Pain in the legs (ankles, feet, toes). What to do if you have pain in your legs, causes of pain in your legs!

The leg (lower limb) is made up of muscles, skin, bones, joints and other structures. All of them are permeated with nerve fibers and contain pain receptors - any structure can become a source of pain.

In a healthy person, pain in the legs can be associated with physical activity or an uncomfortable body position - for example, with prolonged standing. In women, in addition, it occurs during pregnancy and when using certain oral contraceptives. We will not dwell on this - we will consider only cases of pain caused by disorders in the body.

Pain in the legs, not directly related to vascular damage, occurs with many diseases:

injuries;
radiculitis, sciatica, neuritis, diabetic polyneuropathy, tunnel syndromes;
inflammatory diseases (myositis, arthritis, osteomyelitis, tenosynovitis, phlegmon, erysipelas, etc.);
degenerative-dystrophic processes (arthrosis, flat feet, etc.);
violation of water-salt metabolism.

An angiologist surgeon needs to be able to distinguish these conditions from pain associated with vascular changes in the extremities, since most people, when pain occurs, do not know which doctor to turn to for help. It is vascular changes in the lower extremities that often occur and bring the greatest suffering to patients; they require a particularly careful approach to diagnosis and treatment.

In medical practice, various names for the same vascular disorders are used. In order not to confuse the reader, we will adhere to the designations adopted by the International Classification of Diseases ICD-10

Vascular diseases of the legs are divided into diseases of the arteries, veins and lymphatic vessels.

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1.Pain in legs

Almost all people at some point in time experience problems with their legs - pain in the legs, pain in the feet, toes, ankles and other unpleasant sensations.

Why is this happening? In fact, there can be many reasons. Most of the time, our body movements do not cause any problems. But due to daily or too intense stress, a variety of leg diseases can develop. In addition, injuries and the natural aging process can cause discomfort and pain in the legs.

Your toes, feet, and ankles may experience burning, pain, fatigue, numbness, tingling, warmth, or coldness

.
muscle spasms
occur in the legs, especially at night when you sleep, and swelling of the legs.
The feet and ankles may become discolored, pale, or blue
.
There may be an unpleasant odor from your feet
.

Some of these symptoms are normal for older people or pregnant women. In this case, treatment at home is usually sufficient. In other situations, you need to find the cause of the problem and treat it.

Bemer therapy is a modern way to combat all types of pain. You can read more about Swiss physiotherapy in this section

A must read! Help with treatment and hospitalization!

Diagnostics

The choice of therapeutic strategy directly depends on the cause that provoked the appearance of aching pain in the calves, feet and leg joints. What to do first if your legs ache? There is only one answer: go for a consultation with a specialist. This could be a therapist, a neurologist, a phlebologist, or a traumatologist. The doctor will conduct a visual, physical and instrumental examination, based on the results of which he will prescribe the following diagnostic measures. This may include laboratory blood tests, ultrasound of blood vessels, radiography, MRI or CT, serological examination of synovial fluid, biopsy of material if an oncological process is suspected.

2.Causes of leg pain

There are several categories of problems that can cause leg pain, discomfort and the other symptoms listed above. Let's try to figure it out in more detail.

Firstly, it may be problems with the skin of the legs

. Symptoms and the diseases that cause them may be:

If while walking you feel as if you are walking on stones or pebbles, it may be plantar warts on the lower part of your foot;
Areas of dense and hard skin on the heels may appear due to calluses, blisters on the skin or engorgement of the skin due to uncomfortable shoes, walking barefoot;
Redness, peeling of the skin, burning and itching between the toes or on the bottom of the leg are signs of foot fungus (mycosis). Another possible cause is dermatitis due to the shoes you wear;
Red, swollen, and tender skin around the nail may be symptoms of an ingrown toenail or nail infection (paronychia);
Redness, swelling of the feet, pain in the feet when walking or touching are signs of a possible bacterial infection. You can become infected in public showers, swimming pools and other similar institutions.

The toe joints are a very vulnerable area.

. And it is with the joints of the toes that there are more problems than with any other joints in the body.

Big toe joint pain, redness, swelling and tenderness that suddenly appears in the big toe joint can be caused by gout. The same symptoms can appear due to infection;
If you have a swelling or lump at the base of your big toe, it may be a bunion;
A lump on the outside of the little finger may be due to bunion;
Toe joint pain, stiffness, and swelling are common symptoms of bunions, arthritis, lupus, or gout.

