Pain in the lower leg indicates the presence of a pathological process in the region of the tibia and fibula, soft tissues, blood vessels, and nerves. They can be short-term, constant, periodic, acute, dull, weak, intense. Often there is a connection with the load. To determine the cause of pain, radiography, ultrasound, CT, MRI, and other studies are prescribed. Until the diagnosis is clarified, rest is recommended; under certain conditions, it is acceptable to take painkillers.
A bruised shin usually occurs after a blow, less often it becomes a consequence of a fall. It is manifested by short-term severe acute pain, which quickly subsides, becomes dull, aching, weak or moderate. In the area of the bruise, swelling is detected, bruising is possible. Support is preserved, movements are somewhat limited due to pain. Sometimes there is lameness.
According to the mechanism of occurrence and clinical manifestations, a hematoma resembles a bruise, but the pain is of a pressing, bursting nature, which is due to the accumulation of blood in the soft tissues. The difference from a bruise is a dense limited swelling or an area of fluctuation that does not disappear for a long time. Bruising is usually found on the skin.
Damage to the Achilles tendon is manifested by a sharp pain, reminiscent of the sensations of a blow or cut, on the back of the lower leg just above the ankle joint. On examination, edema, tenderness on palpation, retraction at the Achilles site are revealed. Plantar flexion of the foot with a complete rupture is impossible, with a partial rupture it is limited. The support is very difficult.
Fractures of the bones of the lower leg are the result of a high-energy impact: falling from a height, hitting a car bumper, an industrial accident. They are manifested by explosive pain, which subsequently decreases somewhat, but remains very intense. A crackling sound may be heard at the time of injury. The following types of damage are possible:
With a pathological fracture, the clinical manifestations are smoothed out, the pain syndrome is moderately expressed. Bone fragments are often pressed into each other, so crepitus, pathological mobility are absent. Signs that allow one to suspect a violation of the integrity of the bone are the prolonged persistence of symptoms, a previous disease of the bone structures, and periodic pain in the region of this segment of the limb.
Myositis of the leg muscles develops against the background of previous overloads: intensive training, long walks. It is manifested by aching pain that spreads through a muscle or muscle group. Soreness is aggravated by tension, palpation of the muscle. Sometimes there is a slight diffuse compaction of muscle tissue, mild edema, hyperemia.
Pain in the back of the leg above the ankle joint is provoked by inflammation of the Achilles tendon. With tendonitis, the zone of maximum pain is located 3-6 cm above the point of attachment of the Achilles, with peritendinitis, it spreads throughout the tendon. At first, the pain syndrome appears only in the first minutes of the load, then the pain intensifies, becomes prolonged, increases, and does not decrease with continued movements, occurs at rest, at night.
The tibia is often affected in osteitis deformans. The pains are deep, localized in the area of the affected bone, dull, aching, constant, persist for many months. Increased at rest, after rest. May be accompanied by a curvature of the limb, pathological fractures, with the location of the focus near the joint, the development of osteoarthritis is noted.
Pain in the lower leg
Aseptic periostitis usually develops along the anterior surface of the tibia, in an area with a small volume of soft tissues. Occurs after a bruise, characterized by moderate pain, aggravated by palpation of the bone, slight swelling. Sometimes there is a serous inflammation with the formation of a significant amount of fluid, manifested by bursting pain, the formation of a "bump" in the affected area.
Purulent periostitis becomes a consequence of infectious diseases of soft tissues, is formed in the projection of the inflammatory focus or in the area of leakage. The pains are rapidly growing, twitching, throbbing, sharply intensifying on palpation. Appear against the background of fever, chills, weakness, weakness, significant swelling of the limb. Within a few days they become unbearable, they deprive them of a night's sleep.
Hematogenous osteomyelitis often affects the tibia. It develops in children, in half of the cases - after a minor injury, a common infectious disease. Manifests with severe hyperthermia, chills, fever, against which a pain syndrome appears after a few hours or 1-2 days. The pain is deep, extremely intense, throbbing, tearing. The slightest movement causes an explosion of pain, so patients try to lie still.
In some cases, there is a favorable course of hematogenous osteomyelitis with a predominance of local symptoms, moderate severity of pain. It is also possible a hurricane development of the disease with delirium, severe violations of the general condition. In the case of postoperative and post-traumatic osteomyelitis, there is a clinic similar to the hematogenous variety of the disease, but the symptoms are not so pronounced, the progression of the pathology is longer.
With infectious lesions of soft tissues, pain in the first hours is pressing, when touched - stabbing. They grow rapidly, become jerky, pulsating, constant, exhausting. Increased by palpation, lowering the limb. The formation of an abscess usually takes place against the backdrop of a sleepless night. In the affected area, edema, hyperemia, purple-bluish coloration of the skin, and local hyperthermia are detected.
The degree of violation of the general condition depends on the prevalence of the purulent process, varies from minor malaise to severe fever, severe intoxication syndrome. Local pains in the lower leg are noted with boils. Intense pain syndrome, spreading over a significant part of the segment, is observed with carbuncles, abscesses and phlegmon.
The cause of pain in the lower leg is sometimes arterial disease. With obliterating endarteritis, the pain syndrome first appears only when walking for long distances (over 1 km). Soreness is localized in the calf muscles, provokes intermittent claudication, makes the patient stop while moving. In the future, the distance to the appearance of pain is reduced. In the later stages, pain is observed at rest, trophic ulcers form, and gangrene develops.
