Leg pain is common, ranging from muscle strains in professional athletes to degenerative joint diseases affecting elders. The legs can be prone to pain as they, in combination with the hips, knees, ankles and feet, move the entire body’s weight and provide support.

Exercise and excessive or improperly performed activity may cause strain in the legs. In addition, many conditions in the trunk of the body may produce symptoms that radiate into the limbs.

Some types of leg pain are caused by obvious injuries such as falls, sports injuries or other trauma. Leg cramps, one of the more common leg pain complaints, can result after exercise or can be due to an imbalance in the body’s chemicals. Circulatory problems, such as blocked arteries and blood clots, are another cause of leg pain.

Nerve compression or inflammation resulting in radiculopathy that begins in the low back frequently can cause leg pain. This is because the spinal nerve roots travel down the leg and can cause sciatica. Spinal stenosis, which may cause compression of spinal nerves in the spine, can also manifest itself as pain in the legs. Leg pain may also result from neuropathies such as from diabetes or chronic alcoholism.

A physical examination by a physician is the first step in identifying the source of leg pain. An individual’s physician may perform several tests to determine the potential cause of the pain. These tests may include x-rays, other imaging studies of the low back, nerve conduction studies, laboratory blood work, Doppler ultrasound to test blood flow, or a special blood pressure measurement in the legs.

Relief of leg pain involves treating the cause. Additional management may involve lifestyle modification to improve circulatory or nerve health, medications or physical therapy. Some conditions, such as sciatica, may not be helped with these techniques and may require advanced treatments such as spinal injections or surgery.

Lifestyle changes, such as maintaining a healthy weight, getting regular exercise and quitting smoking, may prevent the onset of certain painful leg problems.

Leg pain may occur anywhere from the hip to the ankle. There are many causes ranging from traumatic injury to disorders that block blood flow or damage nerves. Conditions involving the joints, such as the spine, hips and knees, may produce pain in parts of one or both legs.

The upper part of each leg (thigh) is connected to the rest of the body at the hips. The thigh includes the femur, the largest bone in the body, and its associated muscles, ligaments and tendons. The femur runs from the hip to the knee. The top of the femur is ball shaped and fits into a socket located in the pelvic bone of the hip. The ball-and-socket type joint of the hip allows the leg a wide range of motion.

The bottom of the femur has a groove that accomodates the kneecap (patella). The knee provides a hinge-type joint where the leg can bend and connects the thigh to the lower part of the leg (shin). The shin contains two bones (tibia and fibula). The top of the tibia is joined by ligaments to the kneecap and femur. The bottom of the tibia and fibula connect to the ankle bone (talus) at the ankle, another hinge-type joint.

The muscles, ligaments and tendons of the leg enable it to move and provide support. Blood vessels and nerves in these tissues also stimulate movement and provide sensation. Many forms of leg pain begin with blockages or compression of blood vessels and nerves.

Older adults are more susceptible to leg pain. Bones weakened by osteoporosis, arthritic joint conditions and compromised nervous or circulatory systems all contribute to leg pain among the older adult. Leg pain at any age can cause gait disturbances.

Leg pain can occur in conjunction with pain from other areas. This referred pain originates in one area of the body but is perceived in another area. For example, many problems radiate from the hip to cause leg pain. A person who experiences leg pain may also experience:

• Back pain. Lower back problems (e.g., herniated disc, degenerative disc disease) frequently cause pain that radiates into the legs. Poor spine alignment may cause hip or sacroiliac joint pain that may extend into the legs.

• Knee pain. Numerous knee problems can cause pain throughout the leg.
  
  
• Foot pain. Problems related to flat feet or overpronated feet (feet that roll outward) affect walking or gait and may also cause leg pain. In addition, pain in the right foot, for example, may cause a person to favor the left foot, resulting in excess strain on one leg. Pain may also develop from the intrinsic muscles and bones of the feet.
  
  
• Pelvic pain. Muscle spasms in the pelvic floor, for example, may radiate to the hips and thighs.

