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What could be causing leg pain that resembles climbing too many stairs?
A couple months ago I started having unexplained pain and mobility loss in my legs. The best way I can describe the symptoms is to ask you to imagine climbing up 30 flights of stairs and then imagine how your legs would feel. Well that is how my legs feel every day now, some days are worse than others but the pain and stiffness are always present. Let me clarify the symptoms...
When I say "stiffness" I do NOT mean inflexible but rather that the muscles of my legs are **resisting** moving as if I was wearing a set of very heavy shoes. Bending my knees by using only the muscles in my legs is slow and generally I cannot fully bend my knees this way. Standing and bending one leg I cannot get the knee even as high as my hip. However if I bend my knees using my hands to assist, then my range of flexibility is perfectly normal. Using my hands I can bend my knee almost to my chest. This symptom is now present at all times though it varies in intensity from mild to severe.
The pain I am experiencing is of two kinds and located in several different areas. Each of these areas seem to have independently varying levels of intensity (one area can hurt while another does not). What is interesting/odd is that the presence (or absence) of these pains seems to be symmetrical (for example: one time my feet hurt and my calves did not, another time only my calves and knees hurt, but each time the pains were present/absent in BOTH legs.
The first kind of pain is like a bruised feeling and is mostly on the bottoms of my feet (but also has been present elsewhere at times, like the inside of my legs about 6 inches above the insteps). It feels like I ran barefoot on a big pile of round gravel or river stones. Pressing on the soles of the feet produces a strong pain, again like what you would experience when pressing on a deep bruise. There is however no discoloration and the pain is sometimes present and sometimes not. The highest concentration of this type of pain is along the inside edge of the arches which I know suggests plantar fascitis but as far as I know that condition, like bruises, does not simply come and go randomly.
The second kind is pain is a general but intense aching of various muscle groups: the calves, the muscles in the back of the knees, the muscles on the top of the feet, the muscles on the inside of the shin (over the tibia?) Again this pain suggest heavy exertion even though no such exertion has happened. There is however NO cramping of the muscles.
Flexing and rotating the feet does produce varing levels of both kinds of pain in some of these areas.
The pain is more present the more I walk, but the stiffness is less so. Contrarywise the stiffness is more likely to show up after sitting for a while while the pain is unaffected (can be at any level) after resting. This suggest a possible circulatory issue.
A friend who is a sort of amateur reflexologist offered to give me a foot and leg rub and it dramatically helped with the symptoms for a couple of days. That combined with the symetrical nature of the pain locations suggests perhaps something neurological.
Any ideas?
When I say "stiffness" I do NOT mean inflexible but rather that the muscles of my legs are **resisting** moving as if I was wearing a set of very heavy shoes. Bending my knees by using only the muscles in my legs is slow and generally I cannot fully bend my knees this way. Standing and bending one leg I cannot get the knee even as high as my hip. However if I bend my knees using my hands to assist, then my range of flexibility is perfectly normal. Using my hands I can bend my knee almost to my chest. This symptom is now present at all times though it varies in intensity from mild to severe.
The pain I am experiencing is of two kinds and located in several different areas. Each of these areas seem to have independently varying levels of intensity (one area can hurt while another does not). What is interesting/odd is that the presence (or absence) of these pains seems to be symmetrical (for example: one time my feet hurt and my calves did not, another time only my calves and knees hurt, but each time the pains were present/absent in BOTH legs.
The first kind of pain is like a bruised feeling and is mostly on the bottoms of my feet (but also has been present elsewhere at times, like the inside of my legs about 6 inches above the insteps). It feels like I ran barefoot on a big pile of round gravel or river stones. Pressing on the soles of the feet produces a strong pain, again like what you would experience when pressing on a deep bruise. There is however no discoloration and the pain is sometimes present and sometimes not. The highest concentration of this type of pain is along the inside edge of the arches which I know suggests plantar fascitis but as far as I know that condition, like bruises, does not simply come and go randomly.
The second kind is pain is a general but intense aching of various muscle groups: the calves, the muscles in the back of the knees, the muscles on the top of the feet, the muscles on the inside of the shin (over the tibia?) Again this pain suggest heavy exertion even though no such exertion has happened. There is however NO cramping of the muscles.
