Leg Pain

Leg pain can be caused by several different problems involving the vascular system in the leg. These include: peripheral artery disease, blood clots, varicose veins and a rare growth condition called Legg-Calve-Perthes disease.

Peripheral artery disease occurs when plaques are deposited in the arteries of the legs, hardening and narrowing the blood vessels and leading to decreased blood flow to the legs. Peripheral artery disease is a specific type of atherosclerosis, a condition where arteries in the body are hardened and narrowed. People with high cholesterol levels, heart disease, high blood pressure, diabetes, a history of stroke, those on dialysis for kidney problems and cigarette smokers have an increased risk of developing atherosclerosis and peripheral artery disease. Many of the measures to prevent cardiovascular disease, including eating a low-sodium diet, following an aerobic exercise plan and getting treated for high blood pressure and high cholesterol levels also apply to preventing peripheral artery disease.

The symptoms of peripheral artery disease depend on how severely the blood vessels that supply the leg are blocked. When blood flow to the legs is decreased, pain may result. The pain is due to muscle fatigue and lack of oxygen, and it is felt as a dull aching or burning sensation. In the early stages of peripheral artery disease, the pain is felt when oxygen consumption is highest: during strenuous exercise. As the disease progresses and the blood vessels become more narrowed, it takes less activity for the muscles to become fatigued. In severe cases of peripheral artery disease, circulation to the toes can become almost completely cut off. This can be painful and may require surgery.

Treatments for peripheral artery disease include: medications to control blood pressure, cholesterol levels or blood sugar, medications to prevent blood clots, medications to dilate the arteries, medications to control pain and surgery. Surgical procedures used include angioplasty, peripheral artery bypass and, in the worst cases, amputation of the affected limb.

Another vascular cause of leg pain is blood clotting in the leg. Blood clots in the leg can be categorized into two groups: deep vein thrombosis and superficial thrombophlebitis. Deep vein thrombosis is a blood clot that develops in the deep veins of the leg. Superficial thrombophlebitis is when blood clots occur more superficially in the leg, or closer to the skin, and cause inflammation in the blood vessels. Both of these conditions can cause pain and swelling. With a deep vein thrombosis, there may be color changes in the leg due to lack of circulation. Superficial thrombophlebitis, on the other hand, does not cut off circulation to the entire leg.

Certain groups of people are more at risk for developing blood clots in the legs including: people who smoke and take birth control pills, women who have recently given birth, people who have heart disease, people who have undergone surgery recently, people who are obese, people who have been confined to bed rest, people who sit when traveling for long periods of time and people with blood that clots more easily. Ways to decrease your risk of blood clots include quitting smoking, using non-hormonal birth control, losing weight and decreasing the amount of time that you are sedentary. If you must sit for a long period of time, stretching your legs or taking a short walk periodically can reduce the risk of developing blood clots.

Treatment for blood clots in the legs includes medications that thin the blood, or anticoagulants, such as heparin and warfarin, and sometimes medications to dissolve blood clots. A pressure stocking to wear around the leg may also be given to the patient; this device decreases the chance of developing another blood clot. In some cases, surgery to remove the clot or to place a filter device that protects the lungs from emboli, or traveling pieces of blood clots, may be necessary. Treatment for superficial blood clots is similar, but superficial blood clots in the legs are not as dangerous. People who are at a high risk for developing blood clots may have to take anticoagulant medications for the rest of their life.

Varicose veins are swollen superficial veins in the legs. Varicose veins appear dark because of the blood that pools in them. Women are more often afflicted with varicose veins than men. Varicose veins are more likely to form if a person is standing for long periods of time. To some degree, varicose veins can be prevented by avoiding excess standing if you are at risk for developing them. Varicose veins do not usually require much medical treatment, but they can sometimes be painful and some patients opt for treatment for cosmetic reasons. Surgery to remove varicose veins is usually only recommended in severe cases. There are also laser treatments that can help with varicose veins.

Legg-Calve-Perthes disease is a rare vascular disorder of the hip that affects children, usually boys under the age of 10. The cause of this disorder is unknown. The blood supply to the head of the femur, the large bone of the thigh, is decreased to the point where the bone cells in that area start to die. This disease causes limping at first, which can then progress to damage to the hip joint, knee pain and possible deformity of the leg. In some cases, the bone will start to regrow later on when the blood supply to the hip returns. Some patients with Legg-Calve-Perthes disease end up with a nearly normal hip joint, and others suffer from permanent leg deformities. Treatment for Legg-Calve-Perthes disease involves physical therapy, the use of orthopedic braces and anti-inflammatory drugs for symptoms of joint stiffness and pain.


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