Q: I have read your column for years and truly appreciate the service it provides. I am a 59-year-old male but have dealt with the issue of right leg pain for as far back as I can remember. I suffer from a low-grade burning pain in my right leg. It can be in either the upper portion above my knee area or down toward the ankle. Typically in either area it is on the outer side of the right leg but never the left. It can remain with me for weeks at a time, often causing difficulties in sleeping. At times it is so negligible I forget it is there but it seems always to be lurking in the background. I have never read of such an occurrence. I rub the area, stretch or even take an extremely hot bath to get relief.
A: The most common causes of unilateral leg pain are trauma or overuse. When caused by a fall or other injury, this makes for easy identification. However, a simple twist we don’t think about with pain that can lead to torn muscles and ligaments may be more difficult to pinpoint.
Pain in one or both legs may be the result of peripheral artery disease (PAD). This decrease in arterial blood flow because of narrowing of blood vessels can result in pain that exacerbates with exercise or even walking, since the acts require more oxygen for muscles to function properly. Depending on the level of narrowing and which muscles are involved, the areas of the perceived pain location can vary.
Low back pain from a condition known as sciatica can radiate to a lower extremity. Sciatica can be caused by arthritis, injury, muscle spasm, or even a herniated disc. Less likely causes for sciatica include a tumor or infection. Because the pain experienced depends on which nerve root is involved, it can present in the shin, thigh, or foot. This form of pain is commonly described as sharp and intense.
Pain involving muscles and joints can often be palpated, meaning you should be able to finger touch an area on your leg that causes the pain. Keep in mind that there are instances in which the pain may radiate from another location, resulting in total confusion. This is known as referred pain. If arthritis is involved, pain may resolve when the muscle or joint warms because of activity and the pain may exacerbate with use.
Inflammation and infection can often be detected by blood tests such as a sedimentation rate, white blood cell count and measurement of C-reactive protein. X-rays will not reveal needed information; however physicians may take this first step; but an ankle-brachial index comparing blood pressure in the arms to that in the legs might be a better choice. A CT will examine blood vessels and might even be ordered to evaluate your bones for detection of a hidden fracture while MRI can be helpful in testing for sciatica. Further, a nerve conduction study might be done to evaluate nerve function and electrical impulses.
As you can see, there are numerous tests a physician might order in an attempt to get you some relief. I would be interested to know what precedes your pain and why you are essentially pain free at other times. Is there a pattern that might have been overlooked all these years? If you can review this aspect, you might have a clue or two to put the puzzle pieces together. Treatment will depend on the diagnosis. Once the cause for your symptoms is determined, you can hopefully be on the road to recovery.
I’m sorry to say I cannot determine the cause of your unilateral leg pain and recommend you see an orthopedic specialist who can review your case, rule out those issues he feels are irrelevant and pursue those through testing that might be causing your long-standing symptoms. Ask if a trial at physical therapy, water aerobics, or acupuncture might be considered.
