Common causes of leg pain

Leg pain is something nearly all of us experience at some point or other. It can appear and disappear quickly, or it can get worse gradually and last for months (or longer). It can affect one leg or both. It can be a general all-over pain or it can affect a specific part or parts of your leg such as your ankle, calf, shin, knee or thigh. You may also have constant pain or aching legs at different times of the day, such as when you get up in the morning, while moving around or exercising, when you’re resting or when you’re trying to sleep at night.
 
Leg pain can be described as dull, aching, sharp, stabbing, shooting, cramping or burning. It can come with a variety of other symptoms too, including tingling, numbness, stiffness, swelling, bruising, redness, feeling hot to the touch, tenderness and muscle weakness. But however it affects you, all leg pain is bothersome. And more severe leg pain can also have a major effect on your quality of life, since it can reduce your ability to walk or stand.
 
Thankfully, however, most leg pain isn’t serious and it can often be treated at home – though sometimes, especially when it’s severe or persistent, it can be a sign of a medical problem that needs professional treatment.
 

Anatomy of a leg

 
Lots of problems can affect your legs because they’re made from a variety of different elements:
 

• The upper leg consists of the thigh bone (femur), which – running from the hip to the knee – is the longest bone in your body. Muscles in this part of the leg include the quadriceps (front of the thigh), the hamstrings (back of the thigh) and the adductors (inside of the thigh). The sciatic nerve is the main nerve that runs from the lower back to your legs through each thigh – it has two types of functions: motor and sensory.

• The knee joint is a synovial joint (a joint that has a cavity filled with synovial fluid) and the largest joint in the body. It comprises three bones – the thigh bone, shin bone (tibia) and the kneecap (patella) – as well as other elements including cartilage, ligaments, bursae, muscles and nerves (including the sciatic nerve).

• The lower leg is unlike the upper leg in that it has two bones – the fibula and the tibia. It contains several muscles including the tibialis anterior (front of the shin), gastrocnemius (calf) and the soleus (the calf muscle that’s attached to the Achilles tendon at the back of the heel). There are also several nerves in the lower leg, including the tibial nerves – which are branches of the sciatic nerve – and the fibula nerves.

• The ankle joint is also a synovial joint, consisting of several bones, ligaments, muscles and nerves.

• The foot is made from lots of small bones – almost a quarter of all the bones in the body – as well as many different muscles and ligaments.

 

Are you at risk of developing leg pain?

 
Everyone is arguably at risk of experiencing common types of leg pain because there are many factors that make us more susceptible to it, including:
 

• Getting older

• Pregnancy

• Being overweight or obese

• Injuries (sports injuries, for instance, or repetitive strain injuries)

• Sitting for too long

• Smoking

• Drinking too much alcohol

• Not drinking enough water

 
Causes of leg pain tend to affect different elements of the leg – here’s a quick guide to some of the most common causes of leg pain that are related to the muscles, bones, joints, blood vessels and nerves.
 

Problems with the muscles

 

Leg cramps  

 
These are usually harmless but they can be incredibly painful. Muscle cramps in legs are muscle spasms, most often spasms of the calf muscle, and are a common cause of calf muscle pain and leg pain at night (though you can experience leg cramps at any time).
 
Older people are thought to be particularly vulnerable to having leg cramps – according to the National Institute of Health and Care Excellence (NICE), a third of the over-60s experience cramps while at rest – 83 per cent of whom have cramps in their legs – with 40 per cent claiming they have three or more attacks of cramps each week (i).
 
There is often no obvious cause of leg cramps – when this happens they’re called idiopathic cramps. Sometimes, however, they can be a symptom or a complication of a health condition (a neurological condition, for instance, or an underactive thyroid gland). Heavy drinkers of alcohol are more likely to experience leg cramps too, as are people taking certain types of medicines, pregnant women, people who are dehydrated, athletes and sports people. Even wearing high heels for a long period of time can cause cramps in the foot muscles.
 
