Overview Of Leg Pain
Mild and minor symptoms of leg pain are incredibly common and most instances of leg pain are attributable to trauma or injury. Athletes commonly report complaints of leg pain as the result of injury or overexertion. Nonetheless, injury may occur as the result of day-to-day wear and tear that occurs over a long period of time. This degenerative process can lead to a weakening of the tissue within the body, placing the patient at an increased risk for damage.
Symptoms of leg pain can arise as the result of a wide variety of conditions. Many conditions associated with symptoms of leg pain, however, are not serious or life threatening. The conditions believed to contribute to symptoms of leg pain can be divided into three categories:
- Symptoms of leg pain that arise from a condition affecting the musculoskeletal system
- Symptoms of leg pain that arise as the result of a neuropathic condition
- Symptoms of leg pain that arise as the result of pathology within the vascular system
Symptoms accompanying conditions affecting the musculoskeletal system are generally reported to occur within the structures that comprise this system, including bones, ligaments, tendons, and muscles. Leg pain that emerges as the result of conditions affecting the nervous system are generally reported to originate along the pathway of the sciatic nerve, which begins deep within the buttocks and runs down along the back of the leg. Finally, leg pain that arises as the result of vascular pathology is most commonly reported to occur on only one side of the body.
Patients who are interested in treatment for their symptoms of leg pain are encouraged to speak with their doctor. There are a wide variety of conditions that are associated with these symptoms; thus, an appropriate treatment plan will take this into consideration. Your doctor will want to gather a detailed personal and family history. Further, you will also undergo an extensive physical examination. Your doctor will ask you a number of questions about your current symptoms of pain and discomfort, including how these symptoms have affected your ability to complete normal daily activities. There are a number of treatments available for managing symptoms of leg pain. In most instances, your doctor will recommend an initial trial using a more conservative method of pain relief before attempting the more aggressive and interventional approaches.
What Is Leg Pain?
Symptoms of leg pain can arise as the result of a variety of underlying conditions. Conditions that are associated with leg pain can lead to symptoms of discomfort or pain in either one or both legs. Further, these symptoms may even originate within another area of the body and radiate down through the leg. The specific symptoms that characterize leg pain can be widely varied. They may range from a mild, achy soreness to a more sharp and severe, stabbing pain.
Symptoms of leg pain that persist for longer than three months are considered to be chronic in nature. Other symptoms that frequently occur in conjunction with symptoms of pain include numbing sensations, tingling, burning, muscle weakness, joint weakness, muscle stiffness, joint stiffness, inability to bear weight, swelling, bruising, and even tightness.
If patients with persistent pain continue to suffer from debilitating symptoms despite several treatment trials with conservative techniques, more aggressive and interventional treatment techniques may be warranted. Chronic leg pain can impair the individual’s ability to complete day-to-day activities and even significantly limit mobility. A portion of patients may even be forced to leave work on disability as a result of their leg pain.
What Types Of Conditions Cause Leg Pain?
Symptoms of pain and discomfort of the lower limbs can arise as the result of a variety of conditions affecting the underlying structures and tissue within the leg. For instance, symptoms of leg pain can arise as the result of blunt trauma. In these instances, acute damage or injury to the underlying tissue is believed to account for the pain. Symptoms of leg pain can also be the result of a degenerative process, such that injury occurs to the structures as a result of wear and tear to the tissue over time. In many cases, the exact source for the symptoms of leg pain may not be known. These patients will then likely undergo trials of several different treatment techniques before they are able to achieve relief from pain.
Conditions that are known to cause symptoms of leg pain can be grouped into two broad categories based on the affected underlying structures.
Musculoskeletal Conditions Causing Leg Pain
Perhaps one of the more common sources of leg pain is cramping or spasms of the muscle tissue. Muscle cramps are also referred to as muscle spasms or a charley horse and are characterized by involuntary contractions of the muscle tissue within the leg. Cramping or spasms of the muscle tissue generally have a sudden onset and occur with no warning. There are several factors known to lead to muscle cramping, including dehydration, poor circulation of the blood within the legs, overexertion, inadequate pre-workout stretching, muscle exertion in hot climates, fatigue of the muscle tissue, dysfunctional peripheral nerves, and several mineral deficiencies (i.e., potassium, magnesium, and calcium).
