Leg pain when walking
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Leg Pain When Walking: Causes, Diagnosis, and Treatment
Intermittent Claudication and Peripheral Arterial Disease (PAD)
Understanding Intermittent Claudication
Intermittent claudication is a common symptom of peripheral arterial disease (PAD), characterized by leg pain during walking that is relieved by rest. This pain is due to reduced blood flow to the muscles, typically caused by atherosclerosis . The ankle-brachial index (ABI) is a widely used diagnostic tool for PAD, providing a non-invasive and cost-effective method to assess blood flow and diagnose the condition.
Biomechanical Implications
Patients with PAD often exhibit impaired gait mechanics, which can be analyzed using motion capture and ground reaction force measurements. These analyses reveal that gait impairments begin with the first steps and worsen with the onset of claudication pain, affecting muscle function across the ankle, knee, and hip joints. Increased coactivation of leg muscles, particularly the tibialis anterior and gastrocnemius medialis, is observed during walking, indicating a compensatory mechanism in response to pain.
Exercise as a Treatment for Intermittent Claudication
Benefits of Exercise Programs
Exercise programs are an effective, low-risk treatment for intermittent claudication. Studies show that regular exercise significantly improves pain-free walking distance and maximum walking distance in patients with PAD . Meta-analyses indicate that exercise can lead to improvements in walking distances by up to 120 meters and enhance quality of life by improving physical and mental health scores.
Types of Exercise
Various forms of exercise, including walking, strength training, and polestriding, have been shown to be beneficial. Supervised exercise sessions, typically held at least twice a week, are particularly effective in managing symptoms and improving walking performance.
Additional Interventions
Use of Elastic Stockings
Wearing elastic compression stockings during walking can reduce leg pain and edema. A study demonstrated that walking on a treadmill while wearing these stockings significantly decreased leg volume and pain, suggesting that compression therapy can be a useful adjunct to exercise in managing symptoms.
Surgical Interventions
For patients with chronic exertional compartment syndrome (CECS), a condition that can cause exercise-induced leg pain, surgical intervention such as fasciotomy may be necessary. This procedure has shown to be beneficial in relieving symptoms and improving function in both athletic and non-athletic individuals.
Conclusion
Leg pain when walking, often due to intermittent claudication from PAD, can significantly impact quality of life. Diagnosis using tools like the ABI and biomechanical analyses can help understand the underlying mechanisms. Exercise programs are highly effective in improving walking distances and quality of life, while additional interventions like compression stockings and surgical options can provide further relief. Early diagnosis and a combination of these treatments can help manage symptoms and improve overall function.
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