Leg Pain

Leg pain is far and away the most common reason patients visit the office.

Leg pain has many different origins and not every patient who presents to our office  has pain that is related to disease of the arteries or the veins. Pain may be neuroligic (spine or nerve caused) or musculoskeletal (joints and muscles) in origin. Leg pain that is secondary to peripheral arterial disease (poor blood flow in the arteries of the legs) typically causes pain with exercise and is relieved with rest. The pain is the result of poor blood flow to the exercising muscles; its the same reason that patients with coronary artery disease get chest (heart) pain. The pain is also very reproducible in that it occurs with exertion of the same type. The complaint is commonly stated as pain that is associated with walking a certain distance, relieved by a short period of rest, and recurs with walking the same distance. The pain may occur sooner when walking up an incline.  

This is known as claudication; exercise induced pain that is relieved by rest and reproducible with the same level of exertion. The distance walked, or level of exertion, varies from patient to patient. It ranges from minor intermittent claudication which has no measurable impact on lifestyle to disabling claudication which prevents one from participating in activities that they not only enjoy but that they require for daily living. In some cases if the causative factors for arterial disease are not controlled this will progress to rest pain, tissue loss, and in some cases limb loss.

Leg pain may also be caused by poorly functioning veins. This is often accompanied by leg swelling and varicose veins. The veins carry blood back to the heart. The veins, unlike the arteries are very compliant and depend on the left over pressure from the arterial transport of blood across the capillary beds to move blood back towards the heart. The veins have valves within them that prevent the reversal of blood flow in the veins and the pooling of blood. When these valves fail, pooling of blood occurs and leg swelling results. Typically, the leg swelling will resolve or dissappear after a nights sleep with legs elevated and worsen throughout the day. The range of disease may range from nuisance leg swelling to unsightly varicose veins and even skin ulcers. Leg swelling, like leg pain, also has many causes and not all of them are related to vein failure. Varicose veins aren’t just about cosmetic appearrance although this is what most people think of when they hear about veins.