Leg Pain Evaluation
Leg pain is a common condition that afflicts many men and women of all ages. It may occur acutely or maybe a more chronic condition. There are many causes of leg pain, but one of the common etiologies is poor circulation. There are many forms of artery and vein disease that can lead to chronic pain. We will discuss some of the more common circulation conditions that lead to pain. This includes several forms of arterial and venous diseases. The group of circulation conditions that can cause leg pain is referred to collectively as Peripheral Vascular Disease or PVD.
Leg Pain from Venous Insufficiency
Venous insufficiency, also known as venous reflux disease, can cause chronic pain in the legs. This condition results from abnormal vein valves within certain veins of the legs, usually the saphenous veins. This disease is most typically genetically inherited, but it can also be the result of vein trauma or blood clots. When venous insufficiency is present in the legs it leads to a buildup of excessive pressure within the vein of the legs, leading to venous hypertension. This pressure in turn causes the nerves within the vein walls to hurt. Venous reflux disease can lead to many types of leg pain symptoms, including achiness, cramping, burning, throbbing, or even sharp pain. This disease condition is easily identified with medical testing, typically with a non-invasive ultrasound study of the legs. This can be done in the doctor’s office. The condition is also typically curable with the use of either a special vein laser or vein radiofrequency treatment. Venous insufficiency treatments are usually performed within the doctor’s office under local anesthesia and involve very little discomfort.
Blood clots within the legs can also lead to the development of leg pain. Often the pain is of acute onset, occurring immediately after the clot begins to form. There are two types of blood clots that can form in the veins of the legs. One type of clot involves the more superficial veins of the legs and is referred to as superficial thrombophlebitis. The pain is usually of moderate severity, is superficially located, and is often associated with redness, tenderness, and induration of the skin overlying the clotted vein. This condition typically requires treatment by a doctor and therefore you should seek medical care if you have any acute onset of leg pain symptoms.
Another type of blood clot in the leg veins that can cause leg pain is called Deep Venous Thrombosis or DVT. This clot can cause deeper leg pain, diffuse leg pain, or no pain at all. In addition to leg pain, DVT can also be associated with leg swelling or foot swelling. DVT is a more dangerous form of blood clot since it can lead to a pulmonary embolism that can be lethal. A pulmonary embolism is a blood clot that breaks free and travels from the legs to the lungs. It can lead to sudden cardiac arrest with immediate death. There are often little to no symptoms when the clots first form and therefore DVT can often be a “silent” killer. If any unusual leg symptoms occur it is important to seek medical attention and get a D-dimer or vein ultrasound to assess for a possible blood clot in the legs. There are effective treatments for blood clots including blood thinners, compression stockings, vein filters, thrombolytic therapy, or a combination of these therapies.
Another serious form of blood clots in the legs that can cause pain in the legs is artery clots. Artery blood clots are a very serious condition that can lead to ulcers of the legs/feet, gangrene of the legs/feet, and even loss of the leg or foot (amputation). Artery clots can originate inside a normal artery, an artery aneurysm, near artery plaque, or originate in the heart and then float to the legs (and then lodging in the leg). Leg pain is usually the first symptom that one feels when an artery clot occurs. Artery blood clots can be identified with ultrasound, CT scans, MRI, and angiograms. Artery blood clots are considered an emergency medical problem and usually require an immediate surgical procedure.
Varicose Veins of the Legs
Varicose veins are blue bulging veins that are easily visible below the surface of the skin. They are often tortuous or serpentine in appearance and they tend to multiply and enlarge with time. Varicose veins are very commonly associated with symptoms of leg pain. The leg pain may be isolated to the area of visible varicose veins or can involve a larger area of the leg. Any area of the leg can be involved, although the lower legs are most commonly affected. Varicose veins can often be cured with office-based treatments. Over the past couple of decades, the treatments involved to cure varicose veins have become less invasive. Frequently utilized therapies for varicose veins include medications such as horse chestnut extract, compression stockings, laser therapy, radiofrequency therapy, ultrasound-guided sclerotherapy, and micro phlebectomy.
Leg Pain Secondary to Vein Inflammation
Vein inflammation often referred to as phlebitis, can also lead to acute or chronic leg discomfort. When the walls of the leg veins get inflamed, adjacent nerves within the leg often get irritated as a result. This leads to focal pain in the areas adjacent to the vein inflammation. Vein inflammation can result from trauma, surgery, diseased vein valves, blood clots, pregnancy, autoimmune conditions, and varicose veins. Even spider veins and reticular veins can cause chronic inflammation in the legs that leads to leg pain. One should seek out an assessment by a vein specialist if they suspect they may be suffering from leg pain as a result of vein disease.
Leg Pain Secondary to Peripheral Artery Disease / Atherosclerosis
Leg pain can also be the result of diseases of the circulation of the arteries of the legs. Arteries are very different than veins. Arteries deliver arterial blood down the legs, while veins return the blood back up the leg. Arteries are associated with different types of circulation diseases than veins. The most common disease of the arteries is peripheral artery disease, abbreviated PAD. This is also known by the common terms of “hardening of the arteries” or the medical term “atherosclerosis.” This is caused by a build-up of cholesterol and lipid plaque inside of arteries. This build-up of plaque can lead to narrowing of the arteries (known as arterial stenosis) or even complete occlusion of the vessels. One of the early signs of significant arterial disease is the development of leg pain. Leg pulses will be diminished when the significant arterial disease is present. Doctors often order ultrasound and blood pressure testing of the legs to assess for problems with leg arteries.
If you are interested in the assessment of your leg veins and leg arteries to see if they may be causing your leg pain, please contact our vein center at (512) 339-9100.