Some cases of muscle cramps occur as a side effect of certain types of medication. Diuretics, such as hydrochlorothiazide or furosemide, for instance, have been shown to lead to symptoms of leg pain as the result of excessive fluid loss. When the fluid levels within the body become too low, mineral levels also become low. These minerals, which are critical to the function of both muscles and neurons, then become less available where they are needed. Other medications that also are accompanied by the side effect of leg pain include nifedipine (drug used to treat high blood pressure), neostigmine, donepezil (drug used to treat Alzheimer’s disease), statins (drugs used for managing high cholesterol), tolcapone (drug used in Parkinson’s patients), albuterol (drugs used in the treatment of asthma), and raloxifene (drug used for managing osteoporosis).
Muscle Sprain Or Strain
Symptoms of leg pain can also arise as the result of strains or sprains of the muscles. Overly stretched or torn ligaments characterize sprained muscles. Muscle strains, in contrast, occur as the result of stretches or tears that occur within the muscle tissue rather than the connective tissue. Symptoms of pain or discomfort that occur as the result of muscle strains or sprains are believed to emerge as the result of damage to this tissue. Other common symptoms of muscle strains or sprains include tenderness in the area. In some instances, swelling will occur within the area and there may be signs of obvious bruising. For more severe instances of muscle strains and sprains, the patient may not be able to have full use of the muscle. For example, patients who have sprained their ankle will likely report significant difficulty walking normally. A small portion of cases may even lose complete function of the affected muscles.
Fractures occurring to the bones that comprise the leg are known to be associated with symptoms of leg pain. There are four different types of bone found in the leg and these include the femur (the longest and strongest bone found within the body), patella, tibia, and fibula. Bone tissue is very dense and strong, allowing bones to serve as the supportive foundation and structure for the body. For individuals with healthy bone density, it generally takes a very strong force to cause the bone to become compromised and ultimately break. Conditions, such as osteoporosis, however, can lead to a weakening of the bone through reductions in the bone’s density. This diminished bone density then places the individual at an augmented risk for bone fractures.
Bone fractures within the leg can are described as open (also known as a compound fracture; occurs when the fractured bone breaks through the surface of the skin) or closed, incomplete (a portion of the bone tissue remains intact) or complete (bone has been completely fractured into two pieces), displaced (the fractured bone moves within the leg so that the fractured ends are no longer aligned), and comminuted (bone fractures into several smaller pieces). The symptoms associated with a fractured bone within the leg include pain, swelling within the area, and even visible deformity. In most instances, the physician will want to take an X-ray of the area in order to confirm the fractured bone, assess the severity of the fracture, and delineate the alignment of the fractured pieces.
Symptoms of shin splints are found to occur more frequently among athletes. This condition can also be referred to as medial tibial stress syndrome and occurs as the result of overuse of the muscles or tendons found near the shinbone or tibia. Symptoms of shin splints generally include pain in the area along the front of the lower leg. The pain is believed to occur as the result of inflammation of the bone tissue, tendons, and muscles of the area following overuse. Most instances of shin splints will require about two to four weeks of rest from physical activity. Even with appropriate rest, shin splints are expected to take between three to six months to heal completely. It is important for patients suffering from a shin splint injury to reduce physical exertion in order to avoid exacerbating the condition.
Arthritis is a musculoskeletal condition that affects the joints within the body. Osteoarthritis is characterized by a stiffening of the cartilage found within the knee joint. This cartilage is generally supple and provides a protective cushion to the bones and other structures that comprise the knee. The degeneration of cartilage tissue over time, as the result of daily wear and tear, can make the cartilage material prone to damage or injury. There is no cure for osteoarthritis. Eventually, the individual is at an augmented risk for the ends of the bone that meet within the knee to rub together.
