Don’t suffer in silence. There’s often a remedy.
HEALTH The sensation of stepping out of bed or even standing up from a sitting position onto pins and needles is an unappealing prospect some people must endure every day. This can turn a simple a trip to the restroom into a test of balance and endurance.
That pain in your leg could be an early-warning signal of a potential cardiac or pulmonary problem. Your doctor will want to rule out several possible causes. This article distinguishes four common ailments associated with pain in lower extremities.
Deep Vein Thrombosis (DVT)
Basically DVT is a blood clot occurring within a deep vein surrounded by muscle. It most commonly develops in the calf but may spread upwards to the thigh. Rarely, it can be present within arms. Small clots may not manifest any symptoms and dissolve without intervention over time. Large clots can restrict or completely block blood flow, producing the following symptoms:
- Leg swelling
- Pain and tenderness (weight-bearing difficulty)
- Change in skin color (redness)
- Peripheral fever (warm to the touch)
Immobility, hypercoagulation and trauma can precede DVT. A pulmonary embolism is the most serious complication of DVT. This is when a blood clot breaks off and travels to the lungs where it blocks one of the blood vesseles. Post thrombotic syndrome (blood pooling in lower leg) can eventually lead to long-term pain and, in extreme cases, leg ulcers. Limb ischaemia is another rare complication of DVT, where peripheral blood pressure increases in the affected leg.  This can lead to infectious skin ulcers and gangrene. A cardiologist and sometimes a physiatrist or rheumatologist may be consulted for treatment options.
Peripheral Artery Disease (PAD)
PAD is related to atherosclerosis, whereby fatty material thickens and hardens in the walls of the arteries. Oxygenated arterial blood is needed throughout the body. When larger arteries harden and narrow, lower extremities may suffer oxygen deprivation. This results in claudication, or painful cramping of the leg muscles in the calf, buttocks or thighs. Cold or bluish color (cyanosis) feet and lack of hair are symptomatic of decreased oxygenation. Gangrene may develop, which can lead to foot or leg amputation. PAD is often treated with medication, angioplasty, a stent, excimer laser ablation, or arterial bypass. 
Diabetic Peripheral Neuropathy (DPN)
Diabetes can affect multiple organs such as the kidneys, eyes, teeth, and circulatory system. Nerves can also be damaged in the case of DPN. This results in either "pins and needles" sensations or a numbing lack of most sensory perception. An ever present danger for DPN patients is that they may cut their foot and be unaware it. This could lead to infection, and with poor circulation, gangrene. Hence, those with diabetes are encouraged to regularly check their feet even if they feel no pain. But diabetes is not the only cause of neuropathy. There are more than 100 known factors that can lead to peripheral nerve damage.  This is a complex issue that may involve care from several specialists, including internists, dieticians, neurologists, cardiologists, podiatrists, and endocrinologists.
Restless Leg Syndrome (RLS)
RLS is a chronic neurological disorder that often interferes with sleep. Patients report throbbing, creeping, or other unpleasant sensations in the leg(s). There may be uncontrollable, and sometimes overwhelming, urge to move them primarily during the night when a person is relaxing. Paresthesias (abnormal sensations) or dysesthesias (unpleasant abnormal sensations) range in severity from uncomfortable to irritating to painful. 
Because moving the legs (or other affected parts of the body) relieves the discomfort, people with RLS often keep their legs in motion to minimize or prevent the sensations. They may pace the floor, constantly move their legs while sitting, and toss and turn in bed. RLS is treated with various dietary or lifestyle changes and sometimes medical prescriptions.
|Condition||Differential Symptom (in many cases)||Medical Specialty|
|DVT||Warm leg swelling; weight-bearing pain||Cardiovascular|
|PAD||Cold muscle cramps, leg hair loss, diabetes possible||Cardiovascular|
|DPN||Pins and needles, leg or foot paresthesia, numbing, diabetes likely||Neurological|
|RLS||Throbing, pulling, creeping, pain paresthsias or dysesthesias in legs||Neurological|
This is not an exhaustive list of conditions. Raynaud's phenomenon or acrocyanosis can cause temporary vasoconstriction in extremities, which may at times be painful. With these autoimmune disorders, sometimes wearing socks that are too tight can compound pain by reducing circulation. Arthritis or lupus can cause joint pain. The sensation of "pins and needles" (paresthesia) is infrequently a symptom of anxiety though it can also be the result of compressed nerve in the lumbar spine. Sometimes leg discomfort is caused by trauma or joint deterioration. Autonomic disorders may also be indicated.
DVT, PAD and DPN can all lead to gangrene and limb amputation but each has a different physiological origin. Proper circulation keeps blood from pooling and clotting. Sedentary positions have the effect of folding a water hose; flow is restricted. Physical therapy may be therapeutic. Increased sodium intake (salty foods or snacks) and insufficient water consumption combined with sedentary lifestyle, particularly sitting on a chair that restricts blood flow at the back of the thighs, is a dangerous combination. A regular program of physical activity, even walking and stretching, is recommended to improve circulation and break up small clots before they grow and cause harm. [6-8] You can add simple activities throughout the day to augment your aerobic routine. Exercise is less expensive and may offer less side effects than medical prescriptions. When clotting or claudication is advanced, a prescription may be a prerequisite to exercise.
On occasions, a person can suffer from multiple ailments causing leg pain.  Don't accept leg discomfort as a normal aspect of aging. If you have frequent pain or numbness in your lower extremities, consult your doctor. Early diagnosis and treatment can save a limb, prevent a pulmonary embolism, and improve your quality of life.
- Deep Vein Thrombosis. MedicineNet.com
- Peripheral artery disease and exercise. revolutionhealth.com
- Nerve Pain Peripheral Neuropathy. PainClinic.org
- Restless Legs Syndrome Fact Sheet. National Institute of Neurological Disorders and Stroke, ninds.nih.gov
- Peripheral Neuropathy. MayoClinic.com
- The Pain of Diabetes: Peripheral Neuropathy. 6 Diet Tips to Help Manage Diabetes Nerve Pain. MedicineNet.com
- The Pain of Diabetes: Peripheral Neuropathy. Diabetes & Exercise. WebMD
- Why your desk job is slowly killing you. msnbc.com
- Double Whammy: When PAD Complicates Peripheral Neuropathy DiabetesHealth.com