Find out more about leg cramps, including how they are treated and what you can do to help yourself, in our article Leg cramps: treatment & support. 
 

Muscle strains

 
Also called pulled muscles, strains are a frequent cause of leg muscle pain and a common complaint among people who are very active or play a lot of sports. Strains are caused when muscle fibres become stretched or torn because they’ve been stretched beyond their normal limits or forced to contract too quickly or strongly. They can happen suddenly, in the case of an injury or trauma, or more gradually (when using prolonged, repetitive movements, for instance).
 
A common cause of thigh pain is when you pull your hamstring muscle; meanwhile a pulled calf muscle will cause lower leg pain. Indeed, the leg muscles are among those that are most frequently strained, along with the back muscles.
 
Leg muscle strains can cause several symptoms – depending on how bad the injury is – including pain when using the muscle, tenderness, redness, bruising, swelling, weakness and a limited range of motion (they can also cause spasms of the muscle in question).
 
There’s lots more to discover about muscle strains, including self-help advice, in our guide to strains and sprains. 
 

Shin splints

 
Common in dancers and athletes – particularly runners – shin splits are when the muscles, tendons and tissues around the shin bone (tibia) become inflamed and irritated, causing pain in the front part of your lower legs. Considered a symptom of medial tibial stress syndrome (MTSS), shin splints are classed as an overuse injury because they’re caused by repeated stress on the shin bones, muscles and other tissues. Pain can be anything from mild to severe, and may feel worse after you’ve been exercising.
 
As well as athletes and dancers, those who have a high risk of developing shin splints can include:
 

• People who do a lot of walking or marching

• People who take part in sports with lots of sudden stops and starts

• People who have flat feet, high arches or very rigid arches

• People with osteoporosis

• People who wear unsupportive shoes for exercise

 

Tendonitis

 
Tendons are bands of tissue that attach your muscles to your bones, and they can often become injured when you’re playing sports or taking part in other activities, including those that include repetitive actions. When tendons – including those in your knee and ankle – become inflamed as a result of injury, the condition is called tendonitis (Achilles tendonitis, for instance, is inflammation of the Achilles tendon at the back of your heel).
 
Tendonitis can be very painful, especially when you move the affected muscle or bone, and can also cause swelling with redness and skin that feels hot to the touch. However it’s often difficult to tell the difference between a muscle strain and tendonitis, since tendons and muscles are so closely related.
 
If your tendonitis injury is a mild one you should be able to treat it yourself, and according to the NHS you should feel better within two to three weeks (ii). Find out what you can do to care for tendonitis in our guide to sports injuries.
 

Restless leg syndrome

 
Thought to affect up to 10 per cent of people in the UK (iii), restless leg syndrome’s most common symptom is an overwhelming urge to move your legs – though it also causes other uncomfortable sensations in the legs including tingling, burning, cramping and throbbing. It’s often worse when you’re resting and at night, and – as you might expect – can have a significant impact on your ability to get a good night’s sleep.
 
Middle-aged people are the most likely to experience restless leg syndrome, though anyone of any age can be affected, even children. Many pregnant women – about one in five – are also thought to experience restless leg syndrome in the last three months of pregnancy (iv), though nobody really knows why. In fact we don’t know what causes most cases of restless leg syndrome, but some are linked to medical conditions including anaemia, underactive thyroid, diabetes, Parkinson’s disease, rheumatoid arthritis and fibromyalgia. 
 
Read our restless leg syndrome guide to discover more, including the lifestyle changes you could make to ease the symptoms.
 

Bones and joints

 

Fractures  

 
Mostly caused by trauma such as a fall, car accident or sports injury, bone fractures affect around three to four in every 100 people each year in England, with long bones – such as those found in the legs – the most often broken bone after bones in the hands and feet (v). If you fracture a bone in your leg, ankle or foot, you’ll experience sudden, severe pain and you may not be able to walk or stand.
 
