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ULY CLINIC

11 Septemba 2025, 08:30:25

Leg pain

Leg pain is a common symptom that may arise from musculoskeletal, vascular, or neurologic disorders. It can present as sudden or gradual, localized or diffuse, and may be constant or intermittent. Pain descriptors include dull, burning, sharp, shooting, or tingling, potentially limiting weight-bearing and mobility.

Severe leg pain may signal limb-threatening emergencies, such as compartment syndrome or acute arterial occlusion, requiring immediate attention.

History & Symptom Assessment

Ask the patient about onset, duration, intensity, character, and pattern of pain.
Determine if pain is worse in the morning, at night, or with movement.
Assess impact on mobility, including the use of assistive devices.
Review history of leg injury, surgery, or family history of joint, vascular, or back disorders.
Document medications and prior responses to treatment.

Physical examination

Observation
- Inspect leg position while standing and sitting
- Look for swelling, ecchymosis, deformities, or abnormal rotation
Palpation
- Assess tenderness, temperature, distal pulses, and capillary refill
- Check buttocks, lower back, hip, knee, and calf
Range of Motion & Neurologic Assessment
- Evaluate active and passive ROM in hip and knee
- Assess reflexes, sensation, and muscle strength
- Check neurovascular status, especially with casts or restrictive dressings

Medical causes

Causes of leg pain – Detailed Table

Cause	Onset/Pattern	Pain Characteristics	Associated Findings / Special Features	Emergency Concern
Bone Cancer	Gradual	Continuous, deep, worse at night	Swelling, palpable mass, impaired mobility	May indicate underlying malignancy
Compartment Syndrome	Acute, progressive	Severe, increases with passive stretch	Muscle weakness, paresthesia, initially normal distal pulses, late absent pulse	Limb-threatening; surgical emergency
Fracture	Acute	Severe, localized	Swelling, ecchymosis, deformity, impaired distal neurovascular status	May require urgent immobilization or surgery
Infection (Soft tissue/Bone)	Acute/subacute	Local pain, erythema, warmth	Swelling, streaking, fever, tachycardia	Risk of sepsis; may need IV antibiotics
Occlusive Vascular Disease	Gradual	Cramping, worse with walking (claudication)	Cold feet, numbness, tingling, absent pulses, prolonged capillary refill	Risk of ischemia, may need vascular intervention
Sciatica	Variable	Shooting, aching, tingling	Pain radiates along sciatic nerve; worsens with activity	Usually non-emergent, but severe motor deficit may need urgent imaging
Strain / Sprain	Acute or chronic	Sharp (strain) or dull (sprain)	Swelling, tenderness, ecchymosis, reduced ROM	Usually non-emergent; severe loss of function may need imaging
Thrombophlebitis	Acute	Calf tenderness, heaviness	Swelling, warmth, positive Homans’ sign, engorged superficial veins, fever	Risk of DVT; may require anticoagulation
Varicose Veins	Gradual	Aching, heaviness, nocturnal cramps	Orthostatic edema, stasis pigmentation, nodules; more common in women	Usually chronic; rarely emergent
Venous Stasis Ulcer	Chronic	Localized pain	Bleeding, mottled bluish skin, edema, infected ulceration	Chronic wound care needed; risk of infection

Emergency interventions

Acute leg pain with trauma: check vital signs and neurovascular status
Distal circulation: observe for pallor, pulselessness, or cool skin
Immobilization: use sandbags, ice, skeletal traction if fracture suspected
Prepare for X-rays, lab tests, venography, Doppler ultrasound, plethysmography, or angiography
Withhold food, fluids, and analgesics until preliminary diagnosis
Administer anticoagulants or antibiotics as indicated

Patient counseling

Explain proper use of anti-inflammatory drugs, ROM exercises, and assistive devices
Emphasize physical therapy, lifestyle modifications, and prevention of recurrent injury
Educate on warning signs that require urgent medical attention

Pediatric pointers

Common causes: fracture, osteomyelitis, bone cancer
Consider child abuse if explanation for injury is inadequate

Summary

Leg pain may arise from musculoskeletal, vascular, or neurologic disorders, ranging from mild strains to limb-threatening emergencies. Early recognition, thorough assessment, and timely intervention are critical to prevent permanent disability or systemic complications.

References

Konstantinou, K., Hider, S. L., Jordan, J. L., Lewis, M., Dunn, K. M., & Hay, E. M. (2013). The impact of low back-related leg pain on outcomes as compared with low back pain alone: A systematic review of the literature. Clinical Journal of Pain, 29(7), 644–654.
Schafer, A., Hall, T., & Briffa, K. (2009). Classification of low back-related leg pain—A proposed patho-mechanism-based approach. Manual Therapy, 14(2), 222–230.