Leg Pain that Goes Away with Rest
By Richard P. Holm MD
Mr. D, a diabetic patient of mine, came into the clinic with exercise induced leg pain. Iniitally the pain would go away if he stopped exercising, but now it was coming on after walking less than a block. He said, “the pain is meaner and lasts longer after I stop.”
The diagnosis of Mr. D’s condition is claudication, a condition where arterial flow to the legs is blocked. I immediately called the vascular specialist for an urgent appointment. Two weeks later the patient returned to the office after having had his blocked arteries dilated with a balloon followed by the placement of stents to hold them open. Happily, he told me he could once again walk for miles without pain.
His vascular doctor had started artery dilating meds, lipid meds, and daily baby aspirin. I renewed my encouragement for Mr. D to eat fewer calories, exercise daily, keep his blood sugars controlled, and the most important advice, “Stay away from sitting long on that darn couch. It’s like smoking.”
The narrowing process, called atherosclerosis, can be the result of genetic tendencies, diabetes, smoking, high blood pressure, high blood lipids, and even normal aging. Arteries usually narrow gradually, but atherosclerosis can sometimes trigger a clot and a sudden complete blockage resulting in a sudden, and devastating event. It can occur in coronary arteries of the heart, cerebral arteries of the brain, renal arteries of the kidneys, and peripheral arteries of the legs. And, in general, when it’s happening in one, it’s happening in all.
Narrowing of blood flow can deprive muscles, skin, ligaments, and nerves downstream of precious blood flow and oxygen, resulting in an aching and agonizing hurt that would bring anyone to their knees. When it happens in the legs, like what happened with Mr. D., the pain symptom is called claudication and the condition is called peripheral artery disease or PAD.
PAD affects five percent of all people over 50, but more than 30 percent of all diabetics in the same age group. There can be a curve ball with diabetes or with aging, as these people sometimes lose feeling in their legs and feet due to nerve destruction, setting them up for PAD without pain. The presenting sign then would be painless sores on the feet which won’t heal. This is especially treacherous because, without good blood flow, the healing is very slow and the patient, having no pain, is not as motivated to do the work required to heal ulcers.
Leg pain that goes away with rest may not sound so bad, but peripheral arterial disease is one of the most formidable challenges in modern medicine.