[53F] With chronic leg and foot pain exacerbated by activity

Patient Description

A 53-year-old female has been experiencing burning and aching pain in her calves and feet for over 10 years, with a pain severity of 8 out of 10. The pain worsens with activity, particularly bending, squatting, kneeling, and sitting on the ground, and is accompanied by swelling that comes and goes. She also reports aching pain in the arch of her foot, numbness, tingling, and muscle weakness in her legs and feet, all of which come and go. The patient has no history of diabetes, high blood pressure, or high cholesterol, and has not noticed any varicose veins or changes in the appearance of the veins in her legs. She is currently taking esomeprazole magnesium (2 capsules of 20 mg each per day) and does not take any other medications or supplements. She has no known allergies to medications. The patient has been smoking for over 30 years, averaging about 10 cigarettes per day, and consumes a couple of alcoholic drinks a few times a week. Her diet includes a lot of salty or processed foods, and she has not traveled recently.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible explanations for your symptoms:

  1. Chronic Venous Insufficiency (CVI):

    • Rationale: CVI occurs when the veins in your legs are not working effectively, making it difficult for blood to return to the heart. This can cause swelling, aching, and a burning sensation, especially after prolonged standing or activity.
    • Typical Treatments/Testing: Compression stockings, leg elevation, and physical activity can help. A healthcare provider might recommend a Doppler ultrasound to assess blood flow in your legs.
  2. Peripheral Neuropathy:

    • Rationale: This condition involves damage to the peripheral nerves and can cause pain, burning, tingling, and muscle weakness in the legs and feet. It can be exacerbated by activities like squatting or bending.
    • Typical Treatments/Testing: Blood tests, nerve conduction studies, and lifestyle changes. Medications to manage pain and physical therapy may also be recommended.
  3. Plantar Fasciitis:

    • Rationale: This condition involves inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of your foot. It can cause aching pain in the arch of the foot, especially after prolonged activity.
    • Typical Treatments/Testing: Rest, ice, stretching exercises, and supportive footwear. A healthcare provider might recommend physical therapy or orthotic devices.

What you can do

For Chronic Venous Insufficiency:

  • Compression Stockings: Wear compression stockings to help improve blood flow and reduce swelling.
  • Leg Elevation: Elevate your legs when resting to help reduce swelling.
  • Physical Activity: Engage in regular physical activity, such as walking, to improve circulation.

For Peripheral Neuropathy:

  • Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain. Be sure to follow the recommended dosage.
  • Foot Care: Take good care of your feet by wearing comfortable, supportive shoes and avoiding activities that exacerbate your symptoms.
  • Lifestyle Changes: Consider reducing or quitting smoking and limiting alcohol intake, as these can worsen neuropathy.

For Plantar Fasciitis:

  • Rest and Ice: Rest your feet and apply ice to the affected area to reduce inflammation.
  • Stretching Exercises: Perform stretching exercises for your feet and calves to alleviate pain.
  • Supportive Footwear: Wear shoes with good arch support and cushioning to reduce strain on your feet.

General Tips:

  • Symptom Tracking: Use MDandMe to journal your symptoms, track progress, and get insights. This can help you and your healthcare provider understand your condition better.
  • Healthy Diet: Aim for a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Reducing salty and processed foods can help manage swelling.
  • Hydration: Stay well-hydrated to support overall health and circulation.

What you should look out for

Given the chronic nature and severity of your symptoms, it's important to seek medical care to get a formal diagnosis and appropriate treatment. Reasons to seek care more urgently include:

  • Severe Swelling or Pain: If you experience sudden, severe swelling or pain in your legs or feet.
  • Changes in Skin Color or Temperature: If you notice changes in the color or temperature of your skin, such as redness, warmth, or coolness.
  • Numbness or Weakness: If the numbness or weakness in your legs or feet worsens or becomes constant.

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and personalized treatment plan. If you have more questions or need further assistance, feel free to continue the conversation.

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3 mo ago


People Also Ask


What are the common symptoms of chronic venous insufficiency?

Common symptoms of chronic venous insufficiency include swelling in the legs or ankles, a feeling of heaviness or aching in the legs, cramping, and skin changes such as discoloration or ulcers. Symptoms often worsen with prolonged standing or activity.


How can peripheral neuropathy be managed or treated?

Peripheral neuropathy can be managed through medications to relieve pain, physical therapy, and lifestyle changes such as quitting smoking and reducing alcohol intake. It's also important to manage underlying conditions that may contribute to nerve damage.


What lifestyle changes can help alleviate symptoms of leg pain and swelling?

Lifestyle changes that can help alleviate symptoms include quitting smoking, reducing alcohol consumption, maintaining a healthy diet low in processed foods, staying hydrated, and engaging in regular physical activity to improve circulation.


What are the typical signs of plantar fasciitis?

Typical signs of plantar fasciitis include sharp pain in the heel or arch of the foot, especially after periods of rest or prolonged activity. The pain is often worse in the morning or after sitting for a long time.


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1 Comments


Anonymous#38909

3 mo ago

to me that kind of sounds like you have nerve pain. I have fibromyalgia and sometimes experience similar pain to you. I am not sure what medications you are on but Gabapentin has always been very helpful to me for the nerve pain.

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