Dr. Keith Roach: Tightness and burning in lower legs signal nerve involvement
Dear Dr. Roach: I am an active, healthy 67-year-old man. Several months ago, I started having a deep tightness and burning sensation in both lower legs. Nothing I do relieves the pain, including ice, heat, massage and pain medication. It is continuous and worse at night.
I have been referred to specialists, and tests for neuropathy, blood clots and stress fractures have been negative. My circulation tests, MRI, bone scans and blood workups, including ones for diabetes, all have been negative.
It is worse when walking up and down stairs, but the pain prevents me from exercising, and I can’t get a good night’s sleep. Any thoughts would be appreciated.
Dear J.K.S.: While it’s impossible for me to be at all sure, this sounds very much like a neuropathy, based on the burning quality of the pain and the fact that you haven’t arrived at a diagnosis despite extensive testing.
Unfortunately, just saying that I think this pain is a neuropathy isn’t a diagnosis either. “Neuropathy” just means that I think the pain is coming from a condition affecting the nerves to your legs, but there are many different diseases that can do so. Diabetes is the most common, which probably is why you had that test. You said you were tested for neuropathy, but sophisticated testing, including nerve-conduction velocity and EMG testing, may be helpful.
One condition that comes to mind is restless leg syndrome, which may surprise readers, since you haven’t mentioned anything about restless legs. However, restless leg syndrome (properly, Willis-Ekbom disease) is underdiagnosed. Some people are not aware of the leg movements, and symptoms almost always are worse at night. However, you didn’t tell me one key feature that is nearly universal: a desire to move the legs. If that were present, I would certainly pursue that diagnosis.
I recommend visiting a neurologist (preferably one with special expertise in neuropathy) for help with a diagnosis.
Dear Dr. Roach: How does one regain a sense of balance? Even though I use a walker, I still fall often. About two years ago I was hospitalized with piriformis syndrome, which, as I understand it, often causes lack of balance.
Dear W.T.: The piriformis is a hip muscle. Piriformis syndrome is caused by the contracted piriformis muscle compressing the sciatic nerve. Physical therapy is the usual treatment, and a physical therapist can help you with exercises to both relieve the compression, as well as build strength in the muscles of the lower leg and hip to keep you from falling.
Often, what seems like a poor sense of balance is due to weakness in the muscles we use to keep ourselves upright. For that reason, my first recommendation is that you do exercises to improve strength and balance. One of these is done while standing near something you can hold on to, like a kitchen countertop. While steadying yourself by holding the counter, lift up one leg and hold it. Then switch legs. If that’s too easy, don’t hold on to the countertop. If you can do that, try it with your eyes closed.
For someone who has fallen often and uses a walker, like you, I’d recommend you do these exercises with a trained professional.
Email questions to ToYourGoodHealth@med.cornell.edu.