Rheumatoid arthritis is another relatively common type of arthritis. It occurs as the result of tissue inflammation within the knee. More specifically, rheumatoid arthritis is an autoimmune disease, which means that the body’s immune system malfunctions and begins destroying its own tissue. In rheumatoid arthritis cases, the synovial membrane, or synovium, becomes attacked by the body’s immune system. This leads to inflammation of the synovial membrane, which is believed to be the primary source of the pain associated with rheumatoid arthritis. If rheumatoid arthritis is left untreated, it will continue to progress and lead to more severe damage.
Hamstring injuries are an incredibly common condition and are found to occur somewhat more frequently among athletes. The hamstring is a group of three individual muscles that extend down the back of the thigh from the buttocks to the knee. These muscles function together to allow the leg to bend at the knee. A hamstring injury occurs when any one of these three muscles becomes excessively stretched or strained, which leads to tearing of the muscle tissue. In most cases of hamstring injury, the individual will experience sudden and severe symptoms of pain at the time of the injury. Many hamstring injury patients also report sensations of snapping or popping when the injury occurs. There may also be tenderness and bruising within the area of the injury.
Myalgia is a condition characterized by muscle pain, which can occur within the legs. The symptoms of myalgia can range from a mild aching pain to a more severe and debilitating pain within the tissue of the muscles. These symptoms of muscle pain may also be accompanied by inflammation within the area, tenderness, redness, and even fever. The specific symptoms that arise in patients suffering from myalgia tend to be correlated with the underlying condition. The source of muscle pain associated with myalgia can most often be attributed to a minor injury, overexertion, excessive tension, and high levels of stress. Other conditions most commonly related to myalgia include chronic fatigue syndrome and fibromyalgia.
Compartment syndrome is a condition that occurs as the result of a build-up of pressure within the enclosed spaces of the body. Excessive build-up of pressure can impede the flow of blood to and from tissue and important organs of the body, which may require emergency surgery in order to prevent permanent injury to the tissue of the organ due to loss of blood flow to the area. During acute onset compartment syndrome, symptoms generally develop over the course of several hours following injury or trauma to the leg. In chronic cases of compartment syndrome, symptoms tend to come and go depending on activity level. More specifically, patients will report experiencing symptom worsening within a half hour of beginning to exercise, and symptom relief during periods of rest and normal activity levels.
Signs that are indicative of underlying compartment syndrome include a newly emerging deep, aching pain in the leg, pain that is more severe than what would be expected based on the severity of the injury, numbness in the leg, painful tingling sensations (i.e., sensation of pins and needles), inflammation, tightness, and bruising within the affected area.
The condition of osteosarcoma is a type of malignant bone tumor that tends to develop during childhood or adolescence. The average age of onset (i.e., when the condition is first identified and diagnosed) occurs around the age of 15 years. Osteosarcoma has historically been the most common form of bone cancer occurring during childhood. The underlying cause for the development of osteosarcoma is not known. This condition is associated with symptoms of pain within the bone tissue, bone fractures, limited range of motion, pain when lifting, limping during ambulation, tenderness, inflammation, or redness.
Neuropathic Conditions Causing Leg Pain
The peripheral nerves that provide both sensory and motor feedback to the legs can be found either within the lumbar region of the lower back or the sacral region of the tailbone. Should these nerves become irritated or injured, the patient will likely experience symptoms of pain and discomfort that radiates down through the lower limbs. Several conditions that are known to cause symptoms of neuropathic leg pain are described below.
Sciatica is a condition that arises as the result of irritation or injury to the sciatic nerve, which is the relatively large nerve bundle that runs deep within the buttocks and extends down along the back of the legs. Damage and irritation to the sciatic nerve results in symptoms of pain or discomfort that radiate down through the lower limbs. Additionally, this condition can be associated with sensations of numbness and tingling. These symptoms may even worsen with prolonged sitting. Individuals with symptoms of sciatica pain may also report difficulty upon standing or trouble during ambulation. The most commonly reported causes for sciatica pain include lumbar spinal stenosis, lumbar herniated disc, isthmic spondylolisthesis, degenerative disc disease, sacroiliac joint dysfunction, and piriformis syndrome.