Flexing and rotating the feet does produce varing levels of both kinds of pain in some of these areas.
The pain is more present the more I walk, but the stiffness is less so. Contrarywise the stiffness is more likely to show up after sitting for a while while the pain is unaffected (can be at any level) after resting. This suggest a possible circulatory issue.
A friend who is a sort of amateur reflexologist offered to give me a foot and leg rub and it dramatically helped with the symptoms for a couple of days. That combined with the symetrical nature of the pain locations suggests perhaps something neurological.
Any ideas?
"I think my doc just wants to rule out DVT..."
That's entirely reasonable.
Let's presume for the moment that the US will show no venous clots and no serious artery plaque.
Here's a quick 5 second muscular test, since you seemed to have mentioned the shin/anterior-chamber area:
can you walk on your heels like a penguin? Not a joke.
https://www.mda.org/disease/facioscapulohumeral-muscular-dystrophy/signs-and-symptoms
Also, Creatine Kinase is released into circulation when muscle cells break down. I'd write to your doc today and ask for that test.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4233647/
"A PATTERN RECOGNITION APPROACH TO THE PATIENT WITH A SUSPECTED MYOPATHY"
Or maybe you've had that already?
That looks like a very good article to work through.
"Creatine kinase (CK) is an extremely useful laboratory study for the evaluation of patients with a suspected myopathy. The CK is elevated in the majority of patients with muscle disease but may be normal in slowly progressive myopathies. The degree of CK elevation can also be helpful in distinguishing different forms of muscular dystrophy."
That's entirely reasonable.
Let's presume for the moment that the US will show no venous clots and no serious artery plaque.
Here's a quick 5 second muscular test, since you seemed to have mentioned the shin/anterior-chamber area:
can you walk on your heels like a penguin? Not a joke.
https://www.mda.org/disease/facioscapulohumeral-muscular-dystrophy/signs-and-symptoms
Also, Creatine Kinase is released into circulation when muscle cells break down. I'd write to your doc today and ask for that test.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4233647/
"A PATTERN RECOGNITION APPROACH TO THE PATIENT WITH A SUSPECTED MYOPATHY"
Or maybe you've had that already?
That looks like a very good article to work through.
"Creatine kinase (CK) is an extremely useful laboratory study for the evaluation of patients with a suspected myopathy. The CK is elevated in the majority of patients with muscle disease but may be normal in slowly progressive myopathies. The degree of CK elevation can also be helpful in distinguishing different forms of muscular dystrophy."
1 Comments
No problem with the penguin walking so I'll take that as good news. I have been referred for consultation to an ortho specialist in about a week so maybe he will be familiar with this CK and other diagnostic methods.
"The pain is more present the more I walk..."
As I recall, that is a symptom of claudication. The leg muscles don't get enough O2. So that's similar to angina pain in the heart caused by exertion.
=====================
"I came here because I believe two heads are better than one."
If you do not have claudication, then it's likely something more mysterious and uncommon, and so I'd think of trying things like the following:
Do a websearch for--> DDx muscle pain weakness
and/or for--> DDx fibromyalgia
(not because you have fibromyalgia, but because that might turn up some leads)
E.g,. those might lead to 'mitochondrial dysfunction'. Or to folate deficiency -- or other nutrient deficiencies, especially if you have an unusual diet or any gut problems that might result in some malabsorption.
Or more rare, a muscular dystrophy, or a neuromuscular junction disease. Or Channelopathies.
So you'd be compiling a list of possibilities, and then seeing how your symptoms match, or not, to each possibility. That can possibly give you clues which docs to seek out, and what tests to ask for.
As I recall, that is a symptom of claudication. The leg muscles don't get enough O2. So that's similar to angina pain in the heart caused by exertion.
=====================
"I came here because I believe two heads are better than one."