We don’t, however, have any firm figures for the number of people affected by stress fractures – small cracks in the bone that are also painful – though according to Patient UK approximately 20 per cent of all sports medicine injuries are caused by stress fractures (vi). 
 
This type of fracture is defined as a crack in a bone caused by repeated stresses that are individually insufficient to fracture it, with most affecting the legs (vi). Things that often cause stress fractures include playing a sport – especially one that involves repetitive actions such as running – and occupations that involve repetitive motions.
 

Sprains  

 
Another common problem among people who play a lot of sports and those who are physically active at work, sprains can affect any joint – though the most common locations for sprains are the ankle and the knee. Sprains are injured ligaments – bands of supportive connective tissues around joints that connect the bones together. These ligaments – including, for instance, the anterior cruciate ligament (ACL) in the knee – become injured when they’re suddenly overstretched, with pain, inflammation, swelling, bruising and joint function problems often following. However, mild sprains aren’t normally serious and can usually be treated at home.
 
Find out more about them in our strains and sprains guide.
 

Bursitis  

 
The bursae are fluid-filled sacs found in the joints that help cushion the joints and reduce friction. In fact there are around 160 bursae in the human body, each of which help your joints, bones, tendons and muscles move more easily and smoothly.
 
Repeated movements that put pressure on your joints – kneeling, for instance – can damage the bursae, causing the pain and swelling of bursitis (bursitis of the bursa in the front of the kneecap used to be called housemaid’s knee). Repetitive actions are the main cause, but bursitis can also sometimes be caused by a single injury (a fall, for instance), and if you have a medical condition such as gout, [ADD LINK] scleroderma or rheumatoid arthritis you may be more prone than others to developing it.
 
Discover more about bursitis and how you can often treat it yourself at home by reading our article Bursitis: causes & treatments.
 

Veins and arteries (blood vessels)

 

Peripheral artery disease  

 
Also known as peripheral vascular disease, PAD is caused by a narrowing or hardening of the peripheral arteries, most often those that carry blood to the legs. The most common – and usually the first – symptom of PAD is pain, cramping or aching in one or both legs (usually the calf muscles) when you walk that gets better when you rest. Called intermittent claudication, this pain happens because the muscles in your legs aren’t getting enough blood. Other symptoms of PAD include cold feet, shiny skin on the legs often with a lack of hair below the knee, numbness in the legs, slow-growing and brittle toenails and the skin on the legs turning pale or blue.
 
PAD is quite common, especially among the over 50s – according to Patient UK, one in five men and one in eight women aged 50 - 75 are affected by PAD, with your risk of developing it getting higher as you get older (vii). Besides your age there are several other factors that can increase your risk of developing PAD, including smoking, not doing very much exercise and being obese, as well as having one of several medical conditions including diabetes, high blood pressure, high cholesterol, chronic kidney disease, coronary heart disease, asthma and chronic obstructive pulmonary disease (COPD). 
 
Some people with PAD can improve their health by making lifestyle changes such as giving up smoking, taking more exercise and eating healthily. However others may need medication and – occasionally – surgery. To learn more about this condition, read our guide to peripheral artery disease.
 

Deep vein thrombosis (DVT)

 
The most common place for a blood clot called a deep vein thrombosis (DVT) to develop is in a leg. DVTs are so called because they involve clots in a deep vein, such as the large vein that runs through the muscles of the calf and thigh. Because the clot is in a deep vein, however, they can’t usually be seen with the naked eye. To make a diagnosis even more difficult, many people with DVTs have no symptoms – though some may notice a swelling in the foot, ankle or leg, cramp-like pain that usually starts in the calf, pain in the foot and ankle and an area of skin that feels hot to the touch or pale or red/blue in colour.
 
