver disease
• Pregnancy, especially in the last 3 months
• Aging
• A side effect of some medications like statins or medications to treat blood pressure

Strains or sprains

A strain occurs when a muscle is stretched or torn, normally during exercise. A sprain is when a ligament (a band of fibrous tissue that connects bones to bones) is stretched or torn.

Muscle strains can occur anywhere in the body but are most common in the large muscles such as the hamstring, calf muscles or biceps.

Sprains can affect any joint but are most common in the ankle.

Sprains and strains are not normally serious and can usually be treated at home using RICE therapy, over-the-counter painkillers, and non-steroidal anti-inflammatory drugs (NSAIDs). Severe sprains may need surgery to repair the damaged or torn ligament.

Tendonitis

Tendons are thick cords that connect muscles to bone. Tendonitis is inflammation of a tendon. Tendonitis commonly affects the Achilles tendon, causing pain in the lower calf and the back of the heel. Tendonitis is normally treated with the RICE protocol, painkillers and NSAIDs. In severe cases, you may need surgery to repair your tendon.

Bursitis

Bursitis is inflammation of the bursae, fluid-filled sacs that cushion and reduce friction in your joints. Knee bursitis causes pain and swelling in the knee joint and can make moving the knee difficult. It can occur suddenly because of a blow to the knee or gradually due to prolonged pressure on the knee joints, such as kneeling for long periods of time. Bursitis often gets better with RICE treatment and NSAIDs, but if your pain doesn’t improve, you may need physiotherapy or even surgery.

Shin splints

Shin splints (medial tibial stress syndrome) occur when the muscles around the shin bone tear, causing pain and swelling. Shin splints are normally caused by overuse and commonly affect people who take part in strenuous activities such as running, tennis or football. Shin splints can often be treated at home with RICE treatment, painkillers and NSAIDs, but in rare cases, may need surgery.

Fractures

A fracture is a break in a bone. There are several types of fractures depending on how the bone is broken and whether it is open (has pierced the skin) or closed. Some fractures can be treated by immobilising the broken bone in a cast or splint until it has healed. More complex fractures usually need surgery to repair the bone and put it back into its correct position. Fractures are commonly caused by trauma, such as a car accident, sports injury or fall.

Symptoms of a fracture in the leg, ankle, or foot may include:

• Sudden, severe pain
• Swelling, bruising and redness around the fracture site
• Your leg, ankle, or foot may appear deformed (out of place)
• You may see the bone through the skin (open fracture)
• Hearing a snap or crack at the time of the injury
• Difficulty moving the affected area
• Being unable to walk or stand

Stress fractures are small cracks in the bone that usually occur with repetitive activity such as running, football and basketball.

Symptoms of stress fractures include:

• Pain that improves with rest and gets worse with physical activity
• Swelling
• Bruising
• Tenderness

Arthritis

Arthritis means inflammation of the joints. The two main types are osteoarthritis and rheumatoid arthritis.

Osteoarthritis becomes more common as we age and is due to wear and tear on our joints over time.

Rheumatoid arthritis is an autoimmune disease that occurs when the body’s immune system attacks its own cells.

Symptoms of arthritis include:

• Pain
• Swelling
• Stiffness
• Redness
• Heat
• Difficulty moving the joint

Arthritis is normally treated with a combination of lifestyle changes, medication, physiotherapy and, in some cases, surgery to repair or replace the damaged joint.

Infection in the bone or soft tissue

Infection in the bone (osteomyelitis) or the skin or soft tissue of the leg (cellulitis) can cause leg pain. Osteomyelitis occurs when bacteria or other germs spread from infected skin, muscles, or tendons to the bone. The infection may also spread from other parts of the body through the blood or develop after bone surgery.

Symptoms of osteomyelitis include:

• Pain, redness, warmth and swelling around the affected area
• Fever (a temperature above 38C)
• Fatigue

Cellulitis occurs when bacteria penetrate the skin and may be caused by an injury, insect bite, sting, or surgical wound. It can occur anywhere on the body but is most common in the lower legs.

Symptoms of cellulitis include:

• Pain, swelling, heat, irritation, and redness over an area of skin
• Blisters
• Fever (a temperature above 38C)

Osteomyelitis treatment will depend on your age and health as well as the extent of the disease. You may be given antibiotics and other medications, or you may need surgery to drain fluid or to remove dead or infected portions of bone.

Cellulitis is treated with antibiotics. It can be serious if not treated quickly, as the infection can spread rapidly to the blood, muscles, and bones. This can be life-threatening.

Problems with the veins and arteries

Peripheral artery disease (PAD)

Peripheral artery disease occurs when there isn’t enough blood supply to the legs. It may cause pain when walking (claudication) that gets better with rest. Other symptoms may include:

• Cold lower legs (PAD may only affect one leg)
• Shiny skin on the lower legs
• Hair loss or slow hair growth on the lower legs
• No pulse, or a weak pulse in the lower leg and foot
• Sores on the feet or legs that won’t heal
• Erectile dysfunction (impotence)

PAD occurs when fatty deposits build up in the arteries (atherosclerosis), causing the arteries to narrow and restricting blood flow.