If you do not have claudication, then it's likely something more mysterious and uncommon, and so I'd think of trying things like the following:
Do a websearch for--> DDx muscle pain weakness
and/or for--> DDx fibromyalgia
(not because you have fibromyalgia, but because that might turn up some leads)
E.g,. those might lead to 'mitochondrial dysfunction'. Or to folate deficiency -- or other nutrient deficiencies, especially if you have an unusual diet or any gut problems that might result in some malabsorption.
Or more rare, a muscular dystrophy, or a neuromuscular junction disease. Or Channelopathies.
So you'd be compiling a list of possibilities, and then seeing how your symptoms match, or not, to each possibility. That can possibly give you clues which docs to seek out, and what tests to ask for.
2 Comments
...adding in things like age of onset, family history, any event that might have set it off originally: like a bad cold or an accident or traveling...
Thanks for all the various paths to explore. Beyond the serious risks associated with blood clots and cardiovascular issues, my big "fear" is some sort of degenerative issue. Hopefully not and hopefully this is a fixable / manageable condition whatever it is. Right now I just want to get it identified so we can start taking some kind of action. It is the not knowing that is the most stressful.
Hi, koldman. I'd say that
CurfewX's suggestion about impaired circulation in the legs is an excellent place to start.
You can read up a bit on 'claudication', especially if you have risk factors for atherosclerosis (high BP, high LDL etc).
https://www.mayoclinic.org/diseases-conditions/claudication/diagnosis-treatment/drc-20370959
While you're waiting to get a Doppler ultrasound (the kind that shows blood flow), there is a simple test that you can even DIY - using just a blood pressure cuff.
https://www.mayoclinic.org/tests-procedures/ankle-brachial-index/about/pac-20392934
It's just comparing BP in the ankles to that in the upper arm. Maybe your GP did that already? That would be pretty much standard procedure for leg pain in anybody >50yrs -- especially because claudication is often a harbinger that the heart is also undergoing similar blockage.
CurfewX's suggestion about impaired circulation in the legs is an excellent place to start.
You can read up a bit on 'claudication', especially if you have risk factors for atherosclerosis (high BP, high LDL etc).
https://www.mayoclinic.org/diseases-conditions/claudication/diagnosis-treatment/drc-20370959
While you're waiting to get a Doppler ultrasound (the kind that shows blood flow), there is a simple test that you can even DIY - using just a blood pressure cuff.
https://www.mayoclinic.org/tests-procedures/ankle-brachial-index/about/pac-20392934
It's just comparing BP in the ankles to that in the upper arm. Maybe your GP did that already? That would be pretty much standard procedure for leg pain in anybody >50yrs -- especially because claudication is often a harbinger that the heart is also undergoing similar blockage.
4 Comments
I hope to have the ultrasound authorized by today. I am supposed to hear about the ref on the ultrasound today, doc said it was to "detect possible blood clots" so I am not sure if it will be this "doppler" type or not. Interesting idea on the arm vs ankle BP test ... simple tests lie that I think are far too often overlooked. My BP is normally very good (115/75) but the last two visits (both in the past 30 days after all the pain and stress of this started) showed about 135/80. My LDL is okay so far. Doc also drew blood for a "d-dime" test. I am expecting to get the ultrasound referral sometime today.
D-dimer is a sort of breakdown product of clots. Your doc is apparently focusing on DVT, which is not claudication in the arteries, but instead is clotting in the veins.
CurfewX had mentioned both arteries and veins, but since you didn't say the classic symptoms of DVT (swelling, redness, warmth...) I was looking more to the artery side. But you never know.
Your ultrasound will likely therefor be a 'compression ultrasound' (they press down with the probe), maybe followed by the Doppler -- which probably then would also presumably see any artery blockage.
If you are prone to clotting, you should avoid sitting for very long periods. If you get a cut, does it take a long time or a short time to stop bleeding?
Not to be alarmist, but if you feel sharp pain in your chest that could be a clot that moved to the lung, so go to ER immediately -- that could be a fatal PE. That is not likely for you, but just be aware. The Surgeon General made a big deal of this about 10 years ago.
But don't take any blood thinners until after your testing, because that could mask the condition.
Make sure you post the ultrasound report, okay? :) You can also ask the tech right then what they see, many won't tell you but some will.
