Is leg cramping a minor annoyance or a serious problem?
By Is leg pain at night often interrupting your sleep? It could more than a normal sign of getting older. In this report by Sade Oguntola, experts say that this discomfort should not be ignored as it could be a sign of peripheral artery disease, a condition similar to heart disease or stroke.
Most of us experience some form of leg cramping at one time or another, and quite often it is nothing. But that pain in the legs and feet at night, or when trying to sleep, can be a sign of something more serious— peripheral artery disease (PAD).
“I couldn’t realise it unless my wife had this disease. My wife often got painful cramps in her legs. This cramping was severe and caused her to scream,” recalled Mr Richard Adekunle, a businessman.
Muscle cramps are a strong, painful contraction or tightening of a muscle that comes on suddenly and lasts from a few seconds to several minutes. It often occurs in the legs or arms.
Certainly, there are many causes of leg pain ranging from arthritis to bulging discs in the lower spine to an assortment of ailments affecting joints, bones and tendons.
But a painful leg when walking or climbing stairs can also result from poor blood flow to the legs said Dr Okechukwu Ogah, a consultant physician, and cardiologist at the University College Hospital (UCH), Ibadan, Oyo State.
According to him, the main cause of the disease is a process called atherosclerosis, in which fatty deposits build up in the blood vessels and impeding blood flow, adding “this could be any of the body’s blood vessels, but it’s more common in the legs than the arms”.
Although the heart is usually the focus of discussion of atherosclerosis, when it occurs in the blood vessels supplying the limbs, it causes peripheral artery disease.
Less commonly, the cause of peripheral artery disease may be blood vessel inflammation, injury to the limbs, unusual anatomy of the ligaments or muscles, or even radiation exposure.
The most common symptom of peripheral artery disease is leg pain. This may appear as pain in a specific area of the leg, such as in the calf or thigh—anywhere from the buttock and hip down to the foot. Weakness and leg cramps often go along with the pain.
This is especially noticed when walking, though they can appear while resting as well. Everyone’s experience is different. But the pain, weakness and cramping are signs of poor blood circulation in the legs. Resting can improve circulation temporarily and relieve these symptoms.
“When walking, the muscles of the legs are put into exercise and then the blood supply which is supposed to be there is not enough. So the individual may have cramps in the legs and so on.
“But this is on a persistent level; it is not that it will go. Even when you move, you will still feel the pain and you will have to rest for the pain to go and then start walking again,” Dr Ogah stated.
Other common peripheral artery disease symptoms can include changes in the colour or cold feeling in the legs; numbness or tingling in the legs; and toe nails that become thick or opaque (unable to be seen through).
Just like toe nails, hair relies on strong blood flow for the oxygen and nutrients it needs to grow. If the leg hair is growing slower or falling off, it could be a symptom of peripheral artery disease.
It is possible for people with peripheral artery disease to develop sores in the legs, toes or feet that won’t heal. This is because the narrowed blood vessels in the legs restrict blood flow to the feet, which makes it harder for the body to heal cuts, sores and other minor injuries.
Peripheral arterial disease affects both men and women and sometimes it can run in families. Although it is more common in the legs, it can also occur throughout the body, including the abdomen and arms.
Nonetheless, he said that smoking, diabetes, obesity, unhealthy diet and high blood pressure, sedentary living and increasing age (especially after reaching 50 years of age) can all increase the possibility of a person experiencing this exercise-induced leg pain.
Unfortunately, Dr Ogah said that people with PAD are at higher risk of heart attack and stroke, as well. Nonetheless, the more severe the PAD, the higher the risk.
“They are all in the same spectrum of atherosclerotic cardiovascular diseases; if you have a blockage in the blood vessel supplying the legs, you may possibly have another in the arteries to the heart and brain; whether the blockage is in the brain and leading to stroke or in the heart and leading to heart attack.
“If it is the blood vessels that supply the legs and other parts of the body, if nothing is done about it, the whole limb can die —gangrene, sometimes requiring amputation of the affected limb,” said Dr Ogah.
Nonetheless, he said the commonest cause of PAD is diabetes in Nigeria, unlike in developed countries, where it is commoner in people who smoke a lot, who are diabetic or have high cholesterol levels.
In 2012, researchers in a study in African Journal of Primary Health Care Family Medicine indicated that PAD progresses more rapidly in diabetics and its prevalence also increases with age and the duration of diabetes.
Women who smoke are much more likely than non-smokers to develop clogged arteries in the legs. The study, reported in the Annals of Internal Medicine, found that female smokers were up to 17 times more likely than non-smokers to develop peripheral artery disease (PAD).
Tobacco use acts to increase risks and severity of peripheral vascular disease in two ways: first, by accelerating the narrowing of the blood vessels, and second, by increasing risks of diabetes, which itself damages vessels by accelerating atherosclerosis.
PAD is usually diagnosed through a physical examination by the doctor, including listening to the heartbeat, taking blood pressure and performing pulse checks in the legs and arms.
By comparing the blood pressure in the arm and the ankle, a difference between the two may indicate PAD and is called the ankle brachial pressure index (ABPI).
PAD is largely treated through lifestyle changes and medication. Exercising regularly and stopping smoking are the main lifestyle changes that can ease the symptoms of PAD and reduce the chances of the condition getting worse.
Exercise, a minimum of 15 to 30 minutes daily, can clear the build-up of fatty deposits in the blood vessel (arteries). It is also important to eat a healthy diet and lose weight, if overweight or obese to improve poor circulation and slow blockages from forming in the arteries.
The underlying causes should also be treated, including high blood pressure, high cholesterol, and diabetes. Medication, and in some cases surgery, can be used to improve the blood flow in the legs.
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