Walking, often touted as a simple yet powerful exercise, can become a source of discomfort when leg pain interferes. If you find yourself asking, “Why Does My Leg Hurt when I walk?”, you’re not alone. While brisk walking is frequently recommended for maintaining good health, including cardiovascular fitness and mental well-being, leg pain can significantly hinder your ability to enjoy these benefits. It’s important to understand that leg pain during or after walking isn’t always just muscle soreness; it could be a symptom of underlying conditions.
As we age, and sometimes even earlier, various conditions can lead to leg pain that makes walking a challenge. Some of these conditions are well-known, like arthritis affecting the knees and hips. However, others, such as peripheral artery disease, might be less familiar but equally important to recognize.
This article will delve into four non-arthritic conditions that are common causes of leg pain, specifically focusing on pain experienced during walking. We will explore each condition, discuss potential treatments, and offer management strategies so you can address your leg pain and get back to enjoying pain-free walks.
Understanding Leg Pain: Common Conditions
It’s crucial to remember that while we discuss these conditions separately, it’s possible to experience two or more simultaneously. This overlap can make diagnosis and treatment more complex, highlighting the importance of seeking professional medical advice for persistent leg pain.
1. Peripheral Artery Disease (PAD)
Peripheral artery disease (PAD) is a type of atherosclerosis, a condition where arteries narrow due to plaque buildup. This is the same process that underlies most heart attacks and strokes. In PAD, the arteries most commonly affected are those supplying blood to the leg muscles. The risk factors for PAD mirror those for heart disease and stroke, including smoking, high cholesterol, high blood pressure, and particularly diabetes.
The hallmark symptom of PAD is intermittent claudication. This is characterized by cramping or a tight pain in the muscles “downstream” from the narrowed artery. While it can occur in the buttocks, thigh, calf, or foot, it’s most frequently felt in the calf. Typically, the pain emerges during walking, intensifies as you continue, and subsides with rest. Similar to angina (chest pain due to heart condition), the pain in PAD arises from oxygen deprivation in working muscle cells due to restricted blood flow.
Beyond intermittent claudication, individuals with PAD might experience other forms of leg discomfort. Legs may feel heavy or easily fatigued. Often, people unconsciously reduce their activity levels to avoid pain, which can mask the underlying problem and delay diagnosis.
Physical signs of PAD include a weakened pulse below the narrowed artery, slow-healing sores or bruises on the lower leg, and skin that feels cool and appears pale. Diagnosis often involves the ankle-brachial index (ABI), which compares blood pressure in your ankle to that in your arm. Normally, these pressures are similar. However, in PAD, the ankle pressure will be lower due to reduced blood flow.
| Image: Artery narrowing due to atherosclerosis restricts oxygen supply to leg muscles, causing pain. |
PAD is not only debilitating in itself but also serves as a serious warning sign for broader cardiovascular health. Having PAD significantly elevates the risk of heart attack, stroke, or transient ischemic attack (TIA). Therefore, a PAD diagnosis should prompt aggressive management of cardiovascular risk factors.
While walking might seem counterintuitive when it causes pain, structured exercise programs under medical supervision have proven effective in improving walking distance for people with PAD. These programs often involve a walk-rest-walk approach: walking until pain begins, resting until it subsides, and repeating. Sessions of about 30 minutes, several times a week, are generally recommended.
Medications also play a role in PAD management. Low-dose aspirin is often prescribed to lower the risk of heart attack and stroke. Clopidogrel (Plavix) is an alternative for those with aspirin allergies, working similarly to prevent blood clot formation. Cilostazol (Pletal) can help some individuals walk further with less pain.
In severe cases, PAD can cause rest pain, even when not walking, most commonly in the feet. In critical situations, it can lead to tissue death and gangrene. For serious PAD cases unresponsive to exercise and medication, procedures like angioplasty to reopen blocked arteries or bypass surgery to reroute blood flow might be considered. However, the long-term success of these procedures varies, and some studies suggest structured exercise programs can be equally or even more beneficial.
2. Chronic Venous Insufficiency (CVI)
Chronic venous insufficiency (CVI), similar to PAD, is a circulatory issue, but it involves the veins, affecting the return of blood to the heart and lungs. Arteries are elastic and actively propel blood, while veins rely more passively on surrounding muscles for blood flow, especially in the legs. Leg muscles act as pumps, draining surface veins and pushing blood through deeper veins towards the heart. Valves within the veins prevent backflow, maintaining unidirectional blood movement.
In CVI, these valves are damaged, causing blood to pool in the legs and feet instead of efficiently returning to the heart. This creates a cycle: valve malfunction increases blood pressure in the veins, causing them to stretch. Stretched veins further impair valve closure, leading to more backflow and increased pressure.
