Leg pain: Types, causes, and treatment

Leg pain is a common symptom that can arise from musculoskeletal, vascular, or neurological causes. Identifying the underlying reason is crucial, as treatment varies depending on whether the pain originates from circulatory problems, nerve compression, or joint disorders.

Vascular causes of leg pain include peripheral artery disease and varicose veins, which can limit blood flow and cause cramping or heaviness. Early diagnosis prevents progression and reduces the risk of severe complications such as ulcers or tissue loss.

Neurological causes, such as sciatica, occur due to nerve compression or irritation. Pain often radiates from the lower back to the leg, and management may involve physiotherapy, medication, or interventional procedures to relieve nerve pressure.

Musculoskeletal causes include arthritis, muscle strain, or trauma. Treatment typically involves rest, anti-inflammatory medications, and physiotherapy. Accurate diagnosis ensures that therapy targets the exact cause, improving recovery and preventing recurrence.

Common Symptoms	– Constant or intermittent pain- Cramping, burning, stinging, tingling sensation- Pain that increases or decreases with movement- Swelling, redness, increased temperature
Causes	– Muscle strain or tear- Vascular diseases (varicose veins, deep vein thrombosis, peripheral artery disease)- Nerve compression (herniated disc, etc.)- Joint diseases (arthritis, rheumatism)- Bone fractures or trauma- Infections
Risk Factors	– Sedentary lifestyle- Obesity- Prolonged standing- Diabetes- Old age- History of circulatory disorders
Complications	– Limitation of mobility – Development of chronic pain – Wound, ulcer formation (in vascular diseases) – Muscle or nerve loss (in progressive cases)
Diagnostic Methods	– Physical examination- Doppler ultrasound- Magnetic resonance imaging (MRI)- X-ray- Blood tests
Treatment Methods	– Treatment for the underlying cause – Painkillers and muscle relaxants – Physiotherapy and exercise – Compression stockings (for varicose veins) – Surgical intervention (if necessary)
Prevention Methods	– Regular exercise- Weight control- Choosing appropriate footwear- Avoiding long periods of inactivity- Muscle strengthening exercises

What Causes and Types of Leg Pain?

Leg pain is not a single type; it manifests itself in different ways depending on its source. Careful observation of the characteristics of your pain will be very helpful in making the correct diagnosis. if you suffer from “persistent leg pain”, the character of the pain is the most valuable clue to understand the underlying cause.

Possible sources of pain are:

• Arterial origin (Arterial)
• Vein origin (Venous)
• Nerve origin (Neurogenic)
• Musculoskeletal origin

What are the Symptoms of Arterial Leg Pain?

Arteries are “nourishing” vessels that carry clean, oxygen-rich blood from the heart to the tissues. When there is a narrowing or blockage in these vessels, the tissues do not receive enough nutrition and this causes pain. There are two most typical forms of this pain:

The first is exertional pain (intermittent claudication), also known as “window disease”. Because of the stenosis in your blood vessels, your muscles do not receive enough blood when you need to exert yourself, such as walking. Symptoms of this condition are:

• Pain or cramping that occurs after a certain distance after starting to walk
• Pain is usually felt in the calf, thigh or buttock muscles
• Complete passage within a few minutes when rinsed to rest
• Repetition at about the same walking distance each time

The second is rest pain, which is much more serious. This manifests itself as “leg pain when lying down” and is a sign that the disease is progressing. The blood flow in the legs is so reduced that the muscles do not receive enough oxygen even at rest.

Typical symptoms of this condition are as follows:

• Pain that usually occurs at night
• Pain is felt in the toes or the back of the foot
• Constant, gnawing and disturbing in character
• Temporary relief when the leg is lowered from the bed

This kind of pain can be a precursor to critical leg ischemia, which requires urgent medical attention.

How does leg pain from veins manifest itself?

Veins are “collector” vessels that carry dirty blood that has been used in the tissues back to the heart. Problems in these veins are often related to blood pooling and pooling in the legs.

Acute Deep Vein Thrombosis (DVT) is when one of these veins is suddenly blocked by a clot. it is one of the most common causes of “one-sided leg pain” and swelling. Symptoms start suddenly and include

• Marked swelling of the affected leg, usually in the calf
• Pain or tenderness
• Redness or bruising of the skin
• Increased temperature in the leg

Chronic venous insufficiency (CRF) is a condition in which the vein valves do not function properly and blood is constantly pooled in the legs. This is also the main cause of varicose veins. Patients’ complaints usually increase towards the end of the day.

Typical complaints include:

• Feeling of heaviness and fullness in the legs
• Increased swelling towards evening (edema)
• Itching and cramps
• Discoloration of the ankles (brown spots)
• Non-healing wounds in advanced stages (venous ulcer)

How does nerve-induced leg pain differ?