Foot pain may appear in the front of the foot or in the heel.

Sharp pain in the bottom of the heel can be caused by plantar fasciitis;
Pain in the back of the heel or ankle are symptoms of Achilles tendinitis, or as it is also called, Achilles tendinitis;
Pain that worsens before or after exercise but improves during exercise may be caused by a broken bone in the leg (usually a metatarsal);
Small bone spurs under the heel bone that cause heel pain may be a heel spur;
Pain in the midfoot occurs due to flat feet;
Pain in the back of the heel or a lump in this area is a symptom of a type of bunion.

Many diseases can affect the nerves of the foot

, causing foot pain, numbness, tingling and burning.

Foot pain, burning, tingling, or numbness between the toes, especially between the third and fourth toes, and the same sensation in the forefoot may occur due to swelling or thickening of the nerve in the forefoot;
Pain, numbness, or tingling that starts in the back or buttocks and moves down the leg may be caused by sciatica due to a pinched nerve;
Weakness and pain in the ankle, which is often accompanied by numbness, can begin due to a pinched nerve in the ankle (tarsal tunnel syndrome) or sciatica;
Burning in the legs, numbness and loss of sensation appear due to poor blood circulation. This problem is more common among people with diabetes or peripheral artery disease.

As you can see, the causes of leg pain, pain in the feet, ankles, toes, and other causes of discomfort in the legs can be very different. Therefore, if you experience symptoms such as pain in the legs, swelling of the legs, cramps in the legs, burning sensation, numbness, tingling in the legs and toes, paleness or blueness of the legs, you need to consult a good doctor. A specialist will help determine the cause of discomfort in the legs and tell you how to deal with them.

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Diagnosis and treatment of restless legs syndrome

It is customary to prescribe medications for RLS in cases where it significantly disrupts the patient’s vital functions, causing persistent sleep disturbance, and non-drug measures are not effective enough. In mild cases, you can limit yourself to taking sedatives of herbal origin or prescribing a placebo, which can give a good, but sometimes only temporary effect.

In more severe cases, it is necessary to choose a drug from four main groups: benzodiazepines, dopaminergic drugs, anticonvulsants, opioids [17].

Benzodiazepines accelerate the onset of sleep and reduce the frequency of awakenings associated with PDC, but have relatively little effect on the specific sensory and motor manifestations of RLS, as well as PDC. The most commonly used benzodiazepines are clonazepam (0.5–2 mg at night) or alprazolam (0.25–0.5 mg). With long-term use of benzodiazepines, there is a danger of developing tolerance with a gradual decrease in effect and the formation of drug dependence. The negative aspects of the action of benzodiazepines also include the possibility of developing or increasing drowsiness during the day, decreased libido, increased sleep apnea, episodes of confusion at night, as well as worsening cognitive impairment in the elderly. In this regard, benzodiazepines are currently used sporadically in mild or moderate cases - during periods of deterioration, and in severe cases requiring constant treatment, they are prescribed only when dopaminergic drugs are ineffective [16, 17].

Dopaminergic drugs (levodopa and dopamine receptor agonists) are the mainstays of treatment for RLS. They affect all the main manifestations of RLS, including the maximum concentration limit. Dopaminergic drugs are so effective in RLS that a positive reaction to them can serve as an additional criterion for diagnosing RLS, and its absence, as, for example, in Parkinson's disease, should be considered a basis for revising the diagnosis. The effect of dopaminergic drugs in RLS occurs in doses that are significantly lower than those used in Parkinson's disease. Apparently, dopaminergic drugs are equally effective in both primary and symptomatic variants of RLS [6].

Levodopa has been used for RLS since 1985, when its effectiveness in this category of patients was first shown. Currently, levodopa is prescribed in combination with DOPA decarboxylase inhibitors benserazide (Madopar) or carbidopa (Nakom, Sinemet). Treatment begins with 50 mg of levodopa (approximately 1/4 tablet of Madopar “250”), which the patient should take 1–2 hours before bedtime. If the effectiveness is insufficient, after a week the dose is increased to 100 mg, the maximum dose is 200 mg. Taking levodopa provides an adequate effect in 85% of patients. In many patients, it remains effective for many years, and in some patients its effective dose may remain stable and even decrease [10]. Levodopa medications are usually well tolerated by patients with RLS, and side effects (nausea, muscle cramps, tension headaches, irritability, dizziness, dry mouth) are usually mild and do not require discontinuation of the drug. Given the rapid onset of effect and the lack of need for dose titration, levodopa may be considered the treatment of choice for intermittent worsening symptoms.