Every year one in 1,000 people in the UK is affected by a DVT, with those aged 40 and older more at risk than younger people (viii). If left untreated a DVT can cause a pulmonary embolism – where a part of the clot breaks off and travels to the lungs – which can be serious, even fatal. This is why it’s important to be aware of the warning signs, as well as the risk factors that can make some people more susceptible to developing DVTs than others. You can find this information – and more – in our article What is deep vein thrombosis? 
 

Varicose veins  

 
As well as not looking very attractive, varicose veins can cause aching and cramping in your legs – though usually it’s only the larger varicose veins that cause these symptoms. Sometimes you may also experience a sensation of heaviness, throbbing or burning in the affected leg or legs, and the skin over the veins can be thin and itchy.
 
Varicose veins are also common: up to 50 per cent of women may be affected by them, says the Circulation Foundation (ix), though many men get them too. The good news is that, in most cases, varicose veins don’t cause complications. However they can still cause discomfort, both physical and emotional. Find out what you can do to treat varicose veins, and how natural remedies may help, in our varicose veins guide. 
 
If you’re interested in supplements to support blood vessel health, click here.
 

Problems with the nerves

 

Peripheral neuropathy  

 
Pain, tingling, numbness and a burning sensation are all symptoms that can be caused by peripheral neuropathy, a condition that develops when your peripheral nerves (in this instance the nerves in your legs) become damaged. It’s a common complaint, affecting around one in 10 people aged 55 and older (x).
 
And since having diabetes (either type 1 or type 2) is a major cause of peripheral neuropathy, the condition is also sometimes referred to as peripheral diabetic nerve pain, peripheral diabetic neuropathy or simply diabetic leg pain. Indeed, around half of those affected by diabetes for 25 years or longer are estimated to have peripheral neuropathy too (xi).
 
We still don’t know exactly how this damage to the nerves happens, but besides having diabetes there are a few other factors that may have something to do with its development, including obesity, high cholesterol, high blood pressure and smoking. 
 
Meanwhile some of the other conditions that can cause peripheral neuropathy include autoimmune conditions, shingles, an underactive thyroid, liver and kidney disease, Lyme disease, HIV and inherited disorders such as Charcot-Marie-Tooth syndrome. Drinking alcohol heavily for a long time is also thought to cause peripheral neuropathy, as is having low levels of vitamin B12 and taking certain medicines (such as those used to treat cancer). You can read more about peripheral neuropathy, its symptoms and treatments in our article Peripheral neuropathy: signs and symptoms. 
 

Sciatica  

 
Triggered by irritation or compression of the sciatic nerve, sciatica can cause pain in the lower back, but it’s more commonly a cause of leg pain (usually one rather than both legs). The pain is usually sharp rather than dull, and can travel down one side of a buttock or leg, affecting part or all of your leg and sometimes even your foot. Other symptoms include a tingling or even burning sensation in the leg as well as muscle weakness or numbness in the leg. Symptoms usually last for a few weeks before disappearing, but some people can experience chronic sciatica where the pain stays around for months or even years. However long it lasts, sciatica can be extremely painful, though some people may only experience mild symptoms.
 
The most common cause of the compression of the sciatic nerve that causes sciatica is a slipped disc (also known as a prolapsed or herniated disc), with less common causes including a condition called spinal stenosis – this is when part of your spine called the spinal canal becomes too narrow (this causes problems because the sciatic nerve is one of several that pass through the spinal canal).
 
To find out how sciatica is treated – and what you can do to help yourself, including stretching exercises that can provide relief – read our sciatica guide. 
 

Meralgia

 
Not as widely known as sciatica, meralgia – or meralgia parasthetica, to give it its full name – can also cause pain, burning, numbness and tingling in the leg, specifically the outer part of the thigh. This time it’s not compression on the sciatic nerve that’s at fault but compression and damage to the lateral femoral cutaneous nerve, which serves the front and side of the thigh.
 