Obliterating atherosclerosis in terms of the nature and conditions of the appearance of the pain syndrome resembles obliterating endarteritis, but is detected in older men, and not in young ones, and proceeds more favorably. Only 14% have a rapid development of pathology, leading to pain at rest, severe trophic disorders, in other cases, pain remains at the same level for a long time or intensifies during periods of seasonal exacerbations. Similar symptoms are observed with Menckeberg's arteriosclerosis, which is diagnosed in the second half of life, equally often occurs in both sexes.
A common vascular cause of soreness is varicose veins. Initially, the pains are slight, dull, local, short-term, appear in the evening, after a long stay in an upright position, combined with a feeling of heaviness. Subsequently, the pain syndrome becomes prolonged, occurs after a slight load, accompanied by a noticeable pastosity of the limbs. At the final stage, the pain is prolonged, accompanied by nocturnal cramps, edema, hyperpigmentation, and trophic disorders.
Acute phlebitis of the superficial veins of the lower leg often develops with varicose veins, manifested by rapidly progressive pain, the appearance of a band of hyperemia along the vein. The vein is condensed, its palpation is painful. In chronic phlebitis, the symptoms are smoothed out, the pains are recurrent. With damage to the deep veins, there is no red stripe on the skin, the pain is localized in the depths of the tissues, combined with severe edema, general hyperthermia.
With thrombophlebitis, as a rule, varicose veins of the upper third of the segment are affected. There is a pulling acute pain in the projection of the vein, aggravated by walking, the formation of a red stripe, a dense painful cord, and a violation of the general condition. With deep vein thrombosis, pain is deep, bursting, aggravated by palpation, can be combined with edema, pallor of the limb, swelling of the superficial veins.
With lymphedema, pain in the legs is constant, dull, bursting, complemented by heaviness in the legs, a significant dense swelling of the limb. Primary lymphedema is characterized by a gradual spread of pain and swelling in the peripheral direction (from the thigh to the shin), for the secondary - in the central direction (from the foot to the shin). Palpation of the limb segment is painless.
With Schlatter's disease, local pain occurs in the area of the tibial tuberosity, just below the knee joint. The pain syndrome is associated with physical activity, appears when squatting, walking up stairs, disappears at rest. At first, the pain is not intense, then it is significant, attacks of acute cutting pain are possible. Palpation is painful, in the zone of tuberosity a protrusion of bone density is determined.
Pain in the legs can appear with congenital anomalies of the lower extremities, Blount's disease, X-shaped legs, gonarthrosis and arthrosis of the ankle joint. Usually dull, aching, inconsistent, associated with physical activity. Caused by a violation of the normal mechanisms of standing and walking, constant overload of the limb.
Benign tumors of the tibia are characterized by slow growth, non-intense intermittent pain with unclear localization. The exceptions are osteoid osteoma and osteoblastoma, in which the pain is sharp, sharp, intense. Chondromas often form on the tibia. Osteochondromas usually affect the fibula, the pain syndrome is localized in the upper third of the lower leg along the outer surface.
With malignant neoplasia, the pain is initially unclear, dull. Rapidly progressing, becoming constant, extremely intense, painful. Eliminated only by narcotic analgesics. There is a deterioration in the general condition, edema, deformity, varicose veins in the area of the neoplasm. With osteogenic sarcomas, pain is disturbed closer to the knee or ankle joint, with chondrosarcomas - in the upper part of the leg.
Sometimes painful sensations are provoked by neurological pathologies. The pain is burning, shooting, piercing, spreads over a segment or the entire leg, combined with sensitivity disorders, weakening of the limb strength. The cause of the pain syndrome are:
Patients with pain in the shin primarily often turn to orthopedic traumatologists. If there are indications, patients are referred to surgeons, neurologists, and other specialists. The survey plan includes:
Gypsum splint for shin
In case of minor injuries and non-traumatic lesions, it is recommended to ensure peace, an elevated position of the limb. In case of fractures of the lower leg, temporary immobilization is required using splints or improvised materials. The leg is fixed from the foot to the upper third of the thigh. The victim is given an analgesic. For pain of non-traumatic origin without signs of severe inflammation, it is possible to use topical painkillers. With an intense pain syndrome, a violation of the general condition, an immediate examination by a specialist is necessary.
Patients with fractures of the tibia perform a blockade, after which fixation is carried out using skeletal traction. For other diseases and injuries, depending on the severity of the pathology, a plaster splint is applied, rest or a sparing regimen of physical activity, the use of orthopedic devices are recommended. The following methods are applied:
Patients are prescribed massage. According to the indications, manual therapy is carried out. For a number of pathologies, kinesio taping is used. Patients are referred for sanatorium treatment.
Surgical interventions are performed to improve the results and reduce the duration of treatment, prevent complications. Taking into account the nature of the pathology, the following methods are used:
In recent years, low-traumatic interventions have been widely used in many areas. In phlebology, such operations are sclerotherapy, laser coagulation, radiofrequency and adhesive obliteration of veins. In neurology - radiofrequency denervation of facet joints, nucleoplasty. Traditional and minimally invasive surgical techniques are supplemented with drug therapy and rehabilitation measures.