Symptoms of arthritis in the leg
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
Click here: Second Opinion Arthritis Treatment Kit
Pain in the legs is a common complaint or symptom of arthritis and other causes.
Common causes of leg discomfort include:
cramps from muscle fatigue, strain, injury or depletion of certain minerals such as potassium, calcium, sodium, and magnesium (particularly when taking diuretics)
simple muscle spasm or "charley horse"
overuse problems associated with strenuous exercise, often called shin splints
trouble with the veins (the vessels returning from the legs to the heart)
• veins develop blood clots (phlebitis)
• deep venous thrombosis
diseased arteries (the vessels bringing blood to the muscles of the leg)
• arteries become narrowed by arteriosclerosis
• arteries can be blocked by clotted blood fragments (thrombi)
injury to the joints in the leg
infection of the leg joints
inflammation of the leg joints (by arthritis or gout)
neuropathy (nerve damage)
• common in diabetics, smokers, and alcoholics
• pain or weakness is present in one or both legs
• numbness, tingling, or a pins-and-needles feeling may develop
infection (osteomyelitis, cellulitis, pelvic inflammatory disease, retroperitoneal inflammation)
slipped capital femoral epiphysis
Benign tumors or cysts of the femur or tibia ( Osteoid osteoma)
Malignant bone tumors ( Osteosarcoma, Ewing sarcoma)
drugs such as allopurinol and corticosteroids
For unexplained leg pain lasting less than 1 week, rest as much as possible. Elevate the leg and take over-the-counter pain medications. Gentle massage may improve comfort. If pain persists, call the health care provider.
Heat (warm soaks or a warm heating pad) or cool soaks may help improve comfort.
For leg pain caused by varicose veins, leg elevation, and compression with elastic bandages or support hose can help.
For leg pain caused by nerve disorders, control diabetes or eliminate alcohol and tobacco. Avoid tight-fitting shoes with pressure areas.
Call your physician if the leg pain persists or is rapidly worsening.
A careful medical history and physical examination needs to be performed.
Medical history questions documenting leg pain in detail may include:
• Is the pain in the back of the thigh, calf, or foot (posterior)?
• Is the pain on only one side (unilateral)?
• Does the pain seem to be associated with a vein near the surface of the body (superficial vein)?
• Is the pain in the tendon at the back of the heel (Achilles tendon)?
• Does the pain go into the top of the foot?
• Is the pain in the inner side of the thigh (medial thigh)?
• Do you have pain in your shin(s)?
• Is it severe?
• Is it dull and aching or sharp and stabbing?
• Is it a cramping pain?
• Is it worse in the morning or at night?
• Is it the same all the time?
• Is the pain worse after you exercise?
• Is the pain worse after you have been standing?
• Is the pain better after you elevate the legs?
• Is the pain better when you keep the feet down?
• What other symptoms are also present?
• Is there numbness or tingling?
• Is there back pain?
• Are there leg cramps?
• Is there a fever?
• Is there weakness or paralysis of the leg?
If the pain is relieved by elevating the legs, the problem may be phlebitis.
Leg pain caused by arterial problems tends to improve with the help of gravity when the feet are hanging down.
If the pain is accompanied by numbness and tingling, and it radiates from the hip or buttocks region down the leg, the problem might relate to the back.
The physical examination will include a detailed examination of the hip, leg, and feet, including the joints.
Diagnostic tests that may be performed include:
• Duplex Doppler/ultrasound exam of extremity
• X-ray of the back or extremities
• MRI if a malignant tumor is diagnosed and a CT of the lungs to rule out metastasis
• Bone biopsy if malignancy is suspected
• Bone scan
• Blood tests for specific diseases
• Arterial studies of the legs
Treatment depends on the cause. Medications may include pain medicines, anti-inflammatory analgesics - oral, anticoagulants ("blood thinners" such as Coumadin), and others. For some causes, insertion of a special tube (balloon catheter) into the artery may be advised.
If the pain is due to arthritis, then anti-inflammatory medication and physical therapy may be helpful.
In cases where there is obvious joint swelling, then aspiration of the fluid from the joint can aid in diagnosis and management.
Another consideration is the presence of leg ulcers. The presence of these in a patient with rheumatoid arthritis may indicate that the patient has a particularly severe form of disease called Felty’s syndrome.
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