When walking hurts and not because of arthritis

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Doesn’t it always seem like whenever we are told to “move more,” walking is always the suggested exercise to do?  Walking is very beneficial for the majority of people and anyone who is able to do so.  But what if it just plain hurts too much to accomplish this and it’s not because you have bad knees or hips due to arthritis?

Walking may look and appear easy but it’s not for everyone.  Some people find walking as a form of exercise to be agony and simply too painful.  Brisk walking is usually out of the question and even attempts at a slower pace can still be difficult. 

If stiff or creaky knees and hips due to arthritis are not the problem for making walking excruciating, then what is the issue?  As we age, there can be a number of conditions resulting in leg pain other than arthritis.  Here are four such conditions that could be the reason behind the struggle to walk.

1.  Peripheral artery disease

Peripheral artery disease or PAD is a condition of the blood vessels that supply the legs and feet.  It leads to narrowing and hardening of the arteries causing reduced blood flow, which can injure nerves and other tissues.  There are certain factors that make PAD more likely in some people such as smoking, high cholesterol levels, high blood pressure and diabetes.

One of the primary areas of plaque buildup in PAD is in the legs.  Plaque buildup in the legs does not always cause symptoms so many people with PAD can have it and not know it.  People who do experience symptoms, such as pain or cramping in the legs, often do not report them, believing they are a natural part of aging or due to another cause.

Common symptoms of poor leg circulation include:

·      Cramping

·      Fatigue

·      A heavy feeling in the legs

·      Pain or discomfort in the legs and buttocks during activity which usually goes away when the activity stops.  This is called “intermittent claudication.”

·      Sores or wounds on toes, feet or legs that heal slowly, poorly or not at all

·      Color changes in the skin of the feet, including paleness or blueness

·      A lower temperature in one leg compared to the other leg

·      Poor nail growth and decreased hair growth on toes and legs

The goal for treating PAD is to reduce symptoms, improve quality of life and mobility, and to prevent a heart attack, stroke or amputation.  Even though walking is not comfortable, a structured, supervised exercise program can help increase one’s ability to keep active.  What is usually suggested is to walk until it hurts, rest until the pain goes away, and then walk again.  These walk-rest-walk sessions can be very effective if a person does them for about 30 minutes several times a week. 

2. Lumbar spinal stenosis

Lumbar spinal stenosis is a degenerative, age-related narrowing of the lower spinal canal that causes pressure on the nerves, leading to pain and reduced mobility.  Symptoms include pain, numbness, or tingling in the lower back, legs, or buttocks, limiting the ability to walk or stand.

The pain caused by lumbar spinal stenosis resembles the pain caused by PAD – cramping tightness that increases with walking often felt in the thigh rather than in the calf.  The legs may also feel weak and numb.

Treatment for this condition starts with physical therapy and exercises aimed at strengthening back and abdominal muscles.  Pain relievers can also help along with getting corticosteroid injections into the spine.  But evidence is mixed as to whether the injections are effective or not.

Surgery is another option with the most common procedure being a laminectomy which involves cutting away part of the vertebra to create more space for the spinal cord and nerves. 

3.  Diabetic neuropathy

A condition people with diabetes are prone to is diabetic neuropathy (DN).  This condition is caused by nerve damage from long-term high blood sugar levels.  The most common nerve damage occurs in the legs, feet, arms, or hands. Diabetic neuropathy can affect the upper and lower legs differently.  In the upper leg, the pain from ishemic nerves can occur suddenly and be felt in just one leg.  In the lower legs and feet, the symptoms are typically numbness or tingling and are felt equally in both legs.  Numbness can dull painful sensations making it more likely that sores on feet go unnoticed and therefore, can get worse. 

To reduce the chance of developing DN, controlling blood sugar levels is vital.  Once nerve damage has occurred, tight blood sugar control may not be helpful for correcting the situation.  Otherwise, pain relievers, tricyclic antidepressants and anticonvulsants are used to control the burning and tingling sensations from DN.

4.  Chronic venous insufficiency

 The condition of chronic venous insufficiency (CVI) is when the veins cannot pump enough blood back to the heart. The most common cause of CVI is superficial venous reflux which is a treatable condition.  The legs are typically affected since the functional venous valves are required to provide efficient blood return from the lower extremities.  CVI can result in swelling, inflammation of the skin (dermatitis), ulcer formation, varicose veins and superficial venous reflux. The legs may feel achy or heavy and may even cause a feeling of a tight, “bursting’ pain usually in the groin or thigh.  Rest will help stop the pain but it can take longer to ease up than the pain from PAD.

To help alleviate the symptoms, it helps to lie on your back using a pillow to elevate the legs so blood flows downhill to the heart.  When sitting for long periods of time, pointing the toes up and down several times can flex the vein-pumping leg muscles.   Wearing compression hose helps to squeeze blood flow back to the heart from the lower extremities. 

Another treatment is to closed the vein permanently rather than remove it.  This treatment can be performed in an outpatient setting under local anesthesia with the patient being able to walk immediately after the procedure.