Peripheral neuropathy is a pain condition characterized by pain within the extremities, numbing and tingling sensations, and weakness in the area. This condition emerges as the result of damage to the tissue that comprises the peripheral nerves. Over time, patients with peripheral neuropathy will report worsening symptoms that include difficulty with ambulation and muscle cramping. Should the peripheral nerve damage occur within a motor nerve, the patient could suffer from loss of functioning and inactivity. Damage to the peripheral nerves can occur as the result of blunt force trauma, degeneration of tissue over time, or compression as the result of tissue inflammation. Individuals who lead a more sedentary lifestyle are at risk for suffering from symptoms of peripheral neuropathy as continual inactivity can place excessive amounts of pressure on the nerves. This causes them to become irritated, which is believed to be the source of pain associated with peripheral neuropathy.
Diabetic Peripheral Neuropathy
Individuals who suffer from diabetes have been found to be at augmented risk for developing complications related to peripheral neuropathy. While the precise mechanism underlying this condition is not fully understood, several factors have been found to play a significant role in the development of symptoms including neurovascular factors (e.g., compromised blood vessels), metabolic factors (e.g., elevated levels of blood glucose), autoimmune factors (e.g., irritated and inflamed neural tissue), lifestyle factors (e.g., smoking status or alcohol consumption), factors related to mechanical injury (e.g., carpal tunnel syndrome), and genetic factors (e.g., family history of neural conditions). A portion of patients with diabetic peripheral neuropathy may not report any symptoms of pain or discomfort as the result of their condition. For individuals who do experience these symptoms, they tend to be localized to the extremities, such as the legs.
Shingles is a neuropathic condition that occurs as the result of a complication following an outbreak of the herpes zoster virus, which is the virus known to cause chickenpox during childhood. The symptoms of shingles include the development of a painful rash, blisters, and inflammation and irritation of nerve tissue. Typically, the painful rash that characterizes shingles occurs only in one localized area and may even be limited to one side of the body. Symptoms of a shingles rash tend to resolve within several weeks following the onset of the rash; however, the neuropathic pain may continue to persist for much longer. This pain is referred to as post herpetic neuralgia.
Post-laminectomy syndrome, which is also known as failed back surgery, is a relatively rare pain condition that is characterized by the persistence of chronic back and leg pain following back surgery. Patients who report chronic and persistent symptoms of back and leg pain despite having attempted a number of different forms of treatment, including opioid medications or even epidural steroid injections, may eventually consider undergoing back surgery as a way to treat their debilitating symptoms of back and leg pain.
Back pain surgery, unfortunately, is not guaranteed to provide relief from symptoms and a small portion of patients who attempt this form of treatment may experience pain symptoms that persist even after surgery, or pain symptoms that are more severe following surgery.
Vascular Conditions Causing Leg Pain
Deep Vein Thrombosis
Deep vein thrombosis is a vascular pain condition that results from the development of a thrombus, which is commonly referred to as a blood clot, within the veins that extend throughout the legs. Though the precise mechanism that accounts for the development of blood clots is not fully understood, it is believed that individuals who sit for extended periods of time are at an augmented risk. Indeed, other conditions affecting the vascular system may also contribute to the development of blood clots within the circulatory system. Symptoms associated with deep vein thrombosis include pain that radiates throughout the legs and swelling that is frequently localized to the area near the ankle and foot. In a small portion of cases, patients may not report experiencing any symptoms of pain.
Peripheral Artery Disease
Peripheral artery disease is another vascular pain condition that arises as the result of a blood vessel becoming blocked or constricted. While peripheral artery disease may occur within any of the peripheral nerves, it has been found to most commonly occur within the legs. In some cases of peripheral artery disease the cause of the condition may not be fully understood; however, it is believed that in many cases, blood vessels can be constricted as the result of a build up of excess fatty plaque along the interior lining of the arteries. This constriction of blood vessels can result in pain that radiates down the leg. This pain may even be more severe within the area of the thigh or calf during periods of exertion. It is not uncommon for patients to report that their symptoms are greatly improved during periods of rest and inactivity.
Available Treatments For Leg Pain
As we have seen, there are a wide variety of conditions believed to contribute to symptoms of leg pain. Before deciding on a treatment, it is strongly recommended that patients speak with their physician about their particular condition and associated symptoms of leg pain, in order to develop an appropriate treatment plan.
