If you find yourself cutting a golf game short or bench mapping during a walk in the park because of leg pain, you're probably chalking it up to age. But the most likely explanation for your pain is either arthritis or peripheral artery disease (PAD), which is a narrowing of the arteries in the leg that restricts blood flow. Knowing which condition you have can potentially save your life—and will certainly relieve some of your discomfort. So how can you pinpoint what's causing the pain in your leg?
Paying Attention to Your Pain
If you have peripheral artery disease, a lack of blood flow is preventing your leg muscles from getting the oxygen they require. This problem is known as intermittent claudication, and while the pain it causes can vary, it usually appears in the calf, thigh or buttock. Typically, the pain or cramps occur during activity and will stop when you sit down, then start up again when you resume walking.
It may take a mile-long walk to trigger pain in people with mild disease. But with severe disease, pain can show up after a few steps and certain people can even experience pain when they're just resting. You may also notice numbness in the legs, discoloration or slow-to-heal sores on the legs or feet.
Arthritis, on the other hand, primarily causes pain in the joints, such as the hips and knees. "When you have arthritis in the leg, the joints will hurt more when you put weight on the leg," says David Borenstein, MD, a clinical professor of medicine at The George Washington University Medical Center in Washington, DC. "If you're sitting it won't hurt as much."
While arthritis in the knee itself tends to be localized, it can travel down the lower leg, into the shin. What can be tricky is figuring out which joint is the source of the problem, Dr. Borenstein says. For example, arthritis in the hip causes groin pain that can radiate down to the knee.
Deciphering the Diagnosis
Certain people with peripheral artery disease or arthritis in their hip or leg will blame their pain on age, or other problems. "One patient with severe PAD had a shrapnel wound, and he always assumed the pain was from the shrapnel," says Michael Criqui, MD, a professor in the department of family and preventative medicine at the University of California, San Diego. "Other people think they have a muscle strain or pull."
A delayed diagnosis of peripheral artery disease can have serious repercussions, however. "The leg pain can limit people's function," Dr. Criqui says. "PAD can even progress to the point of amputation when the tissues in the leg are very severely damaged by the lack of blood flow."
"The bigger problem," Dr. Criqui continues, "is that a blockage in the arteries in the leg can signal a blockage in the heart or the brain, so these patients have a high risk of heart attack and stroke."
To diagnosis peripheral artery disease, a doctor will not only ask you to describe your leg pain but also evaluate the blood pressure in the ankle and the arm with a test known as the ankle brachial index. This indicates whether enough blood is flowing to your legs, or if it's being blocked. You may also receive an electrocardiogram to measure the electrical impulses in your heart, or magnetic resonance imaging (MRI).
If the ankle brachial index is normal, and you have joint pain and stiffness in the legs, you may have arthritis. While there are more than 100 types of arthritis, the most common type in older people is osteoarthritis. This condition occurs when the cartilage, or the soft tissue found at the end of bones in a joint, begins to wear away and the bones in the joint rub together.
Treatment Tips
While they can both cause serious disability, there are plenty of treatment options for peripheral artery disease and arthritis. With peripheral artery disease, Dr. Criqui says, one of the first things a doctor will recommend is getting your heart disease risk factors under control. For example, smokers should quit immediately to improve oxygen delivery. Other risk factors include high blood pressure, diabetes and high cholesterol.
In addition to treating these risk factors with exercise and diet, and sometimes medication such as cholesterol-lowering statins, you may be treated with pain relievers and anti-blood clotting drugs such as aspirin. If it looks like the arteries in your legs are severely blocked, you may need angioplasty and stenting. To perform an angioplasty for peripheral artery disease, an interventional radiologist threads a catheter though an artery in groin into the leg. The plaque build-up in the arteries is pushed aside with a balloon, and the arteries are often propped open with stents. Another option is bypass surgery, where a vascular surgery would create grafts to bypass the blocked arteries.
Like peripheral artery disease, osteoarthritis can be eased with diet and exercise. Eating well and moving around more can not only get weight under control but also ease the amount of pressure on the leg joints. Doctors may also recommend non-steroidal anti-inflammatory drugs, including over-the-counter options like ibuprofen and naproxen, or other painkillers such as acetaminophen. People who have gastrointestinal problems and low heart disease risk, may be given a prescription for a COX-2 inhibitor such as Celebrex or Bextra. (The COX-2 inhibitor Vioxx was recalled on September 30.) Other arthritis options are injectable medications such as steroids, and, for some, joint-replacement surgery.
So if you're suffering from leg pain that's keeping you in the house when you'd rather be on the tennis court or playing with your grandchildren, don't accept it as just a normal consequence of getting older. As Dr. Borenstein says, "Get evaluated to determine exactly what the pain generator is."
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