Common question from my patients - "Doc, why do my legs hurt when I walk?". Legs are pretty simple to diagnose - there are essentially five categories of major structures in your legs - bone, nerve, muscle, artery, and veins. Lets describe each one, and what they do, as well as what problems they can cause.
1. Bones make up the skeleton that supports your body - bones can become brittle and break, they can become inflamed and develop bone spurs. And they can rub against each other inside joints, get inflamed, and cause pain, which we call arthritis. Arthritis does indeed cause leg pain on walking, but the pain is localized in the bones and joints of the legs, rather than the muscles of the legs.
2. Nerves deliver signals to muscles from the brain. In diabetes, the longest nerves are the most susceptible to injury. When this happens, patients can lose the function of that muscle, such as in a "foot drop" or in a stroke. Nerves tell the brain when the skin touches something - loss of these nerves affects our ability to detect when something is touching our skin. This can allow us to get burned by a hot object, cut by a sharp object, or injured by a cold object, without knowing that it is happening. Nerve disease is given the broad term "neuropathy" and the most common cause is diabetes. Prevention is the key, because there is no cure. nerve pain does not require exercise to occur, and happens frequently at rest.
3. Muscle injury pain is uncommon, and can happen due to certain medications (statin cholesterol meds), severe dehydration, and situations where a person falls and cannot get up - the simple act of lying on a hard surface for a prolonged period of time can cause muscle injury, called myopathy. A good history by your physician should identify this cause readily.
4. Veins are blood vessels that deliver oxygen-deprived blood from the extremity (in this case, the feet and legs) back to the heart. Veins have one way turnstiles, called valves, that prevent blood from pooling at the feet. When these valves fail, the blood does just that - it pools at the feet and ankles, causing the vein to stretch out, and swell even more. then as the pressure builds in the vein, it leaks out into the leg, causing swelling, eventually causing the skin of the leg to turn dark, and scaly, eventually leading to ulcers of the skin. this skin change is called venous stasis changes (changes that occur from blood pooling). Pain from this condition happens mostly at rest, when standing, or sitting with legs hanging down, at night. These patients have restless legs at night, and may develop severe leg cramps at night also. Conservative treatment should be attempted first, before we perform a procedure on the legs. Conservative treatment consists of elevation of the legs above the level of the heart, exercise daily, and wearing compression hose. If conservative treatment does not improve the symptoms, then we can treat this condition with a minor procedure, and improve the swelling, the cramps, the restless legs, and the pain. This can be accomplished in the office, without an operation, and without a hospital stay. After the procedure, patients go home and resume their lifestyle with minimal interruption.
5. Arteries are blood vessels that deliver oxygen-rich blood to the extremities, in this case, the legs and feet. When these arteries get built up with plaque and calcium, the inside diameter of the artery gets smaller, and it cannot deliver sufficient blood. When the supply of oxygen-rich blood is unable to keep up with the demand, then leg pain occurs. Since this typically occurs on demand, the pain occurs in the muscles of the legs, on exertion - climbing stairs, carrying something heavy, performing work, or walking a long distance. This is "angina for your legs" and it develops slowly, lingers for a few minutes until you stop the activity, and then eases off slowly. Sharp pain in the legs is not usually artery pain. We recommend blood thinners and exercise for people who have this condition. We can measure the severity of the blockage easily with a blood pressure cuff and a stethoscope - the test is called Ankle-Brachial Index, and gives us a good idea if there is adequate circulation in the arteries of the legs. If we find that the blood flow is poor, we can open the arteries with a stent, and even use a grinding tool like a Dremel to shave away the plaque from the inside of the artery. Afterwards, we use a blood thinner to keep the blood from sticking to the stent, and encourage exercise, and quitting smoking. Control of diabetes can also help slow down the progression of this condition. If the condition goes untreated, it can become too severe to put a stent into, and then will require a vascular surgeon to do a bypass procedure of the blocked leg artery. In the worst cases, amputation becomes necessary. Obviously we do everything in our power to try to get the condition treated before it gets to that point, but in some cases, the patient may not come to us until he has developed gangrene, and then it is too late. Moral of the story - see your doctor as soon as symptoms develop - so we can address the problem before it is too late.
What can you do to prevent it? Quit smoking, exercise, maintain a healthy weight, avoid cholesterol and fried foods, take your cholesterol medication, and control your blood pressure. Control of your blood sugar goes a long way to delaying this process in the legs.
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