Some of the things that can irritate the LFC nerve include pregnancy, obesity, diabetes, standing or walking for a long time and even wearing tight trousers, leggings or stockings. And besides pregnancy, diabetes and obesity, the conditions that can increase your risk for meralgia include an underactive thyroid and alcoholism.
 
Meralgia treatment aims to ease the pressure on the LFC nerve, and includes physiotherapy, medication and – if neither of these works – surgery.
 

How to cope with leg pain

 
Managing leg pain depends on what’s causing it. However there are certain things you can do that could help bring relief from minor leg pain.
 
If you have injured your foot or leg, try using the PRICER method:
 
Protect   Use something to protect the injured area where possible, such as a sports support or shoes that enclose and support your feet (lace-up ankle boots, for example).

Rest   For the first 48 - 72 hours after an injury you should rest the affected area as much as possible and avoid any type of activity that puts pressure on it and causes more pain.

Ice   Apply ice to the affected area during the first 48 hours, as soon as possible after the injury. Place an ice pack on the affected area for around 20 minutes every three or four hours. If you don’t have an ice pack in your freezer you can make your own by wrapping some ice cubes or a bag of frozen peas in a towel (never apply ice or anything frozen directly on your skin as they can cause ice burns). This may help reduce pain and limit inflammation and bruising, as the cold is thought to reduce blood flow to the area.

Compression   Apply a compression bandage to the affected area. Try an elastic bandage or a tubular compression bandage (both are available without a prescription at pharmacies). Don’t wrap the area too tightly – the bandage needs to be tight enough to apply mild pressure but it shouldn’t be uncomfortable (if it’s too tight, it could interfere with your blood flow). Take the bandage or support off when you go to bed.

Elevation   If possible, raise the affected area above the level of your heart for as long as you can during the first 48 hours. If you’ve sprained your ankle, try to keep your foot on a stool that’s level with your hip or higher when you’re sitting, and put some pillows under your feet when you’re in bed.

Rehabilitation   This is also known as therapeutic exercise and is designed to get you back to fitness gradually and safety – though it usually only applies to sportspeople and athletes. It usually involves following an active rehabilitation programme tailored for the individual by a physiotherapist.
 
At the same time avoid HARM (heat, alcohol, running and massage) for 48 - 72 hours after sustaining your injury:

Heat   Avoid anything that encourages blood flow, including hot baths, saunas and heat packs. However, after 72 hours, when there should be no further bleeding or inflammation, it may be a good idea to use heat, as it can be soothing on a strain or sprain.

Alcohol   Stick to non-alcohol drinks (like heat, alcohol can increase blood flow, which may make bruising and inflammation worse after an injury).

Running   Avoid any type of exercise that could make your injury worse (running is just one example).

Massage   This too may increase bleeding and swelling, as it can increase blood flow to the area. But like heat, massage can be soothing if it’s used after 72 hours.
 
Meanwhile if you need it, try pain relief, such as paracetamol or ibuprofen tablets (these are widely available at pharmacies – talk to a pharmacist to find out which pain relief product would suit you best). If you prefer a more natural approach there are nutritional supplements that can offer support when you’re experiencing pain, including:
PEA   Short for palmitoylethanolamide, PEA is a fatty acid produced naturally by the body and is found in all cells, tissues and fluids. You can also get it in foods such as soya beans, peanuts, eggs, flaxseed and milk.
 
An endocannbinoid-like chemical that belongs to a family of fatty acid compounds called amides, PEA is often described as an alternative to CBD, as both substances are thought to have similar properties. Researchers, however, suggest PEA is safer than CBD, since it has been studied more extensively and has a more robust safety profile (xii) with no known side effects (xiii). A review of 16 clinical trials and meta-analysis also confirms PEA has painkilling actions (xiv).

B vitamins   The B vitamin family plays an important role in nervous system function. Some of the B vitamins may even help with neuropathic (nerve) pain. For instance, some experts claim taking B vitamins – particularly vitamins B1, B6 and B12 – may help repair damaged or irritated nerves, and that being deficient in these vitamins may lead to permanent nerve degeneration and pain (xv). These nutrients are found in a range of foods, but a handy way to top-up your Bs is to take a B complex supplement (though you can take many of the B vitamins individually if you wish).

