Leg Pain (cont.)
Other Causes of Nontraumatic Leg Pain
- Joint pain: Joint pain may occur because of a local injury but may also be due to medical
conditions that can cause inflammation and swelling. Joint pain associated with
swelling is called arthritis (arth=joint+ it is=inflammation) while pain
without swelling is called arthralgia (arthr=joint + algia= pain). Some examples
include the following:
- Patients with progressive
osteoarthritis may have
which affected joints may hurt.
- Similarly, patients with
rheumatoid arthritis may have episodes of joint
inflammation when their disease flares.
- Exacerbations of gout can cause joints to become inflamed if uric
acid crystals start to deposit within the joint. It is often the joints
that are under significant workload that are affected. The joints in the
great toe are commonly involved, but the ankle, knee, wrist, and fingers are also common sites of uric acid
- Pseudogout can also cause joint inflammation. Instead
of uric acid, calcium
pyrophosphate crystals deposited in joints are the cause of this condition. The knee is often affected by pseudogout, and the diagnosis is sometimes made when calcification of the cartilage is seen on plain
X-rays of the knee joint (chondrocalcinosis).
- Systemic illnesses (there are too many to discuss in this article) may
also cause joint inflammation. Some common conditions that may cause joint pain
include systemic lupus
erythematosus (SLE), psoriasis, hepatitis,
bowel disease, and Lyme disease.
- Joints may become inflamed as part of the body's generalized reaction to an
infection. Infections may cause synovitis, or inflammation of the synovium (the
lining tissue of a joint). Most often it is due to a
virus, but in children,
there is always a concern that a bacterial
infection may be the cause.
- People who take warfarin (Coumadin), prasugrel (Effient), or enoxaparin (Lovenox)
for anticoagulation to thin their blood may spontaneously bleed into a joint or muscle, causing pain.
- Muscle pain: Muscle pain or
myalgia (myo=muscle +algia=pain)
is a common complaint and may
be due to overuse (mild trauma) or associated with the generalized aches and
pain of an infection.
- Muscle cramps: Muscles may cramp, causing significant pain. This may be due to a lack of
stretching or an imbalance of electrolytes in the bloodstream. The body needs to
have the right amount of calcium, sodium, and
potassium for muscles to function
well. Calf and foot muscles are particularly prone to cramping, especially at
- Muscles will also go into spasm to help protect an injured site. For example, when a hip bone is broken, the muscles that move the hip will go into spasm to help minimize movement of the injury.
- Heat cramps occur as part of the spectrum of heat-related illness due to dehydration and electrolyte imbalances. They may occur immediately after exercising or working in a hot environment or their onset may be delayed for a few hours. Often it is the large muscles of the legs that are involved because of the amount of work they are asked to do.
- Muscle injuries: The muscles in the leg tend to act in balance with each other to promote joint stability and act as shock absorbers for the forces that are generated by walking and running. The quadriceps muscles on the front of the thigh extend or straighten the knee and are balanced by the hamstring muscles in the back of the thigh responsible for flexing or bending the knee. If this balance is lost, the muscle fibers may become overstretched and tear. This is called a
- Hamstring injury: The hamstring (posterior thigh muscle group) is made up of a group of individual muscles known as the semitendinosus, the semimembranosus, and the biceps femoris. While the tendons can be felt at the back of the knee, the muscle originates and is anchored in the pelvis bone. When the muscle contracts, the knee bends and the leg is able to generate power to push the foot away from the ground so that the body can walk. Walking also requires the quadriceps muscles to fully extend the knee so that the heel of the foot can strike the ground and begin the footstep.
If the hamstring muscle tendon units are not flexible or if there is too much stretch placed on the structure, fibers may be damaged if the knee extends too much. Muscle or tendon fibers may be stretched or even torn, causing pain and swelling. To protect itself, the muscle may go into spasm, which may cause even more pain.
- Skin abnormalities: Skin abnormalities may cause pain. Lacerations and skin tears, ranging from
trauma to ulcers caused by poor blood flow, are among the causes of pain from
skin conditions. The skin has numerous nerve fibers that can sense pain, and
anything that damages the skin can cause pain.
- Leg pain in children: Leg pain in children is a special situation. While most leg pain in children
is not serious, there are times when the pain has a significant cause. These may
include a joint infection causing
hip pain, trauma
causing damage to growth plates, and pain due to systemic illnesses like
juvenile rheumatoid arthritis, or
"Growing pains" are most likely due to muscle overuse, although they may be
associated with a mild stretching as the muscles grow along with bone.
- Diabetes: Diabetes may cause leg pain in a variety of ways. If
blood sugar levels are
not well controlled over a period of many years, nerves and blood vessels
deteriorate and lose their function. Often the damage occurs in the feet. With
loss of sensation, skin infections and foot injuries may occur without the
affected person feeling much discomfort. Alternatively, the nerves may be so inflamed
that the patient feels intractable pain. Diabetes also causes blood vessels to
narrow and cause symptoms of PAD (peripheral artery disease) or claudication.
People with diabetes are also more prone to infection because of an impaired immune system, and with poor blood supply to the legs, the skin integrity and ability to heal itself is lost, increasing the risk of foot and leg infections.
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