However, with long-term use in a significant proportion of patients, the effectiveness of levodopa decreases, while the duration of action of a single dose is reduced to 2-3 hours, which may be followed by a rebound increase in the symptoms of RLS and PDC in the second half of the night. In this case, it is recommended to increase the dose of the drug or add a second dose immediately before bedtime or upon awakening at night. However, with an increase in the dose of levodopa, the rebound increase in symptoms may not be eliminated, but only shift to the early morning hours, and its intensity may increase. Experience shows that a more reasonable alternative in this situation is to switch to a sustained-release levodopa preparation (Madopar GSS). A slow-release drug that acts over 4 to 6 hours to ensure good sleep throughout the night and prevent morning rebound symptoms.

In approximately half of patients, during long-term treatment with levodopa, symptoms gradually begin to appear earlier (sometimes even during the day), becoming more intense and widespread (the so-called “augmentation”). The higher the dose of levodopa, the stronger the augmentation [14], so increasing the dose of levodopa in this situation only worsens the situation, completing a vicious circle. When using Madopar GSS as a basic therapy for RLS, rebound enhancement and augmentation are observed less frequently than when taking standard levodopa drugs. In this regard, Madopar GSS is now often used as a means of initial treatment of RLS (1-2 capsules 1-2 hours before bedtime). Sometimes it is reasonable to recommend to the patient 1 hour before bedtime 100 mg of levodopa as part of a standard drug or a soluble fast-acting drug, which provides a relatively rapid onset of effect, and 100 mg of levodopa as part of a slow-release drug (for example, 1 capsule of Madopar GSS). When augmentation develops, it is recommended to either replace levodopa with a dopamine receptor agonist, or add it to it (by reducing the dose of levodopa).

Dopamine receptor agonists (DRAs) have been used for RLS shortly after levodopa was shown to be effective, in 1988. Experience shows that the effectiveness of ADR for RLS is approximately equivalent to that of levodopa. ADRs can be considered as a means of choice if long-term daily medication is required. For RLS, both ergoline drugs (bromocriptine, cabergoline) and non-ergoline drugs (pramipexole, piribedil) are used [12, 14]. Non-ergoline drugs have the advantage of being free from side effects such as vasospastic reactions, pleuropulmonary, retroperitoneal fibrosis, and fibrosis of the heart valves. To avoid nausea, ADRs are taken immediately after meals and the dose is adjusted by slow titration. Pramipexole is initially prescribed at a dose of 0.125 mg, then gradually increased until the effect is achieved (usually no more than 1 mg). The effective dose of piribedil is 50–150 mg. For bromocriptine treatment, the starting dose is 1.25 mg and the effective dose ranges from 2.5 to 7.5 mg. Cabergoline treatment begins with 0.5 mg, and its effective dose is 1–2 mg. The indicated dose is usually prescribed once 1-2 hours before bedtime, but in severe cases, additional administration of the drug may be necessary in the early evening hours. Side effects when taking ADR include nausea, fatigue, headache, dizziness, and daytime sleepiness. Domperidone may be prescribed at the beginning of treatment to prevent nausea.

With long-term use of ADR, signs of augmentation are detected in approximately 25–30% of patients, but they are almost never as severe as with levodopa treatment. If one of the ADRs turns out to be ineffective, you can try replacing it with another drug from this group. It is important to note that dopaminergic drugs, while eliminating the symptoms of RLS, do not always lead to normalization of sleep, which requires the addition of a sedative drug (benzodiazepine or trazodone).

It should be noted that, probably due to the absence of denervation and the normal number of dopaminergic neurons, dopaminergic drugs are effective in RLS at doses significantly lower than those used in Parkinson's disease. Moreover, side effects such as dyskinesia, psychosis, impulsivity, and compulsive behavior (common in Parkinson's disease) are extremely rare in RLS.

In those few cases where the patient does not tolerate dopaminergic drugs well, and benzodiazepines are ineffective or cause intolerable side effects, they resort to anticonvulsants or opioids. Of the anticonvulsants, gabapentin is currently most often used, at a dose of 300 to 2700 mg/day [9]. The entire daily dose is usually prescribed once in the evening. Opioid drugs (codeine, 15–60 mg; dihydrocodeine, 60–120 mg, tramadol, 50–400 mg at night, etc.) can significantly reduce the symptoms of RLS and PDC, but the risk of developing drug dependence makes their use justified only in the most severe cases where all other treatment methods are ineffective. The treatment algorithm for RLS is shown in the figure.