Leg pain can be caused by injury or stress that affects the mechanical operation of the lower body (hip, leg, knee or foot). Leg pain can occur from circulatory problems, especially in the calf area at the back of the lower leg, or rarely from inflammation of veins called thrombophlebitis. 

Arthritis, most commonly osteoarthritis, may also cause leg pain, particularly in the knees and hips. Rheumatoid arthritis may affect the feet, ankles, knees and, in later stages, the hips. Pseudogout often causes knee pain, and gout can cause excruciating pain in the big toe. Reiter’s syndrome and ankylosing spondylitis can affect the knee, ankle, foot and other parts of the leg.

Other causes of leg pain include:

• Circulatory problems. Disorders of the circulatory system in the legs can cause leg pain. Peripheral artery disease (PAD) affects blood vessels in the legs, resulting in blockage of blood flow, causing swelling and leg pain. This pain, called intermittent claudication, usually is located in the calves, normally occurs while walking and is alleviated with rest. PAD, by definition, refers to any obstructed artery outside the heart, but most commonly occurs in the leg and results in pain.

  

• Deep vein thrombosis (DVT). Blood clots in the venous blood vessels that usually develop in the legs. When these blood clots remain in the legs, they can cause pain and swelling. If the blood clot is left untreated, it may dislodge and travel to a lung, causing a life-threatening condition called pulmonary embolism. Prolonged periods of sitting, leg trauma, inactivity or smoking while on certain contraceptives may predispose a person to a higher risk for DVT.
  
  
• Other vein problems. Smaller blood clots or inflammation near the surface of the legs indicate a condition called phlebitis, which may cause leg pain. Varicose veins, although more frequently a cosmetic problem, have also been linked to pain in the legs. They result from malfunctioning valves in leg veins that cause blood to pool, resulting in enlarged, often painful, veins.
  
  
• Traumatic injuries. Sudden falls or unusual movements can injure the legs, resulting in bone fractures, joint dislocations, muscle strains, or sprains or tears to ligaments. Fractures of the femur most often occur from high-impact injuries in automobile accidents and workplace traumas. Longtime strain can cause femoral neck stress fractures, incomplete fractures that are most common in runners. In the United States, femur fractures occur in about three of every 10,000 people. They usually require surgery, extensive healing time and rehabilitation.
  
  Any femur fracture from a low-impact fall may indicate that the bone has been weakened by osteoporosis or cancer. Fractures of the lower leg typically involve both bones (tibia and fibula). The tibia is one of the most common leg bones to be fractured, often with breakage through the skin (compound fracture). In general, fractured bones in the legs have a good prognosis for healing.
  
  
  Contusions are another common cause of leg pain. For example, a blow to the side of the hip may injure the iliac crest of the pelvic bone and nearby tissues. This acute injury, known as hip pointer, occurs most often during football or other contact sports.

• Overuse and soft tissue injuries. Leg cramps (charley horse) may be caused by muscle fatigue from overuse, dehydration or loss of such body chemicals as potassium or sodium. Leg cramps often occur during sleep and may be related to dehydration or mineral deficiencies.

Shin splints can occur after periods of inactivity or after exercise intensity is increased. Excessive exercise may cause small, painful cracks on the surface of the leg bones called stress fractures. Inflammation of the tendons (tendinitis), bursa (bursitis) or entheses (sites where tendons or ligaments attach to bone; enthesitis) in the legs, knees, feet or hips may cause leg pain. Poor posture and ergonomics can contribute to back, hip and leg pain.

• Nerve problems. A pinched nerve resulting from conditions such as spinal stenosis, degenerative disc disease or a herniated disc can cause pain from the back down the leg. Sciatica refers to pain along the sciatic nerves, which run from the pelvic bone down the back of each leg. Compression at the roots of these nerves in the lower spine causes the pain, which is also known as radiculopathy. This pain may involve one or both legs with associated numbness.

