Features May 2010 Issue

When Walking Hurts, It May Not Be Arthritis

Non-arthritic conditions not only can cause leg pain, they can thwart the treatment of arthritis. Here are the problems, and how to treat them.

Walking often tops the list of effective ways to get exercise. In fact, the Arthritis Foundation recently launched a campaign to inform people about how walking and other activities can help reduce pain, increase mobility, and slow arthritis progression.

But walking isn’t easy for everyone. "A number of conditions can cause leg pain that makes walking difficult—and most often, they occur in people who are at risk for developing osteoarthritis or who have already been diagnosed," says Chad Deal, MD, Head of the Center for Osteoporosis and Metabolic Bone Disease at Cleveland Clinic. "It’s important to uncover and treat these conditions because they can interfere with your ability to be active and thwart efforts to lose weight, halt progression of osteoarthritis, or prevent it altogether."

Following are three common non-arthritic conditions that can cause leg pain and may complicate arthritis treatment and management.


Chronic venous insufficiency

Chronic venous insufficiency is a condition in which your veins have problems sending blood from your legs back to your heart. Normally, valves in the veins keep blood flowing, preventing it from pooling in the vein. But the valves in varicose (swollen) veins are either damaged or missing, so the veins remain filled with blood, especially when you’re standing. Chronic venous insufficiency may also be caused by a clot blocking a vein (deep vein thrombosis).

Symptoms include aching, heaviness, cramping, and edema (swelling) in the feet and legs; bone pain; and skin inflammation. "Compression stockings can be helpful" in treating the disorder, says Dr. Deal. "However, some people are averse to wearing them because they’re tight and constricting, and people with hand arthritis find them difficult to put on." Surgery is an option for very severe cases.

Diabetic neuropathy

Over time, high blood sugar levels may damage the covering on the nerves and/or blood vessels that bring oxygen to your nerves. Symptoms include numbness in the hands, legs, or feet, shooting pains, burning or tingling. The first treatment step is to bring blood sugar levels within the normal range to help prevent further nerve damage. Oral medications such as antidepressants and anticonvulsants may relieve pain.

Peripheral artery disease

Peripheral artery disease is caused by arteriosclerosis, or "hardening of the arteries." It leads to a narrowing of the arteries in the legs and feet, resulting in decreased blood flow, which can injure muscles, nerves, and other tissues. As a result, the muscles of the legs don’t get enough oxygen, which they need during exercise. Eventually, there may not be enough blood and oxygen reaching the legs even when the muscles are resting. Other symptoms include pain or tingling in the toes, numbness, and pale or bluish toes. Management includes smoking cessation, lowering cholesterol, anti-clotting medications, exercise, and pain relievers. Surgery is reserved for severe cases that interfere with your ability to function.

Although management differs for these conditions, "no matter what else you’re doing, move," Dr. Deal stresses. If walking is painful, try swimming or other water exercises, or cycling on a stationary bike or seated elliptical machine. "Exercise increases blood flow throughout the body and helps with weight loss—important because obesity is a major risk factor for osteoarthritis of the knees and other lower-extremity joints. Exercis-ing regularly and maintaining a normal body weight will also reduce the risk of developing osteoarthritis, on top of these other conditions, and may also allow you to cut back on medications," he says.