Leg Pain During, After Walking – Causes, Symptoms of Claudication

Leg pain while walking and after walking is not uncommon. It depends on duration, distance and physical conditioning. A person who is physically fit and conditioned to walk long distances may not experience pain during or after a long walk. A person who is not accustomed to walking for the same distance or duration may experience symptoms like leg pain and muscle cramps.

However, leg pain is not always due to strain from strenuous physical activity. Trauma is an obvious cause of leg pain. It can also be caused by a number of other diseases and disorders where walking and even standing can aggravate the symptoms like leg pain. This may be associated with the muscles and tendons, ligaments, joints or even the blood vessels and nerves in the legs.

Claudication in the Legs

Claudication is the medical term for pain due to insufficient blood flow. It is common in the legs but can also affect the arms. During physical activity the various structures in the limbs, like the muscles, need more oxygen. This is carried by the blood to the area. Therefore claudication is more likely to occur during exercise as the blood supply is insufficient.

It is important to differentiate claudication (leg pain with activity) from leg pain while resting (sleeping or sitting). However, it is important to note that leg pain with physical activity is not always claudication. From joint pain to muscle and tendon strain, there are various other causes of leg pain that does not arise with restricted blood supply. Similarly nerve damage can also cause nerve pain despite the blood supply to the leg being normal and adequate.

Causes of Leg Pain While Walking

As mentioned, leg pain when walking is not only due to limited blood supply. There are a host of other causes that can be responsible for the pain. Some of the more common causes of leg pain when walking are muscle and tendon strain as well as injury. It is therefore important to seek professional medical assistance to identify the exact cause of leg pain.

When assessing symptoms it is important to look at the onset, duration and nature of the pain as well as other symptoms. Leg pain after walking even a few steps generally indicates a more severe conditions. Similarly leg pain that does not ease with rest or is severe in intensity is likely to be caused by more serious or severe diseases and disorders.

Muscles and Tendons

Muscles are responsible for movement. By contracting and pulling on tendons, the leg muscles allow for bending at the hip,knee and ankle joint as well as the smaller toes joints which makes walking possible. The muscles and tendons can be strained with physical exertion and injury to the leg. Less commonly there can be tears of the muscles and tendons with overexertion.

From conditions like Achilles tendonitis to muscle tears, these types of injuries are more likely to occur with sports and endurance activities. The prolonged and severe strain on the muscles and tendons compromise its structure to lead to tears, especially in a person who is not physically conditioned for the activity. The lack of adequate stretching prior to exercise is also a factor.

Signs and Symptoms

• Aching or cramping pain and sometimes severe pain with tears.
• Tenderness of the affected muscle.
• Muscle spasms and cramps.
• Swelling of the leg.
• Limited range of motion involving affected muscles.

Arteries

Insufficient blood flow through the arteries is the most common cause of intermittent claudication. Here the pain is a result of ischemia which is tissue injury due to a lack of sufficient oxygen. The increased demand for oxygen by the muscle cells during activity, like walking, cannot be met due to a restricted blood. This is often as a result of atherosclerosis, blood clot formation (thrombus or embolus) and other causes of a narrowed artery.

Read more on peripheral arterial disease.

Signs and Symptoms

• Cramping or crushing pain that is more prominent in the muscles of the leg, particularly the calf but could extend to the entire thigh and buttock.
• Usually one sided – unilateral.
• Gradually starts after walking a short distance and eases a few minutes after resting.
• Affected leg may be normal to pale in color.
• No swelling is present but the area may be cool to touch.
• Leg or foot pulses may be absent or severely reduced.

Since arterial insufficiency is the most common cause, the term ‘intermittent claudication’ usually refers to arterial occlusion.

Veins

Venous claudication is leg pain that aggravates upon walking and is due to poor drainage of blood from the legs as a result of compromised veins or blockage within the vein. One of the common causes of venous claudication is a blood clot like deep venous thrombosis (DVT) and valve insufficiency as is seen in varicose veins.

Signs and Symptoms

• Burning pain, sensation of tightness or fullness (congestion) that is present through most of the leg.
• Usually one sided – unilateral.
• Develops gradually from the start of walking and eases long after resting, or only upon elevating legs.
• Normal to purple or blue in color
• Swelling almost always present.

Nerves

Also known as spinal claudication, it is due to root compression of the nerve(s) supplying the leg (lumbar spine stenosis). Degeneration of the intervertebral disc and trauma are common causes of a pinched lumbar nerve. Other musculoskeletal conditions involving the lumbar spine may also cause neurogenic claudication. Collectively these nerve conditions in the limbs are known as peripheral neuropathy.

Another relatively common neurologic condition of leg pain is diabetic neuropathy. This is where the nerves are damaged due to the high glucose levels seen in diabetes mellitus. The nerves of the legs are the more commonly affected site. Initially there is leg pain but as the condition progresses, there is loss of sensation (numbness).

Signs and Symptoms

• Shooting or burning pain through the whole leg, especially along the course of the affected nerve. It may be associated with numbness, tingling and “pins and needles” sensation.
• Usually occurs on both legs (bilateral).
• Starts immediately upon standing or walking and eases when leaning forward or sitting.
• No change in skin color.
• No swelling present.
• Ulcers may form due to injury when there is a loss of sensation.