Neuropathy is another form of nerve damage that can cause pain in the legs. Neuropathy is common in diabetes patients and is believed to be related to high glucose (blood sugar). It can result in unsteady gait, numbness, tingling and mild to excruciating pain in the legs. Other conditions may also cause neuropathy, including alcohol abuse, certain vitamin deficiencies or rare hereditary conditions.

• Joint disease in the back. Conditions in a sacroiliac joint or facet joint can cause pain in the back of thighs. Predisposing factors include injury and arthritis.
  

• Infections. Many infectious diseases can cause leg pain, including:
  

• • Shingles (herpes zoster), a viral infection caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox. After a person has had chickenpox, VZV remains in a dormant (inactive) state in the nerve roots for the rest of their life. VZV may reactivate years later in the form of a painful skin rash and postherpetic neuralgia.
    
    
  • Cellulitis, a bacterial infection of the deep layers of the skin that can spread to muscle, blood, lymph nodes and other tissues.
    
    
  • Osteomyelitis, a serious infection of the bone.
    
    
  • Impetigo, a common and highly contagious bacterial skin infection that most often occurs in children.
    
    
  • Scabies, infestation of the skin with a mite whose spread causes intense itching (pruritus).
    
    
  • Restless legs syndrome (RLS). This neurological disorder causes unpleasant leg sensations, ranging from a crawling or burning sensation to pain. The National Institute of Neurological Disorders and Stroke estimate that RLS affects as many as 12 million Americans. It usually occurs when people are sitting or lying down, particularly at night. In addition to discomfort, individuals with RLS have difficulty keeping their legs still and may suffer insomnia. Moving the legs helps relieve the discomfort caused by this condition.
    
    
  • Complex regional pain syndrome. A chronic pain marked by continuous, intense pain that tends to worsen over time. It usually occurs after a significant trauma to an arm or a leg and is characterized by burning or aching pain along with inflammation, skin discoloration, altered temperature, abnormal sweating and hypersensitivity of the affected area. Complex regional pain syndrome may also occur without a known injury or with microscopic injury such as intramuscular injection.
    
    
  • Compartment syndrome. Layers of tissue called fascia divide leg muscles into compartments. Each compartment has a limited amount of space that cannot expand. Any swelling in a compartment (usually in the calf), especially after blunt trauma, may cause the extreme pain of compartment syndrome. Urgent surgery may be necessary to treat this condition.
    
    
  • Osgood-Schlatter disease. A condition that causes swelling and pain at the bony point (tibial tuberosity) just below the knee. It appears most often in young children engaged in athletic activities that stress the muscles and other tissues surrounding this area of the leg.
    
    
  • Coxa saltans (snapping hip). A condition in which a tendon or other connective tissue snaps over pelvic bone when the hip is bent forward or moved in certain other positions. It can be painless at first but can become painful over time. It may be more common in athletes.
    
    
  • Slipped capital femoral epiphysis. An adolescent hip disorder in which the upper end of the thigh bone slips out of place. It is more common in boys than girls, more common in overweight teens than those of normal weight.
    
    
  • Hernia. Intestinal protrusions such as a femoral hernia may cause thigh pain.
    
    
  • Paget’s disease. This involves excessive breakdown of bone and abnormal formation of bone.
    
    
• Cancer. The three most common forms of bone cancer (osteosarcoma, chondrosarcoma and Ewing’s tumor) all occur in the bones of the leg. Additionally, cancer may travel from a different part of the body (metastatic cancer) and be found in the legs. Leg pain is their most frequent symptom, along with swelling and possible growths.
  
  
• Meningitis. Scientists have recently reported that leg pain, cold feet and hands, and abnormal skin coloration can be early indicators of meningitis. These symptoms can appear within hours of infection, long before the onset of better-known signs such as rash, headache and stiffness of the neck.
  
  
• Hypermobile joints. Research suggests that children with very flexible joints might be at increased risk of recurrent leg pain.
  
