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Leg pain is a sign of disease

By Jeremy Cockerill | December 18, 2009

DEAR DR. DONOHUE: About four to six months ago, you wrote about pain in the calves. I suffer from this problem. Would you repeat the information for me? - V.G.

ANSWER: The topic was peripheral artery disease, also called peripheral vascular disease. “Periphery,” when used here, refers to the arms and legs (mostly the legs). The buildup of plaque - cholesterol, fats and other materials - within leg arteries obstructs the flow of blood to leg muscles. The result is pain on exercise, since exercise requires an increased blood supply. Obstructed arteries can’t provide it. It’s as though a tight tourniquet is tied around the legs.

Pain arises in areas downstream of the obstruction. If an artery high up in the legs is blocked, then the pain is felt in the buttocks, hips or thigh. If the obstruction is lower in the thigh, pain is felt in the calves, and that’s where many patients have their pain.

When doctors examine the legs of people with peripheral artery disease, they can’t feel a pulse, as they can in normal people’s legs. One good test is blood pressure measurement at the ankle. Ordinarily, it should be the same as blood pressure in the arm. If ankle blood pressure is much lower than arm blood pressure, that’s evidence of leg artery obstruction.

The same kind of diet that people with blocked heart arteries follow should be the kind of diet for those with peripheral artery disease - one low in fat, high in grains, fruits and vegetables, and low in red meat. An exercise program is essential. People start out modestly by walking for five or 10 minutes. Walk to the point of pain, stop and then start again when the pain leaves. Progressively increase the time and pace of the walk. Aspirin, Pletal and Plavix are medicines frequently prescribed for this condition. Blood pressure and cholesterol have to be controlled.