Leg pain is a common symptom and complaint, often due to a cramp, injury, or other cause.A.D.A.M.

Common Causes

Leg pain can be due to a muscle cramp (also called a charley horse). Common causes of cramps include:

• Dehydration or low amounts of potassium, sodium, calcium, or magnesium in the blood
• Medications such as:

  • Diuretics, which can cause you to lose too much fluid or minerals
  • Statins, which lower cholesterol and can cause muscle injury
• Muscle fatigue or strain from overuse, too much exercise, or holding a muscle in the same position for a long time

An injury can also cause leg pain from:

• A torn or overstretched muscle (strain)
• Hairline crack in the bone (stress fracture)
• Inflamed tendon (tendinitis)Shin splints -- pain in the front of your leg due to overuse or repetitive pounding

Other common causes of leg pain include:

• Atherosclerosis that blocks blood flow in the arteries (this type of pain, called claudication, is generally felt when exercising or walking and is relieved by rest)
• Blood clot (deep vein thrombosis) from long-term bed rest
• Infection of the bone (osteomyelitis) or skin and soft tissue (cellulitis)
• Inflammation of the leg joints caused by arthritis or gout
• Nerve damage -- common in people with diabetes, smokers, and alcoholics (symptoms include numbness, tingling, or a sensation of pins-and-needles)
• Varicose veins

Less common causes include:

• Cancerous bone tumors (osteosarcoma, Ewing sarcoma)
• Drugs such as allopurinol and corticosteroids
• Legg-Calve-Perthes disease -- poor blood flow to the hip that may stop or slow the normal growth of the leg
• Noncancerous (benign) tumors or cysts of the femur or tibia (osteoid osteoma)
• Sciatic nerve pain (radiating pain down the leg) caused by a slipped disk in the back
• Slipped capital femoral epiphysis -- usually seen in boys and overweight children between ages 11 and 15

Home Care

If you have leg pain from cramps or overuse, take these steps first:

• Rest as much as possible.
• Elevate your leg.
• Apply ice for up to 15 minutes. Do this 4 times per day, more often for the first few days.
• Gently stretch and massage cramping muscles.
• Take over-the-counter pain medications like acetaminophen or ibuprofen.

For leg pain caused by varicose veins, elevate the leg and wear elastic bandages or support hose.

For leg pain caused by nerve disorders or claudication:

• Control diabetes
• Stop using alcohol and tobacco
• Wear well-fitting shoes

Call your health care provider if

Call your health care provider if:

• The painful leg is swollen or red
• You have a fever
• Your pain gets worse when you walk or exercise and improves with rest
• The leg is black and blue
• The leg is cold and pale
• You are on medications that may be causing leg pain. DO NOT stop taking or change any of your medicines without talking to your doctor.
• Self-care steps do not help

What to expect at your health care provider's office

Your health care provider will perform a physical examination, with careful attention to your legs, feet, thighs, hips, back, knees, and ankles.

To help diagnose the cause of the problem, your health care provider will ask medical history questions, such as:

• Where exactly is your pain?
• Do you have pain in one or both legs?
• How would you describe the pain? Dull and aching? Sharp and stabbing? Do you consider it to be severe?
• Is the pain worse at any time of day, like in the morning or at night?
• What makes the pain feel worse? For example, does exercise or long periods of standing worsen your pain?
• Does anything make your pain feel better, like elevating your legs?
• Do you have any other symptoms like numbness or tingling? Back pain? A fever? Weakness?

The following tests may be performed:

• Arteriogram to check blood flow
• Blood tests for specific diseases
• Bone biopsy if a tumor is seen on MRI that may be cancerous
• Bone scan
• Duplex Doppler/ultrasound exam to look for a blood clot
• MRI if a cancerous tumor is suspected
• X-ray of your back or legs

Treatment depends on the cause.

• Medications may include pain medicines, anti-inflammatory drugs (NSAIDs), anticoagulants (blood thinners) such as Coumadin if there is a blood clot.
• Cellulitis and osteomyelitis are treated with antibiotics. For osteomyelitis you will need to take antibiotics for a long period of time.

For some causes of leg pain, your health care provider may recommend physical therapy. If you have a blocked artery, inserting a balloon catheter into the artery may improve blood flow.

Prevention

To prevent claudication and nerve damage:

• Don't smoke or use tobacco.
• Limit how much alcohol you drink.
• Keep your blood sugar under good control if you have diabetes.
• Reduce other heart disease risk factors, including high cholesterol and high blood pressure.

To prevent overuse injuries, like shin splints, muscle cramps, and other causes of leg pain:

• Warm up before physical activity and cool down afterward. Be sure to stretch.
• Drink plenty of fluids throughout the day, especially before, during, and after exercise.

References

1. Silverstein JA, Moeller JL, Hutchinson MR. Common issues in orthopedics. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 30.
2. Bederka B, Amendola A. Leg pain and exertional compartment syndromes. In: DeLee JC, Drez D Jr., Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 24. Section B.
3. Ginsberg J. Peripheral venous disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 428.
4. Shy ME. Peripheral neuropathies. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 428.
5. White CJ. Atherosclerotic peripheral arterial disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 79.

Review Date: 8/15/2011.

Reviewed by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.