Risk factors for PAD include:

• Diabetes
• Smoking
• A family history of PAD, heart attack or stroke
• High cholesterol
• Obesity
• Age — PAD is more common in people over 50
• High levels of an amino acid called homocysteine

Treatments for PAD include lifestyle changes, medication, and sometimes, surgery.

Deep vein thrombosis (DVT)

Deep vein thrombosis occurs when a blood clot (a solidified lump of blood) forms in one of the deep veins in the body, commonly the lower leg. A part of this clot can break off and travel to the lungs, blocking the blood supply. This is a serious condition called a pulmonary embolism, which can be life threatening. DVTs commonly occur when you don’t move around for a long time, such as because of surgery, illness, or long-distance travel.

Symptoms of DVT include:

• Pain
• Redness
• Swelling

You may be at a higher risk of developing a DVT if you:

• Have a family history of DVT
• Are overweight or obese
• Smoke
• Are pregnant
• Have a medical disorder that affects how your blood clots
• Have had a bone fracture
• Have certain types of cancer
• Take certain medications like birth control pills, hormone therapy and antidepressants

Varicose veins

Varicose veins are enlarged prominent veins in the legs. They occur when the small valves in the veins stop working properly, causing the blood that flows to the heart to backflow and pool in the legs.

Symptoms of varicose veins include:

• Large, bulging veins in the legs and feet. These may be blue or dark purple and often appear twisted and knotted
• Swollen feet and ankles
• Heaviness, aching, burning, throbbing or discomfort in the legs
• Leg cramps, particularly at night
• Thin, dry, itchy skin over the veins

Varicose veins are initially treated with rest, elevation and wearing tight stockings called compression stockings to improve blood flow. If these home treatments don’t work, your consultant may recommend a procedure to seal the veins or surgery to remove them.

Problems with the nerves

Peripheral neuropathy

Peripheral neuropathy is damage to the peripheral nerves (the nerves located outside the brain and spinal cord). It can be caused by diabetes, trauma, infection, and exposure to some toxins.

Symptoms of peripheral neuropathy include:

• Numbness, prickling and tingling
• Pain — may be sharp, burning, or throbbing
• Extreme sensitivity to touch
• Muscle weakness
• Poor coordination

Peripheral neuropathy is normally treated with medication.

Sciatica

Sciatica is inflammation of the sciatic nerve, the main nerve that runs from your hips to your knees. Sciatica can be caused by any condition that compresses or irritates your sciatic nerve. Common causes include a herniated disc, narrowing of the spinal canal (spinal stenosis) and degenerative disc disease.

Sciatica often gets better with RICE therapy, but sometimes needs further treatment such as physiotherapy, cortisone injections or, rarely, surgery.

Herniated (slipped disc)

A herniated disc occurs when the jelly-filled pads that cushion the spine bulge out, putting pressure on the nearby nerves.

Symptoms of a herniated disc include:

• Pain in the back that may radiate down the legs
• Sciatica
• Weakness, numbness and tingling in the legs
• Loss of bladder and bowel control (this is a medical emergency and needs immediate treatment)

Treatment for a herniated disc includes RICE therapy, NSAIDs, physiotherapy, and steroid injections. If these treatments are not effective, surgery may be required.

Uncommon causes of leg pain

Some less common causes of leg pain include:

Bone cancer

Bone cancer can develop in any bone but is most common in the pelvis and the long bones of the arms and legs.

Symptoms of bone cancer include:

• Bone pain — this may be severe, may come and go, and is often worse at night
• Swelling and tenderness around the affected bone
• Frequent fractures (breaks in the bone) due to weakened bones
• Fatigue
• Weight loss

Treatments for bone cancer include surgery, chemotherapy, and radiation therapy.

Noncancerous bone tumours

Benign (noncancerous) tumours can also develop in the leg bones. They are most common in people under the age of thirty.

Symptoms of noncancerous bone tumours include:

• Pain — this is often severe, gets worse over time and is not relieved by rest
• A swelling or lump in the leg
• Weakened bones, resulting in fractures

Some noncancerous bone tumours do not need treatment and your consultant may decide to monitor your tumour to check that it doesn’t get worse or cause any problems. Other treatments include medication and surgery.

When should I see a doctor for leg pain?

Sometimes leg pain needs medical treatment. Make an appointment with a doctor if you have:

• Severe pain
• Pain that is accompanied by other symptoms
• Pain that gets worse or doesn’t improve after a few days of home treatments
• Swelling in both legs
• Pain when you walk

Go to the hospital immediately if:

• You have a fever (a temperature above 38C)
• Your leg appears red and warm to the touch
• Your leg is pale and cool to the touch
• You have numbness or weakness in your legs
• You have a deep wound, a wound that isn’t healing, or has a strong unpleasant smell
• You have difficulty breathing
• Your leg looks deformed (an unusual shape) and you can’t move it properly
• You heard a pop or snap when you injured your leg

How to prevent leg pain

Sometimes leg pain can’t be prevented, but there are some things you can do to prevent or lower the risk of some types of leg pain, including:

• Maintain a healthy weight
• Take regular exercise (at least thirty minutes a day, five times a week)
• Keep an eye on your blood pressure and cholesterol and try to keep them within healthy limits
• If you have a medical condition, such as diabetes, try to manage it as well as you can
• Stick to safe limits when drinking alcohol
• Don’t smoke