Leg Pain
This section deals with causes of pain arising from local lesions within the leg, or referred into the leg. Pain in the leg is a common complaint and the majority of cases are of vascular or orthopaedic origin. Joint problems are dealt with in the section on Joint disorders (p. 267).
History
Traumatic
Obvious history of trauma.
Inflammatory
History of joint swelling, stiffness, limitation of movement. Pain on walking. There may be an obvious history of rheumatoid arthritis with signs elsewhere, e.g. the hands. Reiter’s disease – conjunctivitis, urethritis. Ankylosing spondylitis – stiffness of the spine, especially in the morning; hip and knee involvement.
Infective
Cellulitis may arise from puncture wounds, e.g. insect bites or in a lymphoedematous leg. The patient presents with pain, redness, tenderness, malaise and fever. Myositis may occur in association with collagen diseases, e.g. scleroderma, dermatomyositis. Osteomyelitis is rare but more common in childhood. History of immunosuppression or diabetes. Recent history of infection elsewhere. Pain aggravated by movement. Swelling and redness of the affected area. Septic arthritis presents with a red, hot, tender, painful joint. More common in children. In adults, enquire about a history of steroid therapy or diabetes.
Degenerative
Osteoarthritis presents with pain, stiffness and deformity. The pain is often worse on starting walking and then improves. Baker’s cyst presents with a lump behind the knee. The patient may complain of pain and swelling of the calf if the cyst ruptures. With meniscal lesions, there is usually a history of twisting the knee, e.g. playing football. The knee may lock.