  
• Pigmented villonodular synovitis. This rare disorder involves abnormal growth of tissue in joints. Joint swelling can damage bone. It most often involves the knee or hip but may also involve the ankle, foot, shoulder, hand or fingers.

In addition, numerous conditions including lupus, fibromyalgia, sarcoidosis, polymyalgia rheumatica, sickle cell anemia, Lyme disease, myositis and chronic fatigue syndrome can cause widespread pain in the joints and may affect the legs.

Many sources of leg pain can lead to gait disturbances, which can in turn worsen or create new types of leg pain.

A physician will begin the investigation of leg pain with a medical history and a physical examination. The legs will be examined for any signs of swelling, ulcers, abnormal structural conditions or restrictions in range of motion. Sensation will be assessed to determine if there is any numbness and strength tested for weakness. The patient may be asked to use a scale called a pain assessment tool to determine the location and severity of the pain.

The patient may be asked to walk, squat or perform other exercises, if possible, to demonstrate the leg’s function. To determine possible causes of the pain or to rule out other conditions, the following tests may be administered:

• X-rays. Uses low levels of radiation to produce images on a screen or special film. X-rays may be used in diagnosing fractures. Arthritic conditions and joint alignment can also be evaluated.

  

• Doppler ultrasound. Uses a wand to produce images from sound waves that can be viewed on a monitor. Ultrasound can detect blood flow through the leg. It is especially useful in cases of peripheral artery disease (PAD) and deep vein thrombosis (DVT).
  
  
• MRI (magnetic resonance imaging). Uses magnets to produce computerized images on a screen. MRIs can be used to detect growths or tumors in the leg as well as most structural abnormalities.

• CAT scan (computed axial tomography). Use multiple computerized images from many angles to show the leg’s tissues, bones and muscles.
  
  
• Arthrography. Enhances an x-ray of a joint via injection of a contrast medium (dye).
  
  
• Ankle-brachial index. Blood pressure measured at the ankles and arms both at rest and after exercise. A difference in the blood pressure at each location may indicate reduced circulation or PAD.
  
  
• Bone scan. Type of radionuclide imaging used to detect areas of increased or decreased bone uptake of a radioactive material (radionuclides) that is injected into a blood vessel. This material collects in areas of abnormality and can be detected with a special camera. This test may used to detect bone cancer, stress fractures or arthritic conditions.
  
  
• Blood tests. Screen for a wide range of condition that may cause leg pain, ranging from infections to arthritis to sickle cell anemia.
  
  
• Bone density test. Measures the density of bones at certain places such as the hip, spine and ankle. This test can diagnose osteoporosis and monitor bone density over time.
  
  
• Biopsy. A small sample of tissue from the bone or other part of the leg is examined under a microscope. Depending on the part of the leg being tested, it may involve a needle to remove fluid or a larger incision to remove some sort of tissue. Biopsies are usually taken to investigate cancer.

Relief considerations for leg pain depend on the underlying condition causing the pain. Traumatic injuries may require first aid such as immobilization, splinting or surgery. Lifestyle changes such as adjusting a diet, increasing exercise and quitting smoking may help alleviate pain caused by circulatory or nerve problems.

Other options may include:

• Elevation of the leg
• Cold therapy, water therapy or heat therapy
• Support garments (hose, socks)
• Stretching following sports activities
• Manipulation therapy such as massage therapy

Certain over the counter medications may be used to help leg pain, including nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, or analgesic pain medications such as acetaminophen or pain-relieving creams. Strong medications such as opioids or COX-2 inhibitors are used in severe cases. 

The U.S. Food and Drug Administration (FDA) has recently approved an antidepressant for the relief of diabetic neuropathy, and several other treatments, including anti-epileptic medications, are also used to treat this common cause of leg pain. Drugs that lower cholesterol, reduce coagulation or control blood pressure may be used treat certain types of leg pain, such as peripheral artery disease (PAD). Even aspirin has been found capable of relieving PAD through its anti-platelet clotting properties.