CurfewX had mentioned both arteries and veins, but since you didn't say the classic symptoms of DVT (swelling, redness, warmth...) I was looking more to the artery side. But you never know.
Your ultrasound will likely therefor be a 'compression ultrasound' (they press down with the probe), maybe followed by the Doppler -- which probably then would also presumably see any artery blockage.
If you are prone to clotting, you should avoid sitting for very long periods. If you get a cut, does it take a long time or a short time to stop bleeding?
Not to be alarmist, but if you feel sharp pain in your chest that could be a clot that moved to the lung, so go to ER immediately -- that could be a fatal PE. That is not likely for you, but just be aware. The Surgeon General made a big deal of this about 10 years ago.
But don't take any blood thinners until after your testing, because that could mask the condition.
Make sure you post the ultrasound report, okay? :) You can also ask the tech right then what they see, many won't tell you but some will.
It would be very unusual to get a DVT in both legs starting at the same time, so that's another thing that tends against DVT. But you never know.
I'd ask the GP why they didn't automatically do the ankle/brachial BP test.
I'd ask the GP why they didn't automatically do the ankle/brachial BP test.
I think my doc just wants to rule out DVT rather than making it a strong suspect. She also asked about any sensation of hot/cold too. My clotting is pretty normal. I've never had any doctor comment otherwise, including surgeons and dentists who would certainly notice such things. My work involves sitting for extended periods but I try to move around whenever I can. As for why not the A/B BP test, I can only guess they are unfamiliar with it. Odd considering they used to work in an ER before going into private practice, I would think such a simple non-invasive test would be handy in an ER but maybe not.
Ask your physician to order an ultrasound on the veins in your legs. Fatigue and pain like this is often associated with restricted blood flow through the legs - narrowing of either arteries or veins. I don't know how old you are, but obviously this is more common in people over 50. I've had two male friends who were diagnosed with this problem. Both managed the condition through a same-day surgery.
For your foot problem - well, this sounds like what I and my mother both experience. IF it's the same thing, and I obviously can't diagnose that it is, it is, believe it or not, related to the tendons in your heel and ankle. I described it as feeling like someone had pounded my heels and feet with a hammer, and mine DID come and go. Gentle stretching exercises were recommended; for example, I was told to do a bit of a lunge, then slowly raise and lower the back heel up and down 10 times, then switch which leg was in the back, and do this several times per day. It really does help me, so may be something to try for you.
For your foot problem - well, this sounds like what I and my mother both experience. IF it's the same thing, and I obviously can't diagnose that it is, it is, believe it or not, related to the tendons in your heel and ankle. I described it as feeling like someone had pounded my heels and feet with a hammer, and mine DID come and go. Gentle stretching exercises were recommended; for example, I was told to do a bit of a lunge, then slowly raise and lower the back heel up and down 10 times, then switch which leg was in the back, and do this several times per day. It really does help me, so may be something to try for you.
2 Comments
My primary doctor has requested an authorization (danged gatekeepers) for exactly that, an ultrasound of the legs because of the pain in my calves. And yes, I am in my mid-50's. What kind of surgery fixed this?.
They put some stents in. He's a tennis player and was playing tennis again less than a week after surgery, and his ended up being more extensive surgery than they thought. I'm glad to hear you're getting some tests done!
It is not likely that you can diagnose the cause since you do not have the training in this area. As an example, my nurse friend was in pain for decades, but never went to a professional because she was convinced it was sciatica because the symptoms were similar and sciatica is a common nursing ailment caused by lifting heavy people. Ten years ago she made one visit to a chiropractor who does active release therapy and discovered that her self-diagnosis was wrong because he fixed her and she has never had any pain or problem since. If she hadn't seen this pro, she would have spent another decade in pain.
No one can diagnose from here, so I suggest you see your doc or someone with training and work experience dealing with body pains. Doctors don`t do rehab, but might give you a good diagnosis of what your problem is and how to resolve it on your own if that is possible.
I don't know anything about reflexology but the guy who fixed my friend snorted when she mentioned reflexology. On the other hand, you think the amateur reflexologist seems to have helped, so perhaps the rub is all you need or else some of the problem might be in your imagination.