For RLS, it is possible to use some other drugs (clonidine, folic acid, magnesium, vitamins E, B, C), but their effectiveness has not been confirmed in controlled studies [18]. In some patients, amantadine, baclofen, zolpidem are effective; beta blockers (for example, propranolol) can reduce symptoms, but sometimes cause them to worsen.

Treatment of RLS has to be carried out over a long period of time over many years, and therefore it is very important to follow a unified treatment strategy. Sometimes it is carried out only during the period of intensification of symptoms, but often patients are forced to take certain drugs for life to maintain drug remission. It is better to start treatment with monotherapy, choosing a drug taking into account its effectiveness in each individual patient and the presence of concomitant diseases. If monotherapy is insufficiently effective or in cases where, due to side effects, it is not possible to achieve a therapeutic dose of one of the drugs, it is possible to use a combination of drugs with different mechanisms of action in relatively small doses. In some cases, it is advisable to rotate several drugs that are effective for a given patient, which allows them to maintain their effectiveness for many years.

Treatment of RLS in pregnant women is particularly challenging. None of the drugs commonly used for RLS are considered safe during pregnancy. Therefore, when RLS develops during pregnancy, they are usually limited to non-drug measures (for example, a walk and a warm shower before bed) and the administration of folic acid (3 mg/day), as well as iron supplements (if there is a deficiency). Only in severe cases is it permissible to use small doses of clonazepam, and if they are ineffective, small doses of levodopa.

Trazodone and monoamine oxidase inhibitors (MAOIs) can be used to treat depression in patients with RLS. Data on the effect of selective serotonin reuptake inhibitors in patients with RLS and PDC are contradictory. However, in some patients they can nevertheless improve the condition, which is explained by the suppression of the activity of dopaminergic neurons. Tricyclic antidepressants, like antipsychotics, are contraindicated.

3. Treatment of pain in the legs (ankles, feet, toes)

Treating leg pain at home often helps to cope not only with pain, but also with other symptoms - swelling of the legs, cramps, and discomfort. Treatment, as a rule, begins with eliminating the factors that caused pain in the legs.

and other unpleasant sensations.
For example, you should stop exercising at least temporarily if you experience pain in your legs (feet, ankles, or toes) during exercise. Physical activity “through pain” is contraindicated. It is important to wear high-quality and comfortable shoes. Arch supports and other orthopedic devices
will help make walking more comfortable.

Cold application, rest, foot massage, gentle and gentle exercises

(for example, for stretching tendons) will help cope with leg pain, leg swelling or cramps. To relieve leg pain, you can take over-the-counter pain medications.

For swelling of the legs, swelling of the feet and ankles

You can raise your swollen legs just above the level of your heart and sit like that for a while. If you have a sedentary job, get up and walk around for a few minutes every hour. Reduce your salt intake.

If your home treatments for leg pain (feet, ankles, toes), leg swelling, and other problems do not have the desired effect, consult your doctor. Consultation with a specialist is required

and when the pain and swelling intensify, signs of infection appear, the skin turns pale, tingling and numbness appear.

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Treatment methods

Doctors at the Sanmedexpert clinic prescribe treatment for leg pain only after a complete examination of the patient and identification of pathological processes. Therapeutic therapy can be either medication or surgery.

If the legs hurt due to neurological diseases, the patient is prescribed physiotherapeutic procedures, physical therapy, massage, wearing bandages and corsets. When identifying vascular diseases, the use of special medications is required, the action of which is aimed at increasing vascular tone and improving blood circulation, as well as therapeutic exercises and reducing physical activity.

The treatment technique for leg pain is determined individually depending on the nature of its origin. But in any case, you should not delay treatment, because the disease is easier to treat at an early stage.

4.Bemer therapy

In our medical practice, Bemer therapy has proven to be the most successful way to combat any type of pain. BEMER therapy is electromagnetic physiotherapy from Switzerland, the main goal of which is to improve blood circulation.

The Bemer device consists of three elements: an induction mattress aimed at general health improvement, a reinforced applicator - a device that allows you to influence a specific place, and a laser magnet, which has the strongest effect on the pain point

read more about Bemer therapy by following the link. If you want to get a consultation or make an appointment, you can do this using the feedback form or by phone: +7-495-212-08-85