Leg ache – causes and symptoms
Many people are bothered by painful aching legs. Although many of the causes of this problem are not serious, it is important to seek medical advice if your legs frequently give you pain or if you have some of the symptoms below.
Symptoms of leg pain
There are signs and symptoms of leg pain that can help your doctor find the cause. Features such as whether the pain is constant or intermittent. Did it come on suddenly? Where does it hurt? What does the pain feel like – is it a stabbing pain, a dull ache, a tingling sensation? Does the pain come on with walking or exercise? Is the pain associated with an increase in activity such as exercise? Is it worse at night?
When should I seek immediate medical attention?
There are some features of leg pain or leg ache that should cause you to seek immediate medical attention, such as:
- if you have redness, swelling or warmth in your calf
- If your leg is pale, swollen and abnormally cool
- If you have calf pain after sitting for a long time, such as on a plane or train journey
- If you can’t weight bear on your leg and are unable to walk
- If the pain is persistent or getting worse
- If you have a fever
- If you have swelling in both legs
Causes of leg pain
There are many causes of leg pain, including:
Muscle cramps are uncontrollable, painful contractions of muscles. The calf muscles are a common group of muscles to be affected. The affected muscle will feel like it has balled up, and you may feel a lump. They may be associated with overuse or dehydration, and can usually be relieved by stretching out the affected muscle. Leg cramps commonly occur at night, often after exercise.
Muscle strains, tendonitis, and shin splints
Injuries to the muscles, such as muscle strains when muscle fibres tear, are a common cause of leg pain. The muscles in the leg commonly affected are quadriceps, hamstrings and calves. Sports injuries are a common cause of muscle injuries.
Tendonitis is another common cause of leg pain and can affect the Achilles tendon (Achilles tendonitis or the medial tibial tendon (causing shin pain or ‘shin splints’). Compartment syndrome causes lower leg pain or calf pain, accompanied by burning or tingling sensations. The pain of compartment syndrome can increase on activity, to the point the person may have to stop exercising.
Stress fractures are small fractures (cracks) in the bone, often caused by overuse. The pain of stress fractures usually gets worse during exercise and goes away or decreases on rest.
Deep vein thrombosis (DVT)
Deep vein thrombosis happens when a blood clot forms in a vein deep within the body – often in the calf. It can result in a blood clot travelling to your lung and causing a pulmonary embolism. DVT is a serious cause of leg pain that needs immediate medical attention. Symptoms include swelling, redness and pain, with the leg feeling warm to the touch.
Varicose veins are enlarged, twisted and swollen veins, often found in the legs. They are blue or dark purple in colour. Symptoms of varicose veins are a heavy feeling and dull ache in your legs; possibly there may be cramping. The skin may feel irritated.
One of the more serious causes of leg pain is intermittent claudication. This is due to narrowing of the arteries in the leg, known as peripheral vascular disease or PVD, and occurs during exercise, such as walking.
When the leg muscles are being used, they require increased oxygen. If the arteries are narrowed, not enough blood — necessary to provide the oxygen — gets to the muscles, resulting in pain.
People with claudication find that they can walk only a certain distance before leg pain forces them to stop for a rest. After a few minutes, they can usually carry on for a while until the next attack.
Claudication is more common in smokers, overweight people, people who have diabetes, and people with high blood pressure and increased cholesterol in the blood.
If ignored, the poor circulation can lead to leg ulcers and even gangrene, meaning the possible amputation of toes or feet.
When claudication is suspected, various tests can determine the degree and site of any narrowing of the arteries. Surgical treatment can sometimes help improve the situation, but equally important are lifestyle changes such as stopping smoking, a graduated exercise programme and losing weight.
As well as being important in its own right, claudication caused by PVD can alert your doctor that you may have problems with narrowing of other important blood vessels such as those supplying your heart or brain.
Restless legs syndrome
Restless legs syndrome is characterised by discomfort and an urge to move the legs. The other symptoms are variable, but include pain in the legs, and are usually worse at night.
Cellulitis is a bacterial infection that commonly affects the skin of the lower leg. It is a dangerous infection which requires immediate treatment with appropriate antibiotics. The skin feels warm to the touch and may feel swollen and tight. If you experience fevers or chills, you should get emergency medical help immediately.
Gout is caused by a build-up of uric acid in the blood, which then forms crystals in the joints. It affects the big toe joint commonly, but can also cause pain in the knee and ankle joints.
Sciatica is a type of nerve pain, which results in pain radiating down the leg along the path of the sciatic nerve. It is usually only present in one leg at a time. The pain may feel like a tingling or a pins and needles sensation. Sciatica is often caused by a herniated disc in the spine compressing the sciatic nerve.
Damage to the nerves in the feet or lower leg is a possible complication of diabetes and is known as diabetic neuropathy. It can cause tingling or burning sensations, pain in the lower leg and feet, numbness and sensitivity to touch.
Tests and diagnosis
There is no one specific test to diagnose the cause of leg ache or pain. Depending on your symptoms and a physical examination of your leg(s), your doctor will decide whether you need any tests, such as imaging tests.
Treatment for leg pain
Treatment for leg pain depends on what is causing your pain. For minor leg pain that is the result of sports injuries or overuse injuries, you may be able to treat this at home. Sports Medicine Australia recommends the RICER protocol (rest, ice, compression, elevation of your leg and referral), although there is now debate around the use of ice in soft tissue injuries. Over the counter pain relief, such as paracetamol or NSAIDs, may be helpful.
If your leg pain is the result of vascular disease (circulation problems), your doctor may suggest lifestyle measures to reduce your risk of heart disease and stroke, in combination with medications to control your blood pressure or cholesterol, if appropriate.
Leg cramps usually respond to stretching.
Prevention of leg pain
Leg pain due to overuse injuries or sports injuries may be avoided by warming up before activity and stretching afterwards. Make sure you don’t increase the intensity or duration of your activity too quickly.
Leg pain caused by circulation problems may be avoided by getting enough regular exercise, maintaining a healthy weight, not smoking, and other lifestyle measures. Be sure to keep your blood pressure, blood sugar and cholesterol under control.
What doctor should I see for leg pain?
Your GP should be able to help diagnose the cause of your leg pain and suggest appropriate treatment. Depending on the cause, other healthcare professionals who may be involved in your care include sports physicians, sports podiatrists, physiotherapists or medical specialists.
Last Reviewed: 06/02/2020
1. Therapeutic Guidelines. Restless legs syndrome and periodic limb movements of sleep/wakefulness. Published November 2017. © Therapeutic Guidelines Ltd (eTG December 2019 edition)
2. Therapeutic Guidelines. Peripheral arterial disease. Intermittent claudication. Published March 2018. © Therapeutic Guidelines Ltd (eTG December 2019 edition) https://tgldcdp.tg.org.au/viewTopic?topicfile=peripheral-artery-disease&guidelineName=Cardiovascular#toc_d1e59
3. Sports Medicine Australia. Shin pain. https://sma.org.au/resources-advice/injury-fact-sheets/shin-pain/
4. Sports Medicine Australia. Soft tissue injuries. https://sma.org.au/resources-advice/injury-fact-sheets/soft-tissue-injuries/
5. RACGP. Dr Evelyn Lewin. Is it time to rethink RICE for soft-tissue injuries? 15 October 2019. https://www1.racgp.org.au/newsgp/clinical/is-it-time-to-rethink-rice-for-soft-tissue-injurie