Magnesium   Found naturally in the body, magnesium is needed for more than 300 biochemical reactions including muscle and nerve function. It has been studied in a variety of pain conditions, with researchers finding it may help with the pain of conditions including diabetic neuropathy (xvi) – though they added that more large-scale studies are needed to better understand how magnesium may help manage chronic pain. 
 
Turmeric   The active antioxidant substance in turmeric called curcumin is widely believed to have anti-inflammatory properties, and scientists are still discovering more about turmeric’s possibilities for pain relief. One review of 10 studies, for instance, concludes turmeric may be beneficial for pain caused by arthritis of the knee, and that the effects of taking it are similar to those of taking anti-inflammatory painkillers (xvii).
 

Need more info about pain?

 
If you need more details about pain in general our pharmacy health library has a section on pain that includes information on a range of different pain conditions, with advice on how they are treated plus self-care and support suggestions. 

 

References:

1. Available online: https://cks.nice.org.uk/topics/leg-cramps/background-information/prevalence/.

2. Available online: https://www.nhs.uk/conditions/tendonitis/.

3. Available online: https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/restless-legs-syndrome.

4. Available online: https://www.nhs.uk/conditions/restless-legs-syndrome/.

5. Donaldson LJ et al. (2008) "The epidemiology of fractures in England." J Epidemiol Community Health 62(2):174-80. Available online: https://discovery.ucl.ac.uk/id/eprint/4968/1/4968.pdf.

6. Available online: https://patient.info/doctor/stress-fractures.

7. Available online: https://patient.info/heart-health/peripheral-arterial-disease-leaflet.

8. Available online: https://www.nhsinform.scot/illnesses-and-conditions/blood-and-lymph/deep-vein-thrombosis.

9. Available online: https://www.circulationfoundation.org.uk/help-advice/veins.

10. Available online: https://www.nhs.uk/conditions/peripheral-neuropathy/.

11. Available online: https://patient.info/brain-nerves/peripheral-neuropathy-leaflet.

12. Clayton P et al. (2021) "Palmitoylethanolamide: A Potential Alternative to Cannabidiol." J Diet Suppl. 28;1-26. Available online: https://www.tandfonline.com/doi/full/10.1080/19390211.2021.2005733.

13. Clayton P et al. (2021) "Palmitoylethanolamide: A Natural Compound for Health Management." Int J Mol Sci. 22(10): 5305. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157570/.

14. Gabrielsson L, Mattsson S, Fowler CJ. (2016) "Palmitoylethanolamide for the treatment of pain: pharmacokinetics, safety and efficacy." Br J Clin Pharmacol. 82(4): 932–942. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094513/.

15. Geller M et al. (2017) "B Vitamins for Neuropathy and Neuropathic Pain." Vitam Miner. 6:2. Available online: https://www.hilarispublisher.com/open-access/b-vitamins-for-neuropathy-and-neuropathic-pain-2376-1318-1000161.pdf.

16. Baltrusch S. (2021) "The Role of Neurotropic B Vitamins in Nerve Regeneration." Biomed Res Int. 9968228. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8294980/.

17. Park R et al. (2020) "Efficacy and Safety of Magnesium for the Management of Chronic Pain in Adults: A Systematic Review." Anesth Analg. 131(3):764-775. Available online: https://journals.lww.com/anesthesia-analgesia/fulltext/2020/09000/efficacy_and_safety_of_magnesium_for_the.20.aspx.

18. Paultre K et al. (2021) "Therapeutic effects of turmeric or curcumin extract on pain and function for individuals with knee osteoarthritis: a systematic review." BMJ Open Sport Exerc Med. 7(1):e000935. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812094/.
    
     

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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