To treat restless leg syndrome, a common cause of leg pain, the FDA has approved one drug that was originally developed for Parkinson’s disease. Other measures that may help, according to the National Institutes of Health, are restriction of caffeine, tobacco and alcohol, supplements to correct any mineral deficiencies, massage, heat therapy, cold therapy, opioids, central nervous system depressants (benzodiazepines) and dopaminergics.

In cases where leg pain is caused by bacterial, viral, fungal or other infections, the underlying cause is treated with the appropriate medication, such as antibiotics, antivirals or antifungals. Medications such as antihistamines may be used to relieve itching (pruritus).

In some cases, corticosteroid or other injections may alleviate inflammation or sciatica pain. These procedures may be performed in the spine or leg joints. Because much of this pain originates in nerve pathways in the back, injections are given as epidurals in the lower back. A physician may use an x-ray procedure called fluoroscopy to help guide these injections. Injections can also be given in a sacroiliac or facet joint of the back.

The physician may also prescribe physical therapy. Exercises can strengthen muscles and may increase the range of motion of a strained area. Certain stimulation treatments, such as ultrasound therapy or electrical therapy, can relieve pain. A home exercise program may be developed to continue gains made in therapy. If leg pain is impeding performance of daily activities, the physician may recommend occupational therapy.

Some other alternative forms of medicine have been tried for some types of pain including acupuncture and acupressure. Each practice is based on the theory that there are key points on the body that serve as pathways.  Acupuncture involves the insertion of needles in these areas.  Multiple treatments must be performed to assess for pain relief. Acupressure involves applying pressure without use of needles. Chiropractic services also may offer short-term relief to some individuals. Individuals must check with their physician before beginning these types of programs to see if they are right for their condition.

Certain types of leg pain may require surgical resolution. Surgeons may perform angioplasty to open a blocked blood vessel. During this procedure, a small tube called a catheter is inserted through the blood vessels to the point of blockage, where an even smaller tube called a stent may be placed to keep the artery open. Grafts that bypass blocked blood vessels may also be used. For blood clots, the physician may inject thrombolytic drugs that will dissolve the blood clot.  

For joint pain, an individual may undergo arthroposcopic surgery or a total joint replacement (arthroplasty) to relieve pain and improve mobility. For neuropathy, nerve compression surgery may provide relief. In addition, spine surgery to implant a spinal cord stimulation device might reduce pain and prevent leg amputation in patients with severely impaired circulation, according to recent research.

Certain lifestyle changes may help prevent the onset of leg pain, especially pain associated with circulatory problems, osteoarthritis or nerve conditions. These changes include:

• Quitting smoking
  
  
• Losing weight, or maintaining a healthy weight
  
  
• Getting moderate regular exercise, increased at a gradual rate
  
  
• Warming up and stretching properly before and after exercise
  
  
• Eating a balanced diet
  
  
• Preventing or controlling diabetes

Controlling weight can avert the need for a hip joint replacement due to arthritis. Research has shown that being overweight or obese, especially in young adults, increases the risk of hip replacement as well as knee replacement in later years.

Deep vein thrombosis (DVT) is more common after periods of inactivity, such as long flights. People should try to move about frequently or even stretch their legs while sitting. Prescription medications such as anticoagulants may prevent blood clots that can cause leg pain.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about leg pain:

1. What conditions are causing my leg pain?
   
   
2. Is this leg pain related to other pain I have in my back?
   
   
3. Should I modify my level of exercise to alleviate this pain?
   
   
4. Are there over-the-counter medications or treatments that will help my pain?
   
   
5. What prescription medications might I need?
   
   
6. Are other symptoms likely to occur with my leg pain?
   
   
7. How will quitting smoking help my leg pain?
   
   
8. Would losing weight reduce my leg pain or risk of future pain?
   
   
9. Is there a way to prevent muscle cramps in my legs?
   
   
10. Will support hose help my condition?
    
    
11. Will physical therapy help my pain?
    
    
12. Are there any injections that can relieve my pain?