In many cases of mild leg pain, in which the patient is not experiencing any significant interference in daily functioning, the patient is expected to feel relief from symptoms of pain and discomfort by using conservative, at-home treatments.
A common treatment recommended for patients with symptoms of leg pain is pharmacotherapy. This group of treatment options includes non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. This class of medication is believed to be effective in providing relief form pain owing to its anti-inflammatory properties. These medications are widely available over the counter and are recommended only for providing temporary relief from symptoms of pain. There are some side effects associated with taking NSAIDs. These include stomach ulcers, bleeding, and gastrointestinal irritation.
Antidepressants are another class of medication that are recommended for managing symptoms of leg pain, as they have received some limited support for their effectiveness in treating conditions of chronic pain. Nonetheless, data on the effectiveness of these medications in treating pain specifically within the leg is scant. Tricyclics, such as clomipramine, amitriptyline, and doxepin, are among the most commonly explored class of antidepressants. The mechanism of action for the analgesic properties of these medications is not fully understood; however, it is generally believed that these medications provide relief from pain through their role in blocking the reuptake of two neurotransmitters (norepinephrine and serotonin) within the synapse.
Further, there are two new classes of antidepressants available that have shown some promise in terms of effectively treating symptoms of chronic pain. These classes of drugs include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, fluvoxamine, and citalopram; and serotonin and norepinephrine reuptake inhibitors (SNRIs), such as desvenlafaxine, duloxetine, and venlafaxine. The drugs included in these two new classes have been preferred by some physicians as they are accompanied by a favorable side-effect profile, which includes fewer side effects when compared to other antidepressants, such as tricyclics.
Individuals suffering from severe, chronic, and unremitting symptoms of leg pain that have been unresponsive to trials of other medications may wish to consider the short-term use of a more aggressive type of pain medication, such as opioids. Drugs that fall within this class include oxycodone, morphine, tramadol, or codeine. However, these medications are accompanied by an increased risk for dependence and abuse; thus, they are contraindicated in instances requiring long-term maintenance of symptoms.
Patients taking opioids for their symptoms of pain are generally very closely monitored by a physician. Studies examining the effectiveness of opioid medications in treating symptoms of chronic and severe pain have supported their short-term use for symptoms that are characterized by a sudden onset. There is a risk for side effects associated with these medications, which include sexual impotence, sweating, constipation, and dizziness.
Treatments For Musculoskeletal Leg Pain
Muscle relaxants are a group of medication commonly prescribed for managing symptoms of leg pain that are believed to be the result of an underlying musculoskeletal condition, in particular muscle cramps or spasms. There are two classes of muscle relaxants, including antispasticity and antispasmodic. Medications within the antispasticity class, which include baclofen and dantrolene, work by decreasing the degree of muscle spasticity. Medications that fall within the antispasmodic class, which include non-benzodiazepines and benzodiazepines, reduce the severity of muscle spasms. Studies examining the effectiveness of these medications report mixed results.
Another form of treatment for musculoskeletal leg pain includes Botox injections. Botox is a purified toxic enzyme that is a product of the Clostridium botulinum bacteria. When injected into the tissue of the body, Botox has paralytic effects on the musculature. Though the mechanism is not completely understood, Botox is believed to provide pain relief both by impeding neural impulses of overactive sensory nerves and by blocking the release of neurotransmitters that are involved in the transmission of information regarding the sensation of pain. Studies examining the effectiveness of Botox injections have provided some support for conditions of chronic pain, though data examining its effects on conditions of leg pain in particular is limited.
Treatments For Leg Pain Associated With The Nervous System
Several medications that fall into the class of anticonvulsants, including gabapentin, are believed to be effective for treating symptoms of chronic neuropathic pain. It is believed that these medications work by balancing the ratio of glutamate to gamma-aminobutyric acid (GABA), though more work is necessary to provide support for using these drugs to treat neuropathic pain and to more fully understand the underlying mechanisms of action.
