10 conditions that cause leg ache

Leg pain — ie pain anywhere from the top of your thigh to your ankle — is very common and can have a variety of causes. Injury or disease can cause an ache or pain anywhere in this region. It can vary from dull or throbbing to sharp and shooting pain.

Here, we’ll take a look at 10 of the most common causes of leg pain and how they’re treated.

1. Muscle cramps

Muscle cramps are caused by an imbalance in electrolytes (eg calcium, sodium and potassium) in your muscles. This causes sudden tightening of your muscles, which produces a sharp pain lasting from a few seconds to 10 minutes, and soreness for up to 24 hours.

Common causes are dehydration and overexertion of the muscle eg after intense exercise, especially in the heat and/or when sweating a lot. However, liver disease and certain medications (eg statins for and diuretics) can also cause muscle cramps.

Over-the-counter pain medications, such as paracetamol and ibuprofen, can ease soreness after a leg cramp but don’t work quickly enough to ease pain during cramping. During a leg cramp, try to stretch your leg muscle and massage it to ease the pain. Sometimes, bearing weight on the cramping leg also helps.

2. Arthritis

Arthritis causes joint pain and stiffness, and in the leg, often affects the knee. Wear and tear of the joint, which occurs in osteoarthritis, or inflammation of the joint, which occurs in rheumatoid arthritis, cause a deep ache in and around the joint. This worsens with activity and can be accompanied by sharp, shooting pain.

For osteoarthritis, strengthening exercises and exercises that improve the range of movement can ease leg pain, alongside losing excess weight and taking over-the-counter painkillers.

For rheumatoid arthritis, exercise is important, but medications are also needed to reduce inflammation. This includes disease-modifying anti-rheumatic drugs (DMARDs), biological medicines and non-steroidal anti-inflammatory drugs (NSAIDs).

3. Muscle, tendon and ligament injuries

Injuries due to physical activity can damage the muscles, tendons or ligaments in the leg.

For example, overstretching a leg muscle causes a pulled muscle. The pain is often initially sudden and intense and then becomes a dull ache. Similarly, overstretching a ligament can cause a sprain eg a sprained ankle.

Injuries can also develop gradually due to overuse. For example, repetitive movements can cause tendons in your leg to become inflamed (tendonitis). This can cause a dull ache as well as sharp pain on movement.

These injuries can be treated by following the RICE principle:

Rest — rest your leg and avoid activities that strain your leg
Ice — apply an ice pack for up to 20 minutes at a time to reduce swelling and inflammation
Compression — support the affected joint by carefully wrapping it with a compression bandage
Elevate — to reduce swelling, raise your leg above the level of your heart

4. Shin splints and stress fractures

Both shin splints and stress fractures are common overuse injuries.

Shin splints refer to inflammation of the tissues around the shin bone (tibia) in the front part of your lower leg. They develop from repeated stress placed on these tissues, such as from regular running on hard surfaces.

Stress fractures are small cracks in your bones that occur due to repeated pressure placed on the bones eg regular running or jumping on hard or uneven surfaces can cause stress fractures in your tibia.

Both shin splints and stress fractures in the tibia cause a dull ache or soreness along the front, inner part of your leg. Your leg may also be swollen and feel tender.

Treatment for shin splints and stress fractures involves following the RICE principle described earlier and taking over-the-counter painkillers. In severe cases of stress fractures, you may need to wear a cast and use crutches to relieve pressure on the affected bone.

5. Peripheral artery disease (PAD)

Peripheral artery disease (PAD) doesn’t always cause symptoms but can cause a dull ache, cramping and/or heavy feeling in the calf muscles of your legs, especially when walking up stairs. This pain usually subsides when resting.

PAD is caused by narrowing of the arteries in your legs due to a build-up of fatty deposits called plaques. You are more likely to develop PAD if you smoke, are overweight or obese, and/or have heart disease, high cholesterol, diabetes or high blood pressure.

PAD is treated by managing these health conditions as well as following a healthy diet, quitting smoking and exercising regularly. For more immediate symptom relief, your doctor may prescribe medication to improve blood flow.

They may also recommend a minimally invasive procedure to widen the arteries in your leg (angioplasty). In severe cases where an artery is completely blocked, they may recommend bypass graft surgery to reroute blood flow around this blockage.

6. Deep vein thrombosis (DVT)

Deep vein thrombosis (DVT) refers to a blood clot in a vein. It usually occurs in the leg and does not always cause symptoms.

When symptoms occur, you may notice a throbbing pain in your leg, often in the calf muscle or thigh, especially when you stand or walk. Your leg may also become swollen and warm, and the skin may appear red or darker.

DVT increases your risk of developing a life-threatening condition called a pulmonary embolism where the blood clot travels to the lungs. You should, therefore, seek immediate medical attention if you are concerned that you have a DVT.

DVT is treated with an injection of a blood-thinning medication. In some cases, surgery is needed to remove the blood clot (thrombectomy).

7. Varicose veins

Varicose veins are widened, swollen, twisted veins that appear as bulging blue–purple lines under the skin. They occur when the valves in your veins stop working properly, causing blood to build up and stretch your veins.

Varicose veins can cause a burning, throbbing and/or cramping pain in your legs as well as a feeling of heaviness. You can manage your symptoms by elevating your legs whenever possible and wearing compression stockings.

If your varicose veins are causing you significant leg pain, your doctor may recommend:

Endothermal ablation to close off affected veins using heat produced by radio waves or a laser
Foam sclerotherapy to block affected veins by injecting a special chemical mixed with foam
Surgery to tie off and remove affected veins

8. Sciatica

Sciatica is caused by pressure on the sciatic nerve that runs from your lower back to your feet. It occurs when the start of the nerve is compressed, usually by a slipped disc (bulging of the soft cushion that sits between the bones in your spine) but sometimes by a slipped spinal bone or narrowed spinal canal (spinal stenosis).

Treatment depends on the underlying cause. In general, rest, applying heat or ice packs, taking NSAIDs, physiotherapy and spinal steroid injections all help treat sciatica. In more severe cases, you may need surgery to remove part of the slipped disc (discectomy) or slipped spinal bone (laminectomy).

9. Peripheral neuropathy

Peripheral neuropathy refers to damage to the nerves that extend out from your brain and spine to the rest of your body. It can cause a variety of sensations in your leg, including burning, tingling, pins and needles, and/or sharp, shooting or stabbing pain.

Damage to the peripheral nerves in your legs is often caused by poorly controlled diabetes but can also be caused by infections (eg shingles, HIV and lyme disease), autoimmune conditions (eg rheumatoid arthritis, lupus and vasculitis), vitamin deficiencies and physical injuries.

Treatment varies considerably depending on the underlying cause and may include medications, physiotherapy, dietary changes, injections, electrical nerve stimulation and surgery.

10. Gout

Gout is a type of inflammatory arthritis caused by too much uric acid in your blood. Uric acid is produced when your body breaks down substances called purines in your food.

If your body makes too much uric acid or your kidneys are not effectively removing it, levels rise in your blood and uric acid crystals form in your joints. These crystals cause swelling and intense joint pain. Although gout usually affects the joint in the big toe, it can affect other joints including the knees and ankles.

Gout often comes and goes, with periods of swelling and severe pain referred to as gout attacks or flare-ups. These flare-ups usually last 1–2 weeks but can last longer.

During a flare-up, your doctor may prescribe medications to ease your symptoms, including NSAIDs, colchicine and corticosteroids. They may also prescribe medication to help reduce your uric acid levels, but you will also need to avoid eating foods high in purine, such as: