Overview
Pain in the lower limbs is a non-specific symptom that may be due to traumatic, vascular, neurologic, rheumatologic, infectious or malignant pathology.
Aetiology
Causes of Leg Pain
- Arterial - acute occlusion, claudication
- Venous - deep venous thrombosis, superficial thrombophlebitis
- Neurological - spinal stenosis, radiculopathy
- Trauma - soft tissue injury, fracture, dislocation, compartment syndrome
- Arthritis - osteoarthritis, rheumatoid arthritis, gout, pseudogout, reactive arthritis, psoriatic arthritis
- Infection - cellulitis, osteomyelitis, septic arthritis
- Malignancy - osteosarcoma, bone metastasis
History of Presenting Complaint
Site
Whether the pain is in the thigh / calf / ankle, and whether it affects one leg or both.- Pain tracking along a veinSuggestive of superficial thrombophlebitis
Onset
Whether the pain came on suddenly or gradually, and whether it began after trauma.- Sudden onset severe painSuggestive of acute arterial occlusion or acute disc herniation
- Onset post traumaSuggestive of fracture or soft tissue injury
- Onset post superficial injury / drug injectionSuggestive of cellulitis +/- osteomyelitis
Character
The type of pain - sharp, dull, tight or burning.- Deep, constant acheRed flag for bone tumour
- Extreme tight sensationLook for compartment syndrome
Radiation
Whether the pain radiates anywhere else.- Burning pain radiating down the legSuggestive of radiculopathy
Associated Symptoms
Whether the pain is associated with any other symptoms.- Redness, warmth and tendernessSuggestive of cellulitis or DVT
- Numbness / paraesthesiaSuggestive of spinal stenosis / radiculopathy
- Coolness and paraesthesiaRed flag for acute arterial occlusion
- Lower back painSuggestive of spinal stenosis / radiculopathy
- Dyspnoea / chest painMay suggest DVT with PE
Timing
- How long the pain has been going on for, and whether varies throughout the day.
Exacerbating Factors
Whether there is anything that makes the pain worse.- Worse with exerciseSuggestive of arterial insufficiency (claudication)
- Worse with movementMay be suggestive of spinal stenosis or radiculopathy
Alleviating Factors
Whether there is anything that relieves the pain, and whether the patient has taken analgesia.- Relieved with restSuggestive of arterial insufficiency (claudication)
Severity
- How severe the pain is on a scale of 1 to 10, with 10 being the worst pain
- Whether the patient is able to walk
- How the pain is affecting the patient's daily life
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