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Leg Pain

By Tom Tran PA-C, MPAs, NCCPA Surgery Board Certified

Leg PainDiagnosing Leg Pain
Leg pain can be debilitating and a bothersome aspect of one’s daily life. There are many causes of leg pain, most of which are diagnosed incorrectly or even overlooked during examination. When evaluating leg pain, it is crucial to find the source of the pain by ruling out different causes to come up with a diagnosis. To achieve a correct diagnosis, one must obtain a good history and physical exam on the patient. Also, many tests can be conducted to achieve a proper diagnosis. These things are critical in order to receive the right treatment with the right specialist.

Tests Include:
. Arterial Ultrasound (to evaluate arterial disease or PAD)
. Venous Reflux Ultrasound (to rule out a vein problem)
. Nerve Conduction Study (to rule out a neuropathy problem)
. Electromyography (to rule out a muscle problem)
. Lab Testing (to evaluate deficiencies in certain Vitamins, electrolytes)
. Muscle, Skin, or Bone Biopsy (to evaluate any abnormal cellular changes, Cancer, or musculoskeletal diseases)

Most Common Causes of Leg Pain
Two of the most common causes of leg pain include PAD (Peripheral Arterial Disease) and Venous Insufficiency.

Peripheral Arterial Disease or PAD
PAD involves blockages in the arteries (which bring blood to your legs from your heart) resulting in a diminished blood supply to your muscles, causing leg pain, cramping, and intermittent claudication (walking to where you have to rest for the pain to relieve itself and then you are able to keep walking).

It affects more than 10% of the population older than 65 years and expected to increase to 22% by 2040. 12.2% of patients with 10 years of symptoms end up requiring amputations.

PAD Causes and Symptoms
Common causes include smoking tobacco, diabetes, hypertension, hyperlipidemia, family history, and sedentary lifestyle. Symptoms are leg pain, cramping, having to stop walking to rest and then resuming, hair loss on legs, shiny skin, atrophy or smaller muscles in the legs, ulcers, numbness, and discoloration. Finding out whether you have PAD starts with having your Family Physician ask questions about your leg pain and examine your legs by palpating for pulses in your groin, behind your knee, the inside aspect of your ankle, and on the top part of your foot. If there are any indications of diminished pulses, the next step would be to order an arterial ultrasound examination. From there, depending on the results, you may need a referral to a Vascular Surgeon who specializes in PAD and has extensive training in minimally invasive techniques to correct the problem.

PAD Treatment Options
Some of the treatment options include medications alone and exercise to balloon and stent placement to bypass surgery in your legs. This is all determined by your Vascular Surgeon and your arteriogram (a dye study test to give a picture of your arteries and areas of blockage).

Venous Insufficiency
This is a defect in the valves of your veins, thus, causing blood to pull in your legs and failing to return to your heart. 40% of the population have underlying reflux (blood pulling) with 40% of those being women and 25% being men.

Causes and Symptoms of Venous
Insufficiency
Venous Insufficiency can be caused by genetics, standing or sitting for a prolonged amount of time, pregnancy, obesity, wearing high heels, traumatic episodes, blood clots in the legs, and using heavy weights or high impact exercises in the legs. These activities cause large bulging varicose veins, swelling, leg cramping, aching (mostly at night), increasing spider veins, skin color changes (dark pigmented brownish staining), dry skin, and even ulcers.

Eliminate Veins Without Surgery
To determine whether or not you have vein disease is simple. Make an appointment with a dedicated Vein Center for a Free Consultation. Most Primary Care Doctors are not well educated about vein disease, diagnosing, and treatment options. The dedicated vein center will evaluate with a careful history and physical examination. An ultrasound is performed at the vein center to determine if you have any blood pooling, the size of your veins, blood clots, and connecting veins or large varicose veins. Ultrasounds done at the Vein Center are more advanced and detailed than an ultrasound done at the hospital (which only tells you if you have a blood clot or not). Depending on the ultrasound results, there are advanced techniques to eliminate the veins without surgery. Dedicated vein centers perform office-based Laser Ablations of the underlying vein along with ultrasound guided foam Sclerotherapy or phlebectomy of the secondary veins. These procedures are an alternative to stripping and ligation and have no downtime or scarring. They are done under local anesthesia and most patients can return to work the next day.

Choose a Specialist Dedicated Exclusively
to Vein Treatment
In conclusion, to find out the cause and treatment of your leg pain requires a careful history, physical examination, testing, and going to the right specialist. Choosing the right specialist is crucial in getting the correct treatment and diagnosis of your leg pain. In order to choose the right specialist to treat you, determine how many procedures your specialist has done, how many years in that same field, and is that his/her only specialty. It is vital to choose the practitioner that only does that specialty versus one who has had minimal training to an added procedure to his/her practice. Whether it is an MD, DO, PA, or ARNP, make sure they are specialized and dedicated in that field and that it is not just an added specialty to their practice. Going to a practitioner that is not specialized in your area of concern is like going to an Italian restaurant and ordering shrimp fried rice. The shrimp fried rice would be at an enormously higher quality at a Chinese restaurant because that is their specialty; the same thing applies to your health care providers.

Tom Tran PA-C, MPAs is one of the few Physician Assistants in the US that is NCCPA Surgery Boarded. He has extensive training, which includes 10 years experience in Trauma, General, and Vascular Surgery. He invented the Transcatheter Extractor®. He was awarded Florida PA of the year in 2007, and is the current Treasurer of the National PA Foundation. He is the Clinical Director at Comprehensive Vein Center in The Villages, which has been a state of the art Vein Center designated to vein treatment for over four years. He has performed over 2,500 Laser and VNUS Closure procedures, and over 10,000 combined Ultrasound Guided foam and Visual Cosmetic Sclerotherapy procedures.

VEIN CENTER AT THE VILLAGES
(352) 259-5960  |  www.TheCBC.net

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