Swelling in the feet and ankles is the most common symptom of CVI. Fluid buildup can also cause skin inflammation (dermatitis), ulcers, and increased susceptibility to skin infections (cellulitis). Legs may feel heavy or achy, and walking can induce an uncomfortable tightness.
| Image: Damaged vein valves in chronic venous insufficiency impede proper blood flow. |
Symptoms of CVI can be relieved by elevating your legs above heart level, encouraging gravity-assisted blood flow back to the heart. If you sit for extended periods, ankle flexion exercises (pointing toes up and down) can activate leg muscle pumps.
Compression stockings, tighter at the ankle and looser towards the knee, are highly effective in reducing swelling and discomfort associated with CVI. These stockings need to be significantly tighter than standard hospital antiembolism stockings to be effective. Putting them on can be challenging due to their tightness; washing new stockings or using talcum powder or thin socks underneath can help.
Currently, there are no specific medications for CVI itself. However, significant advancements have been made in surgical treatments for varicose veins related to CVI. Modern treatments have moved away from invasive saphenous vein stripping, which involved incisions, vein removal, general anesthesia, and lengthy recovery.
Today, minimally invasive techniques are preferred. These procedures, guided by ultrasound and performed via catheters inserted into the veins, focus on closing the affected vein rather than removing it. They are typically outpatient procedures under local anesthesia, allowing patients to walk immediately afterward.
3. Lumbar Spinal Stenosis (LSS)
Spinal stenosis refers to any narrowing within the spinal column. Lumbar spinal stenosis (LSS) occurs in the lower back (lumbar region), where narrowing of the spinal canal compresses the spinal cord and nerve roots. This compression can be caused by changes in vertebrae, discs, or surrounding structures. The pain arises from mechanical pressure and potentially reduced blood flow to the nerves.
While lower back pain can be a symptom of LSS, leg pain is often the predominant issue. The leg pain can mimic that of PAD, presenting as cramping tightness that worsens with walking, although it’s more frequently felt in the thigh rather than the calf. Legs may also feel weak and numb.
Historically, leg pain from LSS was termed pseudo-claudication due to its non-arterial origin. Now, the preferred term is neurogenic claudication, emphasizing its neurological basis.
| Image: Lumbar spinal stenosis compresses the spinal cord and nerves, causing leg pain. |
Diagnosis begins with discussing symptoms and medical history. A key diagnostic clue is pain relief when bending forward or flexing the back. This posture reduces pressure on the lumbar spine, explaining why some individuals with LSS find walking easier when leaning on a shopping cart or walker.
MRI or CT scans are often used to confirm LSS, but imaging findings alone shouldn’t dictate diagnosis, as many people have spinal stenosis visible on scans without experiencing symptoms.
Initial treatment for LSS typically involves physical therapy and exercises to strengthen back and abdominal muscles. Pain relievers can provide symptomatic relief. Corticosteroid injections into the spine might offer temporary pain reduction but are not a long-term solution.
If pain persists despite conservative treatments, surgery becomes an option. Laminectomy, the most common surgical procedure, involves removing a portion of a vertebra to create more space for the spinal cord and nerves. Bone spurs, disc fragments, and parts of facet joints may also be removed to alleviate pressure.
4. Diabetic Neuropathy (DN)
Diabetic neuropathy (DN) is nerve damage that occurs in people with diabetes. The exact mechanisms are still being researched, but high blood sugar levels are thought to damage small blood vessels supplying nerves, impairing oxygen and nutrient delivery. Diabetes may also deplete neurotrophic peptides, chemicals essential for nerve repair and regeneration.
| Image: High blood sugar can damage blood vessels nourishing nerve cells in diabetic neuropathy. |
DN affects the legs in different ways depending on location. In the upper leg, nerve damage can cause sudden pain in one leg. In the lower legs and feet, which is more common, symptoms typically include numbness or tingling, usually felt symmetrically in both legs. Numbness can mask painful sensations, allowing foot sores to go unnoticed and worsen. While DN can make walking difficult, exercise may paradoxically improve leg pain in some cases.
People with diabetes can reduce their risk of developing neuropathy by diligently managing their blood sugar levels. While it’s less certain if strict blood sugar control can reverse existing nerve damage, it remains a crucial goal for overall health and preventing further complications. Pain management for DN often involves pain relievers, tricyclic antidepressants (like amitriptyline, desipramine, duloxetine), and anticonvulsants (such as carbamazepine, gabapentin, pregabalin) to control burning and tingling sensations.
Seeking Help for Leg Pain
If you are experiencing persistent leg pain when walking, it’s essential to consult with a healthcare professional. Accurate diagnosis is crucial to determine the underlying cause and receive appropriate treatment. Do not dismiss leg pain as a normal part of aging or exercise. Understanding why your leg hurts is the first step towards finding relief and maintaining an active, healthy lifestyle.
Image: lzf/Getty Images
Disclaimer:
This article provides general information and should not be considered medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment of any medical condition.