There is no substitute for a trained professional when it comes to body pain relief, unless it is a free rub from a friend if it works.
No one can diagnose from here, so I suggest you see your doc or someone with training and work experience dealing with body pains. Doctors don`t do rehab, but might give you a good diagnosis of what your problem is and how to resolve it on your own if that is possible.
I don't know anything about reflexology but the guy who fixed my friend snorted when she mentioned reflexology. On the other hand, you think the amateur reflexologist seems to have helped, so perhaps the rub is all you need or else some of the problem might be in your imagination.
There is no substitute for a trained professional when it comes to body pain relief, unless it is a free rub from a friend if it works.
4 Comments
Sorry, did not mean to leave the false impression that I am trying to self-diagnose and self-treat. I do have a GP and frankly they are unsure what this is so they put in a referral and I am seeing an ortho doctor next month (insurance gatekeepers make the process so slow) but I was hoping for some suggestable avenues of investigation for my doctors. The pain seems to be growing worse, mobility is decreasing, and because the process of getting referrals is so time consuming I am hoping to narrow the avenues of exploration to more likely causes.
What I am looking for in short is if these symptoms suggest some known condition, then what issue(s) are suspected and what kind of doctor would be a "best bet" / "first choice" for consulting to confirm or eliminate said suspect(s)? Ortho? Circulatory? Neuro? etc ...
I came here because I believe two heads are better than one. I believe in the power of multiple specialists pooling their knowledge and experience. I have sadly experienced the OPPOSITE of that. That experience has made me pro-active in my own medical care and so I am here now that I need those "two heads".
Years ago a family member had ONE simple symptom: a "constant burning pain" sensation in her upper legs ... she described it as "having a blowtorch on her skin 24/7" ... she spent two months in agony as she went from doctor to doctor, specialist to specialist ... each doctor saw things only from their own field of specialization and so she received eight different diagnoses (prickly heat, bursitis, fungal infection, muscle trauma, etc) all of which were wrong ... eventually it was an out-of-network doctor who ran a simple finger-prick blood sugar test and correctly identified it as diabetes + diabetic neuropathy. He called her group and demanded she be seen by a neurologist (she had already been seen by an in-house endocrinologist who, like all the other doctors, had not bothered to actually check her blood sugar) ... the neuro prescribed gabapentin + elavil and the pain vanished in a matter of hours.
Now the lessons I learned from this experience are as follows:
(1) Nobody knows the patient better than the patient. Doctors need to LISTEN to their patients ... her one symptom (constant burning pain) description was a textbook description of symptoms for either (a) neuropathy or (b) causalgia/CRPS ... the latter being a time-sensitive condition that could have been catastrophic with all the delays in diagnosis.
(2) Specialists can be awesome and wonderful, or they can be overspecialized and have tunnel vision. Amazing how a bursitis specialist saw neuropathy as bursitis. A pain management specialist dared to suggest she was faking it and just wanted drugs.
(3) Doctors need to run appropriate tests to confirm/eliminate possibilities. To this day I am amazed that NOT ONE of her first 7 doctors checked her blood sugar levels, not even the endocrinologist. They all saw the box on her paperwork that said "no family history of diabetes" and stopped there.
(4) Patients need to be proactive in their own care. Doctors are not gods and do not know everything (though I have met some who believe otherwise). To be proactive a patient needs to be informed.
What I am looking for in short is if these symptoms suggest some known condition, then what issue(s) are suspected and what kind of doctor would be a "best bet" / "first choice" for consulting to confirm or eliminate said suspect(s)? Ortho? Circulatory? Neuro? etc ...
I came here because I believe two heads are better than one. I believe in the power of multiple specialists pooling their knowledge and experience. I have sadly experienced the OPPOSITE of that. That experience has made me pro-active in my own medical care and so I am here now that I need those "two heads".
