Leg discomfort: beyond the joints.
Although simple characterization of discomfort as cramps, heaviness, shooting pains, and so forth can be misleading, history and examination are key to accurate diagnosis. Absence of both dorsalis pedis and posterior tibial pulses strongly suggests peripheral arterial disease (PAD), and the presence of either pulse makes PAD less likely. Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) are a common cause of lower extremity myalgias. Restless legs syndrome causes nocturnal discomfort but must be distinguished from confounding“mimics." Neurologic causes of leg symptoms include lumbar spinal stenosis, radiculopathy, distal symmetric polyneuropathy, and entrapment neuropathy. Many common causes of leg discomfort can be managed conservatively.
General Medicine Service, Department of Medicine, VA Puget Sound, University of Washington, 1660 South Columbian Way, Seattle, WA 98108, USA. Electronic address: douglas.berger@va.gov.
Douglas
D
Berger
D003937:Diagnosis, Differential; D019468:Disease Management; D006801:Humans; D007866:Leg / Q000503:physiopathology*; D009120:Muscle Cramp / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D010146:Pain / Q000175:diagnosis* / Q000503:physiopathology; D059408:Pain Management / Q000379:methods; D010292:Paresthesia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy
Claudication; Cramp; Leg pain; Myalgia; Neuropathy; Paresthesia