The most common cause of this type of pain is a narrowing of the spinal canal in the lower back (lumbar spinal stenosis), resulting in pinched nerves. This is often confused with pain from a blocked blood vessel, but there are important differences:

The characteristics of pain due to nerve compression are as follows:

• Triggered not only by walking but also by standing for a long time
• Pain starting in the lower back or buttocks and radiating down the legs
• Pain is often accompanied by numbness, tingling and weakness

It is not enough to simply stand still to rest; changes in position such as sitting, squatting or leaning forward are required

How to Distinguish Between Vascular Occlusion and Lumbar Hernia Pain?

The most important distinction in patients presenting with leg pain with walking is whether the problem is caused by blood vessels or a pinched nerve in the lower back. This distinction is vital as it requires completely different treatment options. The patient’s history is the most valuable guide in making this distinction.

For example, a condition known as the “shopping cart sign” is very typical of a pinched nerve. When the patient leans forward into the shopping cart at the grocery store, he or she notices that the pain is reduced or absent. This is because leaning forward widens the spinal canal slightly, relieving pressure on the nerves. For a patient with a blocked artery, bending forward is of no use; the pain will only go away when they stop walking.

The main differences that distinguish the two situations are as follows:

Pain Triggering Condition

Vascular Occlusion: Muscle effort, such as walking a certain distance.

Nerve Compression: Standing for long periods of time as well as walking.

Pain Relief Condition

Vascular occlusion Resting for a few minutes standing or sitting, regardless of position.

Nerve Compression: Relaxation only by changing position; sitting, leaning forward or squatting.

Location and Distribution of Pain

Vascular occlusion: The pain is limited to muscle groups with reduced blood supply (e.g. only the calf).

Nerve Compression: The pain usually starts in the lower back or buttocks and radiates downwards along the back of the leg.

Accompanying Symptoms

Vascular occlusion: Usually just cramps or a feeling of tiredness.

Nerve Compression: In addition to pain, numbness, tingling, pins and needles and weakness.

What’s Waiting for Me at the Doctor for Leg Pain?

When you consult a physician with a complaint of leg pain, a systematic pathway is followed to reach a diagnosis. This process starts with your story, continues with a physical examination and ends with further tests if necessary.

The first step is to take a detailed history, followed by a physical examination to look for some objective evidence.

What is looked for in a physical examination?

• Checking arterial pulses in the legs (groin, behind the knee, foot)
• Whether there is a difference in color or temperature between the two legs
• Findings such as shine, thinning or hair loss on the skin of the legs
• Thickening of the nails or fungal infection
• Presence of non-healing wounds or ulcers
• Presence of varicose veins or capillaries
• Whether there is swelling (edema) in the legs and whether it is unilateral or bilateral

After the examination, some simple and painless tests are used to clarify the diagnosis. The most important of these is the Ankle-Arm Index (ABI). In this test, a sphygmomanometer and a small Doppler device are used to measure the blood pressures in the arm and ankle and compare them. This ratio gives valuable information about how much blood is flowing to your legs. The normal value is between 1.0 and 1.3. 0.a value below 9% diagnoses vascular occlusion (peripheral arterial disease).

Because this test can be misleading in people with calcification of the vessel wall, such as diabetics, more sensitive tests such as the Toe-to-Tibia Index (TBI) are sometimes required.

If a problem is detected in these basic tests or if a condition such as DVT is suspected, Color Doppler Ultrasonography comes into play. This is a harmless and highly informative method that uses sound waves to visualize the inside of the veins and blood flow. When a more detailed roadmap for treatment planning is required, advanced imaging modalities such as Computed Tomographic Angiography (CTA) or Magnetic Resonance Angiography (MRA) may be used.

Which Risk Factors Are Prominent in Arterial Diseases?

The main cause of peripheral arterial disease (PAD) is atherosclerosis, also known as arteriosclerosis. You can think of this process as the build-up of fat, cholesterol and calcium on the inner surface of the vessel wall over time, forming plaques and narrowing the vessel. Just as an old water pipe builds up limescale and rusts over time, the blood vessels become narrowed by these plaques and blood flow becomes difficult.

There are some important factors that accelerate this process and increase the risk of the disease occurring:

• Smoking (the most important of all risk factors)
• Diabetes (diabetes)
• Hypertension (high blood pressure)
• Dyslipidemia (high blood fats and cholesterol)
• Advanced age
• Family history of cardiovascular disease
• Chronic renal failure
• Sedentary lifestyle

What are the treatment options for walking pain (claudication)?

In the early stages, when the disease only causes walking pain, treatment is primarily focused on lifestyle changes and medication. The aim is both to improve quality of life by increasing walking distance and to prevent more serious problems such as heart attack and stroke by stopping the progression of underlying atherosclerosis.

Treatment approaches at this stage include

Absolute Smoking Cessation: It is the most effective step in treatment.

Regular Exercise: based on the principle “the vein feeds the vein”, regular walking programs promote the development of new capillaries (collaterals) and increase the pain-free walking distance.

Drug Therapy: Blood thinners (antiplatelet drugs) and cholesterol-lowering statin drugs slow the progression of plaques and reduce the risk of clots.