It has been widely accepted that stress has a number of deleterious effects on the overall health of the body. As such, training in biofeedback, given its beneficial effects on symptoms of stress, is believed to provide individuals with significant reductions in the severity of their symptoms of chronic pain. During biofeedback training, individuals are taught how to recognize their symptoms then, using real-time feedback of the underlying physiological processes, practice skills in stress reduction and relaxation practice.
Another treatment technique that may be beneficial for providing relief from symptoms of chronic leg pain is the use of capsaicin skin patches. These are considered most effective for providing relief from pain that is neuropathic in nature. Capsaicin skin patches use capsaicin, which is drawn from chili peppers, to bind to the nociceptors of the skin and excite the underlying neurons. The sensation is a momentary increase in sensory sensitivity, which is characterized by burning, pricking, or itching, followed by a refractory period of blunted sensory feedback. Repeated use of capsaicin patches is believed to contribute to longer lasting blunting of sensory feedback.
Neuropathic leg pain that emerges from irritation or injury to spinal nerves may be effectively managed using epidural steroid injections. These injections deliver targeted analgesic medication directly to the area within the epidural space surrounding the affected spinal nerve. The analgesic medications used for this procedure are corticosteroids. These medications are believed to provide relief from neuropathic pain owing to the anti-inflammatory effects of the drug.
Conditions of leg pain that emerge as the result of injury or damage to the sciatic nerve may wish to consider another injection technique for pain management known as the sciatic nerve block, which delivers the analgesic medication directly to the affected area along the sciatic nerve. Sacroiliac joint injections are used to treat joint pain by directing the pain relieving medication to the sacroiliac joint.
Several other non-surgical and minimally invasive techniques that utilize the stimulation of the spinal cord are available for treating neuropathic pain. For instance, radiofrequency ablation is a technique that uses electro-thermal methods for disrupting neural function. Transcutaneous electrical nerve stimulation (TENS) is a technique that also utilizes electrical stimulation of the peripheral nerves to treat symptoms of sciatica pain.
Another technique available is the lysis of adhesions, which uses a chemical compound to break down scar tissue at the molecular level. This technique is used particularly in instances of failed back surgery. Patients who suffer from symptoms of chronic pain that persist despite back surgery targeting pain relief are believed to be suffering from these symptoms in part due to the build up of scar tissue surrounding the spinal nerves within the epidural space. Previous studies examining the effectiveness of this procedure have provided some support; however, more studies are warranted.
It should be noted that there are some risks associated with these techniques for pain management, including bleeding, bruising, loss of sensory sensation, nerve damage, inadvertent injection into a blood vessel, or even paralysis. A portion of patients may report complaints of temporary neurological symptoms, including headache.
Outside of these traditionally used methods for pain management, there are a few alternative treatment techniques that have been shown to provide additional pain relieving benefits when used in conjunction with other treatment methods. For example, acupuncture is an alternative intervention option whose target is to provide relief from leg pain by activating specific acupuncture points. This is done using very tiny needles that are between 1cm to no more than 10cm. Needles are placed in specified regions along the leg. Needles may also be placed within other areas of the body that are believed to contribute to the symptoms of pain. This technique is considered to be associated with very few risks. In fact, side effects are limited to mild soreness, slight bruising, and minimal bleeding in the location of the needle placement. There is evidence providing support for the beneficial contribution acupuncture has in blood circulation, as well as the flow of other fluids within the tissues of the body.
Symptoms of leg pain are quite common and can range in severity from a mild soreness to an acute, sharp, and stabbing pain. Other symptoms that may accompany pain in the legs include numbness, tingling, muscle weakness, joint or muscle stiffness, sensory sensitivity, or pressure. Specific clusters of symptoms that accompany leg pain are widely varied. Thus, it is not surprising that there are a vast number of conditions associated with symptoms of leg pain. These conditions can arise as the result of trauma or injury or occur as the result of a degenerative process that develops more slowly over time.
Patients who are interested in exploring possible treatments for their leg pain are encouraged to speak with their doctor to develop an appropriate treatment plan. There are a large number of treatment options available for managing mild to more severe symptoms of leg pain. Typically, it is recommended that patients undergo a trial of the more conservative treatment options available before attempting the more interventional approaches.
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