Book menuACHING LEGS - Full extract 

Aching legs is a very common symptom. Although more common in the elderly, it can affect people of any age. Because an underlying medical problem may be responsible, it is important to carefully establish the cause of the discomfort.

  • A detailed history is the best starting point.
  • Does the aching affect one or both legs?
  • Has the leg been hot or swollen? Has the ache come on suddenly ?
  • Is it localized to a joint like the knee or ankle?
  • Does it come on with walking?
  • Does it keep the person awake at night?
  • Has there been an injury to the leg?
  • Are there any other symptoms like back pain?
  • What about the person's general health?

The answers to these questions give the doctor a fairly good idea of the cause of the aching legs even before examining the patient.  After a general examination the doctor then has a close look at the legs. Of special interest is whether they are swollen or inflamed. Sometimes they can look dusky or pale. The warmth of the legs is also felt. They are then inspected to see whether there are any varicose veins. The pulses are also checked to see whether the arteries are normal. The joints are examined and the person might be observed walking. By this stage the cause of the leg pain is usually evident.

The treatment of the aching legs depends on the underlying cause. If there is any doubt about the diagnosis, X-rays and other tests may be required. 

There are numerous causes of aching legs. Here are just a few...

Vascular disease in the legs  usually causes pain that comes on with walking and goes away with rest. The feet may also feel cool. Pain that occurs at rest requires urgent specialist assessment, in case an artery has become completely blocked.

Varicose veins The legs may swell and ache after being on them for several hours. There may be also be some varicose eczema, pigmentation and leg ulcers. Sometimes the superficial veins can become very tender and inflamed.

Thrombosis in a deep vein usually develops over a day or so. It tends to affect just one leg and may cause it to become swollen, warm and tender. An urgent check is essential because of the risk of a clot becoming dislodged and travelling to the lungs. Infection in a leg may cause  a similar appearance.

Osteoarthritis usually affects a particular joint like the hip or knee. The pain may occur at any time, for instance when the person goes to stand up after sitting for a while. X-rays help to confirm the diagnosis.

Sciatica is a very specific type of ache. It is a sharp pain that shoots down the back of the leg and may be associated with tingling or loss of sensation in the foot and lower leg. It is usually caused by a protruding disc in the lower back. CT scans and a specialist assessment may be required.

Muscle cramps are of various types and may follow heavy work or an injury to a leg. Recurrent muscle cramps that occur at night can be very distressing but are rarely due to vascular disease. The precise cause of cramps is not fully understood. Sometimes they are made worse by being on fluid tablets. Quinate tablets may help, and there are numerous home remedies of doubtful benefit. 

Restless leg syndrome is a poorly understood condition characterized by a burning jumpy discomfort in the legs at night, especially when the person is trying to go to sleep. Sometimes people find it necessary to get out of bed and walk around. There is usually nothing to find on examination. Various medications and alternative treatments like acupuncture may be of use. 

Health Tip
* The most important thing about aching legs is knowing the cause. Ask your doctor for advice.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001