Dear Ask The Doctor: My husband complains of severe pain in his left leg which only occurs in the morning when he wakes up to go to the bathroom to urinate. He says that the pain is so bad that he can't lay down, sit or stand. The pain will last for almost 45 minutes as he tries to find a comfortable position for his leg. Usually if he sits on the bed with his left leg outstretched and his back leaning towards the leg, the pain will subside. However more recently that position has not helped. He has taken pain relievers, but they don't help either. I have told him that he needs to have this checked, but he thinks it is just a pinched nerve that will eventually go away with exercise. Can you tell me what this condition might indicate?
Dear Patient: There are many causes of non-traumatic leg pain. Pain in the legs may be present because of several conditions that may affect joints, muscles, tendons, ligaments, blood vessels, skin or nerves. So as you see there is a vast array of diseases that can be causing the type of pain that you described, vascular causes have to be ruled out (PAD) and also other important causes of leg pain: as nerve compression at the lumbar level of the spine, and also your husband is diabetic, what you describe may be symptom of a possible diabetic neuropathic pain. After your doctors rule out those causes, just remain if he can relate those pains with a physical stress that he might have done, give it a try with anti inflammatory medication for one week (“Advil”, “Motrin”). And finally if your husband is overweight, try to lose weight. If the pain in the leg is associated with low back pain, then a nerve compression has to be rule out. The back pain associated to a nerve compression can produce an inflammatory process that affects nerve roots (neuritis), and it manifests as traveling pain to the lower limbs and other symptoms as numbness. On the other hand this can be just a leg cramp. Muscle cramps are extremely common, and nearly everyone experiences a cramp at some time in their life. Cramps are common in adults and become increasingly frequent with aging. Cramps of the extremities, especially the legs and feet, and most particularly the calf (the classic "charley horse"), are very common. Muscle cramps are felt to be caused by excessively excited nerves that stimulate the muscles. This can occur particularly after injury to nerve and/or muscle; dehydration with low blood levels of calcium, magnesium, or potassium; from certain medications; and even at rest. The pain that is associated with muscle cramps that are caused by poor circulation to the legs that worsens with walking is referred to as claudication. Deficiencies of certain vitamins or minerals, including iron deficiency, thiamine (B1), pantothenic acid (B5), and pyridoxine(B6), can also cause muscle cramps.