Control of Underlying Diseases: It is essential to keep blood pressure and blood sugar at ideal levels.

If, despite these treatments, the patient’s symptoms severely interfere with their daily life (e.g. commuting to work, shopping), then interventional methods to open the vessels are considered.

Which interventional methods are used to open leg veins?

Interventional therapies aim to physically open the stenosis or blockage by entering the vessel. Today, most of these procedures are performed with endovascular methods known as “non-surgical”. These methods are usually performed through a small needle puncture in the groin, accompanied by angiography.

The main endovascular techniques used are as follows:

Balloon Angioplasty: A balloon is sent through a catheter into the narrowed area and inflated to open the stenosis.

Stenting: A metal cage (stent) is inserted into the vessel wall to provide support to prevent the area opened by the balloon from closing again.

Drug Coated Balloons and Stents: The use of balloons or stents coated with special medicines to reduce the risk of re-narrowing.

Atherectomy (Vascular Shaving): These are special devices that are used to open especially very hard and calcareous plaques and clean the plaque by shaving or chiseling.

These methods are less invasive than open surgery, hospitalization is shorter and recovery is faster. However, not all patients and vascular structures may be suitable for these methods. Open surgery (bypass) may still be the best option for very long and widespread blockages or in cases where these methods fail. In bypass surgery, a new blood pathway is created between before and after the blocked area, usually using a vein from the patient’s own leg or an artificial vein.

Why is Sudden and Severe Leg Pain an Emergency?

Acute Leg Ischemia, a sudden blockage of the leg artery, is one of the most urgent conditions in vascular surgery. The blood supply to the leg is suddenly cut off and tissues begin to die rapidly. This situation carries the risk of “leg loss within hours”. This can be caused by a clot from the heart or a clot forming on an existing stenosis.

there are classic symptoms known as the “6 P’s” and if any of these symptoms are present, an emergency room should be contacted immediately:

Pain: Very sudden and severe onset of pain.

Pallor (Pallor): The color of the leg becomes white like wax.

Pulselessness: Failure to obtain pulses below the level of obstruction.

Poikilothermia (coldness): The leg is noticeably colder than the other leg.

Paresthesia (Loss of Sensation): Numbness and sensation starts to disappear.

Paralysis (paralysis): The inability to move the leg is the last and most dangerous symptom.

In this case, time is tissue. If the blocked vessel is not opened within the first 6 hours, irreversible damage to the nerves and muscles in the leg will occur. Treatment consists of dissolving the clot with angiographic methods or surgical removal of the clot.

What Conditions Increase the Risk of Deep Vein Thrombosis (DVT)?

Deep vein thrombosis (DVT) is the formation of a clot in the deep veins of the legs, and the greatest danger is that the clot can break off and travel to the lungs, causing a pulmonary embolism. Some conditions significantly increase the risk of DVT.

These risk factors are:

• Major surgeries (especially hip and knee replacement, cancer surgery)
• Prolonged bed rest or inactivity
• Long plane or bus journeys
• Cancer and chemotherapy
• Pregnancy and puerperium
• Birth control pills or hormone treatments
• Inherited coagulation disorders (thrombophilia)
• Obesity
• Advanced age
• Previous history of DVT

If you have one or more of these risk factors, you should consult a doctor, especially if you notice “left leg pain” or “unilateral leg pain” with swelling and redness. The mainstay of treatment is blood-thinning medication, which prevents the clot from growing and throwing itself into the lung. The duration of treatment can vary from 3 months to a lifetime, depending on the cause of the DVT.

What is Good for Chronic Venous Insufficiency and Varicose Veins?

Chronic venous insufficiency is a condition in which the veins are unable to transport blood to the heart effectively against gravity. When the valves fail, blood escapes backwards (reflux) and pools in the legs. This is the main cause of varicose veins, swelling, pain and, in advanced stages, skin changes and sores. the answer to the question “what is good for leg pain” in this disease is methods to reduce ponding.

Methods that can be applied to improve quality of life and reduce complaints include the following:

Compression (Pressure) Therapy: Compression stockings with appropriate pressure are the cornerstone of treatment. It prevents blood from pooling by applying pressure from the outside.

Elevation: Raising the legs above the level of the heart during the day and at night when lying down reduces swelling and pain.

Exercise: Exercises that work the muscle pump in the calf, such as walking and swimming, help blood circulation.

Weight Control: Excess weight increases venous pressure in the legs.

Avoid standing or sitting for long periods of time: If this is not possible, it is important to take small breaks every hour and keep moving.

If the symptoms are caused by a valve leak in a large superficial vein (saphenous vein), modern treatments to close this vein can offer a permanent solution. Using thermal methods such as laser (EVLA), radiofrequency (RFA) or chemical methods such as foam sclerotherapy, this problematic vein is canceled and blood is redirected to healthy veins. These procedures provide a dramatic improvement in the patient’s symptoms.