Years ago a family member had ONE simple symptom: a "constant burning pain" sensation in her upper legs ... she described it as "having a blowtorch on her skin 24/7" ... she spent two months in agony as she went from doctor to doctor, specialist to specialist ... each doctor saw things only from their own field of specialization and so she received eight different diagnoses (prickly heat, bursitis, fungal infection, muscle trauma, etc) all of which were wrong ... eventually it was an out-of-network doctor who ran a simple finger-prick blood sugar test and correctly identified it as diabetes + diabetic neuropathy. He called her group and demanded she be seen by a neurologist (she had already been seen by an in-house endocrinologist who, like all the other doctors, had not bothered to actually check her blood sugar) ... the neuro prescribed gabapentin + elavil and the pain vanished in a matter of hours.
Now the lessons I learned from this experience are as follows:
(1) Nobody knows the patient better than the patient. Doctors need to LISTEN to their patients ... her one symptom (constant burning pain) description was a textbook description of symptoms for either (a) neuropathy or (b) causalgia/CRPS ... the latter being a time-sensitive condition that could have been catastrophic with all the delays in diagnosis.
(2) Specialists can be awesome and wonderful, or they can be overspecialized and have tunnel vision. Amazing how a bursitis specialist saw neuropathy as bursitis. A pain management specialist dared to suggest she was faking it and just wanted drugs.
(3) Doctors need to run appropriate tests to confirm/eliminate possibilities. To this day I am amazed that NOT ONE of her first 7 doctors checked her blood sugar levels, not even the endocrinologist. They all saw the box on her paperwork that said "no family history of diabetes" and stopped there.
(4) Patients need to be proactive in their own care. Doctors are not gods and do not know everything (though I have met some who believe otherwise). To be proactive a patient needs to be informed.
This is an aside related to your comment about the chiropractor "snorting" at reflexology ... this is really kind of funny since for so many years the professional medical world has made fun of chiropractors and said they are not "real doctors". Pot/Kettle Syndrome?
I mentioned my friend as an "amateur" because I do understand their is a big difference between what he knows and what a skilled professional knows. Like you I do not know if reflexology or acupressure work, but I am not going to lightly dismiss them either. To me the fact that a form of massage helped only suggests an avenue of investigation and a possible form of therapy, nothing more.
I mentioned my friend as an "amateur" because I do understand their is a big difference between what he knows and what a skilled professional knows. Like you I do not know if reflexology or acupressure work, but I am not going to lightly dismiss them either. To me the fact that a form of massage helped only suggests an avenue of investigation and a possible form of therapy, nothing more.
I would see a physio/active release person because if you have a few things wrong, then they might be able to correct at least one. In fact, there might even just be one issue that has created confusing phantom pains.
I am doubting this " the presence (or absence) of these pains seems to be symmetrical .." is true or even that it can be true. It may have been just a coincidence or just a mistake you made in your attempt to identify a pattern.
Good luck.
I am doubting this " the presence (or absence) of these pains seems to be symmetrical .." is true or even that it can be true. It may have been just a coincidence or just a mistake you made in your attempt to identify a pattern.
Good luck.
I would go to a gym and do as many different leg exercises as possible taking note of how much you can lift each time. If you do this 3 times a week for a few weeks and notice increases in your limits, then you have strength improvement so may be healing. This will likely be useful info for anyone attempting to diagnose you.
I was diagnosed with a brachial plexitis attack which destroyed the nerves in one arm and shoulder but a BP attack goes away and your body will rebuild if you exercise. Without nerves the muscles atrophy. Then the nerves naturally grow back a few millimeters per day and after many boring weight lifting sessions starting with incredibly small weights (which were all I could lift) I got back to normal a few years later.
The reflexologist has less training than the chiro guy which is why he didn't think it was a good option. He fixed me a few times and has pictures of famous athletes with testimonials about how great he is - fwiw.
I was diagnosed with a brachial plexitis attack which destroyed the nerves in one arm and shoulder but a BP attack goes away and your body will rebuild if you exercise. Without nerves the muscles atrophy. Then the nerves naturally grow back a few millimeters per day and after many boring weight lifting sessions starting with incredibly small weights (which were all I could lift) I got back to normal a few years later.
The reflexologist has less training than the chiro guy which is why he didn't think it was a good option. He fixed me a few times and has pictures of famous athletes with testimonials about how great he is - fwiw.
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