Causes of Vascular Pain in Lower Limbs
The manifestations are diverse and their presentation helps us differentiate the etiology of pain.
Pain is the most frequent cause of medical consultationis an unpleasant sensitive and emotional experience, associated with a real or potential tissue injury, in this case we will talk about pain located in the lower limbs.
It is worth mentioning that there are multiple causes of pain in the lower limbs and they are the following:
- Injuries to the musculoskeletal systemMuscle strain due to overuse, Muscle strain or tear, Tendonitis or inflammation of a tendon, Sprains, Bone fissure or fracture)
- Vascular pathologies that include venous problems (varicose veins-thrombosis) or arterial problems (acute arterial occlusion, atherosclerosis)
- Joint Pathology such as Arthritis, Osteoarthritis, Bone or soft tissue infections, Nerve compression such as Neuropathy or Sciatica, Benign or malignant bone and soft tissue tumors, Fibromyalgia and Cramps
Pain manifestation and prevention
The manifestations are diverse and its presentation helps us differentiate the etiology of pain.
The pain due to injury to the Musculoskeletal Systemwhich almost always have a trigger such as trauma, are located at the site of the injury and are acute with functional limitation.
He pain of venous etiology, which is associated with the visualization of varicose veins or spider veins, where there is a feeling of tiredness and heaviness, especially at the end of the day, it is also associated with heat in the venous tracts, burning in the legs, cramps and edema, the symptoms worsen after sitting or standing for a long time. It is worth mentioning that, in more advanced stages of the disease, skin changes or ulcers occur.
In case of Venous Thrombosisthere is edema of the affected extremity when the deep veins are involved or if the thrombosis is of superficial veins, the veins become hard, painful and purplish.
He pain of arterial origin It can be acute of less than 14 days of evolution that is generated by occlusion of blood flow, causing intense pain in the extremity associated with coldness, pulses are lost and depending on the advanced nature of the injury, alterations in mobility and sensitivity may occur. until reaching gangrene.
But there is also the Chronic Arterial Occlusive Diseasein which one of the causes is Atherosclerosis and patients can manifest it from claudication, which is pain when walking a certain distance that improves with rest, and in more advanced cases, the pain is constant even at night and occurs wounds on the feet.
Deciphering the pain
The joint pathologies Such as Arthritis or Osteoarthritis manifest with pain localized to the affected joint with edema, functional limitation, and sometimes, they present inflammatory changes or infection.
It is worth mentioning that the bone or soft tissue infections They can manifest with inflammatory changes localized to the site of the injury with redness of the skin in case of cellulitis and in case of Osteomyelitis, an infectious lesion with bone compression and nerve compression such as Neuropathy or Sciatica.
The symptoms of the above are poorly localized pain, burning type and present with alterations in sensitivity, numbness in the legs, hypersensitivity to palpation and can also generate weakness and alteration in walking, benign or malignant tumors of bone and soft tissues that They can generally be associated with the presence of masses.
On the other hand, there appears Fibromyalgiaa disorder characterized by widespread musculoskeletal pain accompanied by fatigue and sleep, memory, and mood problems.
While, the cramps They can be related to different problems and are characterized by sudden, involuntary contractions or spasms in one or more muscles. They can occur after exercising and last from a few seconds to several minutes.
Regarding prevention, it should be said that pain is difficult to prevent, since it can occur as a response of the body to an injury, but the progression of the disease that generates it must be prevented.
In the case of venous pathology, there is a hereditary factor, but also factors that we can avoid such as Obesity and a sedentary lifestyle. In arterial pathology it is important to take into account the risk factors by avoiding smoking, a high-calorie diet, a sedentary lifestyle and letting the pain pass without consulting in time, putting the extremity at risk.
The risks of not treating the pain They depend on the etiology that causes it and can lead to loss of functionality of the extremities.alteration of the quality of life, longer healing time of the injuries and progression of the injury until loss of the limb.
Vascular Pain Treatment
The proper diagnosis generates the possibility of good treatment, not all leg pain problems are due to vascular problems.
He Treatment depends on the injury and it should be referred to the indicated specialist, in all patients an analgesic may be required and when it comes to vascular pain, a treatment should be carried out according to the pathology and the advanced nature of the disease.
In the case of venous disease, a proper diagnosis is required by performing venous duplex and treating the veins according to their involvement. In this case, the use of elastic compression stockings is recommended, if there is no contraindication to their use, and phlebotonic medications that can help improve symptoms.
For spider veins, Sclerotherapy and Laser may be indicated, larger veins can be managed with surgery depending on the veins affected and their size. Conventional surgery can be used with resection of the affected veins, thermoablation with Laser or Radiofrequency, Sclerofoam or a combination of techniques and in advanced cases, healing of the ulcers will also be required.
In case of the Arterial Disease It also depends on the stadium. In patients with claudication, management is medical with supervised exercise therapy; control of underlying diseases and strict surveillance, although patients with threatened limbs, with constant pain or ulcers are operated on and, depending on the diseased arteries, endovascular management can be performed.
Endovascular management consists of dilation of the arteries with a balloon or placement of a stent or surgery.
These treatments are aimed at improving circulation in the limb, improving pain and accelerating the closure of the ulcer to save the limb. In special cases, medications such as prostaglandins or stem cell transplant can be used, but In very advanced cases, amputation of the limb or fingers may be required.
However, every day there are more innovations and new techniques are minimally invasive endovascular, without the need for an operating room, with little disability, using laser technology and diagnostic support in the intervention.
Age and other factors can damage the lower limbs
Pain of the musculoskeletal system They are more common in people who do physical activity, especially young people., whether men or women. Venous problems are more common in middle-aged women with family inheritance and Obesityin addition to the use of oral contraceptives.
Arterial problems, in the case of acute occlusions, frequently occur in patients with cardiac pathology.. And chronic occlusive arterial disease occurs in patients with a history of smoking. It is more common in men over 60 years of age with a history of HTN, High Cholesterol and Diabetes.
Regarding joint pathology such as ArthritisIf it is due to infection, it is generated especially after trauma or by distant seeding of bacteria or it can also be generated by autoimmune diseases.
The Osteoarthritis, generally degenerative, occurs in elderly people. Nerve involvement such as Neuropathy or Sciatica occurs in patients with spinal pathology, benign or malignant bone and soft tissue tumors.
It is worth mentioning that they will be primary, especially in young patients, who, depending on age, there are different categories. It also originates in elderly people, but is classified as secondary to metastasis and Fibromyalgia.