This section deals with causes of pain arising from local lesions within the leg, or referred into the leg. Pain in the leg is a common complaint and the majority of cases are of vascular or orthopaedic origin. Joint problems are dealt with in the section on Joint disorders (p. 267). Obvious history of trauma. History of joint swelling, stiffness, limitation of movement. Pain on walking. There may be an obvious history of rheumatoid arthritis with signs elsewhere, e.g. the hands. Reiter’s disease – conjunctivitis, urethritis. Ankylosing spondylitis – stiffness of the spine, especially in the morning; hip and knee involvement. Cellulitis may arise from puncture wounds, e.g. insect bites or in a lymphoedematous leg. The patient presents with pain, redness, tenderness, malaise and fever. Myositis may occur in association with collagen diseases, e.g. scleroderma, dermatomyositis. Osteomyelitis is rare but more common in childhood. History of immunosuppression or diabetes. Recent history of infection elsewhere. Pain aggravated by movement. Swelling and redness of the affected area. Septic arthritis presents with a red, hot, tender, painful joint. More common in children. In adults, enquire about a history of steroid therapy or diabetes. Osteoarthritis presents with pain, stiffness and deformity. The pain is often worse on starting walking and then improves. Baker’s cyst presents with a lump behind the knee. The patient may complain of pain and swelling of the calf if the cyst ruptures. With meniscal lesions, there is usually a history of twisting the knee, e.g. playing football. The knee may lock. Deep venous thrombosis presents with painful swelling of the leg. There may be a history of the contraceptive pill, prolonged immobilisation, recent surgery, malignancy. Acute arterial occlusion results in sudden onset of severe pain in the affected limb. The patient is unable to move the leg and complains that the leg feels cold. With intermittent claudication, there is pain on walking, relieved by rest. It may affect the calf, thigh or buttock. Rest pain in the foot may occur with advanced arterial disease. The pain is often worse in bed at night and the patient obtains relief by hanging the foot out of bed.
Leg Pain
History
Traumatic
Inflammatory
Infective
Degenerative
Vascular
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
Basicmedical Key
Fastest Basicmedical Insight Engine
