Lower Leg Pain

Differential Diagnosis
A SELECTION OF ARTERIAL CAUSES
Peripheral Arterial Disease
 Description
 Peripheral arterial disease is also known as
atherosclerotic lower extremity artery occlusive disease.
The arteries that supply the legs become increasingly
narrowed, restricting the legs from the necessary blood
supply. This disease can put a patient at increased risk of
myocardial infarction, ischemic strokes, and
cardiovascular death; as well as adverse limb events
including amputations.
 Causes
 ​vascular changes
 atherosclerosis
 can be exercise-induced
 vessel kinking
 high cardiac output increases stress on vessels
 Peripheral Arterial Disease
 Signs & Symptoms  critical limb ischemia - emergency
 Intermittent Claudication
 ischemic rest pain for more than 2 weeks
 calf pain or discomfort
 ischemic wounds or tissue loss
 fatigue or cramping
 possible varied leg symptoms
 gangrene
 pain in muscles other than the calf  acute limb ischemia - emergency
 exertional pain that does not limit walking  abrupt interruption of arterial blood flow
 pain that does not resolve with 10 minutes of rest  cold, painful, and pale limb
 nonhealing wounds  diminished or absent pulse
 arterial ulcerations
 sensory loss and muscle weakness
 limb hair loss
 shiny skin
 muscular atrophy
 dependent rubor and pallor with elevation
 abnormal ABI
Intermittent Claudication
 Description
 Intermittent claudication is a potential symptom of peripheral arterial disease and atherosclerosis. It
is characterized by muscle pain that occurs and worsens during exercise, but is relieved by rest. As
a result, intermittent claudication can be a serious limiting factor in a person's ability to perform
exercise and activities of daily living.
 Causes
 peripheral arterial disease
 narrowing until total occlusion of leg vessels
 atherosclerosis
 plaques that narrow the lumen of blood vessels
Intermittent Claudication
 Signs & Symptoms
 muscle pain and cramping
 a result of muscle ischemia
 exercise induced
 relieved with rest
 limited locomotion
 disabilities in walking
 disabilities in activities of daily living
 loss of palpable pulse distal to occlusion
 pallor with limb elevation
 hair loss on affected limb
 thickened, deformed, slow-growing toenails
 possible muscular atrophy
Arterial Occlusion
 Description
 An arterial occlusion is a blockage or closing of an artery, preventing proper blood flow downstream of
the occlusion. If this happens in an artery that supplies the legs with blood, then tissues of the leg can be
deprived of the necessary blood and nutrients, causing pain and other serious symptoms.
 Causes
 post-operative complication
 post-total knee arthroplasty
 arterial insufficiency
 atherosclerosis
Arterial Occlusion
 Signs & Symptoms
 limb ischemia 6 P’s
 pain
 pallor
 paresthesia
 paralysis
 pulselessness
 poikilothermia
 blood and pulse pressure changes
 death in severe and untreated cases
References
 Firnhaber, J. M., & Powell, C. S. (2019). Lower Extremity Peripheral Artery Disease: Diagnosis and Treatment. American family
physician, 99(6), 362–369.
 ​ ähwiler, R., Hirschmüller, A., Grumann, T., Isaak, A., & Thalhammer, C. (2021). Exercise induced leg pain due to endofibrosis
G
of external iliac artery. VASA. Zeitschrift fur Gefasskrankheiten, 50(2), 92–100. https://doi.org/10.1024/0301-1526/a000909​
 Hamburg, N. M., & Creager, M. A. (2017). Pathophysiology of Intermittent Claudication in Peripheral Artery Disease.
Circulation Journal: Official Journal of the Japanese Circulation Society, 81(3), 281–289. https://doi.org/10.1253/circj.CJ-16-
1286
 Huml, E. L., Davies, R. A., Kearns, G. A., Petersen, S. M., & Brismée, J.-M. (2018). Common iliac artery occlusion presenting
with back and leg pain: Case report and differential diagnosis considerations for neurogenic/vascular claudication. The Journal of
Manual & Manipulative Therapy, 26(5), 249–253. https://doi.org/10.1080/10669817.2018.1526465
 Ikuta, K., Matsumoto, T., Takayama, K., Nakano, N., Takashima, Y., Ohnishi, H., Hayashi, S., Kuroda, Y., & Kuroda, R. (2022).
Successful Conservative Treatment of an Acute Arterial Occlusion After Total Knee Arthroplasty: Report of 2 Cases and Review
of the Literature. The American journal of case reports, 23, e936295. https://doi.org/10.12659/AJCR.936295
 Li, Z., Xiang, S., Bian, Y. Y., Feng, B., Zeng, R., & Weng, X. S. (2019). Diagnosis and Treatment of Arterial Occlusion after
Knee Arthroplasty: The Sooner, the Better. Orthopaedic surgery, 11(3), 366–372. https://doi.org/10.1111/os.12494
 Spannbauer, A., Chwała, M., Ridan, T., Berwecki, A., Mika, P., Kulik, A., Berwecka, M., & Szewczyk, M. T. (2019). Intermittent
Claudication in Physiotherapists' Practice. BioMed research international, 2019, 2470801. https://doi.org/10.1155/2019/2470801
 Yang, S., Shao, Y., Yan, Q., Wu, C., Yang, H., & Zou, J. (2021). Differential Diagnosis Strategy between Lower Extremity
Arterial Occlusive Disease and Lumbar Disc Herniation. BioMed research international, 2021, 6653579.
https://doi.org/10.1155/2021/6653579