Heaviness in legs - Causes, symptoms and treatment. MF.

Heaviness in the legs is a fairly common reason for the patient to consult a doctor. More than a third of the world's population complain of "buzzing", "aching" legs, "a feeling of shaking of the legs," "constant fatigue" in the lower extremities. The mechanism of gravity in the legs is reduced to stagnant phenomena in the vessels of the lower limbs.

Causes of heaviness in the legs

Possible causes of heaviness in the legs, not caused by the disease

1. Sedentary lifestyle, prolonged static loads.
2. Excess body weight. Heaviness in the legs occurs both directly due to excess weight, and because of the increase in the volume of circulating fluid in the body and the interstitial fluid. In addition, a significant layer of subcutaneous fat prevents the normal reduction of blood vessels.
3. Taking medications( some hormonal contraceptives).
4. Pregnancy.
5. Weather conditions( in hot weather, the general motor activity of a person decreases, the volume of circulating fluid in the body changes, the vessels of the lower extremities expand, their tone decreases, which contributes to the formation of blood stagnation).

6. Changing the hormonal background( in women, the heaviness in the legs appears or strengthens in the second phase of the menstrual cycle).

However, heaviness in the legs can often become a "first sign", indicating the development of a serious disease.

Diseases accompanied by weight in the legs

1. Diseases of the lower extremity vessels .
The most common pathology, accompanied by this symptom, is varicose disease of the lower extremities. This multifactorial disease associated with the weakness of the muscular wall of the superficial veins and the inherent inferiority of their valvular apparatus. In the early stages, patients pay attention to the heaviness in the legs, which occurs in the afternoon and intensifies toward evening, there are no visible skin changes. It is necessary not to miss this stage, since during this period the most favorable treatment and preventive measures that significantly slow the course of the disease. With the progression of the disease, complaints of pain in the legs, convulsions, cosmetic defect( convoluted enlarged subcutaneous veins of the lower limbs) are added. With worsening of the condition, edema of the lower leg appears, at first not permanent( towards evening), painless. In advanced cases, edema becomes permanent, the appearance of varicose veins becomes inflamed, poorly healing ulcers, bleeding from varicose nodules, and the disease may be complicated by acute varicothrombophlebitis. However, varicose disease of the lower limbs is a rather slow progressing disease, even with extensive varicose veins, the patients' well-being can not suffer for decades. But with seeming harmlessness of the disease, one should not forget about such a dangerous complication as varicothrombophlebitis, which is manifested by the appearance of blood clots in the veins, the detachment of which and further movement through the venous system of the body, can lead to the development of a deadly condition - pulmonary embolism.

With chronic arterial insufficiency of the lower extremities, the lumen of the vessels of the legs and hands narrows down to a complete blockage, which is accompanied by various degrees of circulatory disorders in the limb. This group includes atherosclerosis obliterans, thromboangiitis obliterans, nonspecific aortoarteritis, diabetic arteritis as a consequence of diabetic microangiopathy, connective tissue diseases( scleroderma, nodular periarteritis , rheumatoid arthritis, systemic lupus erythematosus).Manifestations are manifold, but usually consist of symptoms of insufficient blood supply to the lower extremities. Initially, the symptoms of the disease appear only with physical activity. Patients complain of weakness, high fatigue and heaviness in the affected limb, paresthesia( sensation of "crawling crawling"), cold feet, pain in the legs. A characteristic symptom is intermittent claudication. At the onset of the disease, it appears only after a long walk, but with the progression of the pathological process, the distance that the patient can pass painlessly without stopping is reduced to 100-150 m. On examination, the skin of the lower limb is pale, sometimes with a cyanotic hue, the decrease or absence of the haircover, brittle nails, later come trophic disorders( ulcers, gangrene toes of the foot).The temperature of the affected limb is reduced, the pulsation of the main vessels is significantly weakened or absent.
Lymphostasis( lymphedema) is the accumulation of lymph in the intercellular space and the complete cessation of its current through the lymphatic vessels. The disease is characterized by the appearance of edema on the lower limbs, heaviness and fatigue in the legs, pain, trophic skin changes. The edema is located at the rear of the foot or in the lower third of the shin, not constant( it increases in summer, after physical exertion and decreases in the autumn-winter period or after a long rest).Skin of usual color, soft edema, painless. There is a tendency to inflammatory diseases on the skin of the affected limb, which contributes to the progression of the disease and the deterioration of its course.

One of the most formidable complications of the defeat of the venous channel of the lower limbs is a violation of the integrity of the skin, up to the development of ulcerative defects and gangrene, in which amputation of the lower limb is shown, therefore, at the first signs of diseases it is necessary to consult a doctor in time.

2. Pathology of the musculoskeletal system .
Pathology of the spine. Lumbosacral osteochondrosis( dystrophic disease of intervertebral discs and underlying vertebral bodies) in the initial stages is manifested by low back pain, convulsive contraction of the calf muscles, and heaviness in the legs. Neurological manifestations depend on the period of the course of the disease. During an exacerbation, pain( lumbalgia), lumbago( lumbago), radicular pain and sensitivity disorders in the legs, vegetative-trophic disorders are observed, tendon reflexes often decrease. In the period of remission, the symptoms abate or not manifest at all.

Diseases of the lower extremities joints .
Osteoarthritis - degenerative-dystrophic joint disease. With all the diversity of the location, the manifestations of the disease are formed from the pain syndrome, a feeling of stiffness during movements, increased fatigue of the lower extremities, stiffness, rough crunch. The pains are stupid, not permanent, intensifying in cold and damp weather, after prolonged exercise. Very often in older people, arthrosis proceeds with minimal manifestations: aches and feelings of heaviness in the lower limbs, pain is absent. All these symptoms are caused by a violation of the relationship to each other articular surfaces, a change in the joint capsule( calcification, sclerosis), tendons and muscle spasm. An important feature of arthrosis is the discrepancy between clinical manifestations( patient complaints) and morphological changes in the joints observed on radiographs. Sometimes, even with minor changes on the radiograph, severe pain and joint function disorder are noted.
Arthritis is an inflammatory disease of the joints. The causes of their occurrence may be a local or general infectious process, an allergic reaction, an auto-allergic reaction, a local trauma, etc. However, the nature of some serious joint diseases( rheumatoid arthritis, ankylosing spondylitis, etc.) has not been sufficiently elucidated. The course of arthritis can be acute, subacute and chronic. The general kinemic symptoms are reduced to joint pain, deformity, impaired function, changes in temperature and coloration of the skin over the joint. However, each disease has its own specific manifestations. For example, in rheumatoid arthritis, in addition to articular manifestations, extra-articular symptoms are present in the symptoms. These include rheumatoid nodules - formations of connective tissue, dense, rounded in size from a few centimeters to larger ones, which are most often located on the forearm below the elbow fold;cutaneous vasculitis( ulcerative necrotic vasculitis, infarction of the nail bed);polyneuropathy( with the deformation of the joints there is compression of the nerves: median, ulnar, etc.).In the gouty attack, in the majority of cases, arthritis of the big toe leaves( sharp soreness in the area of ​​the metatarsophalangeal joint of the first toe, movement in the foot is difficult, redness of the joint, increase in body temperature to 38 ° C), which spontaneously passes through 3-5 days and tophi(uric acid deposits limited by connective tissue), located more often on the auricles, feet, fingers. Tofusi small sizes dissolve with adequate treatment. Excessive amount of urate leads to the formation of urolithiasis with attacks of renal colic.

Tofusi with the launched gout

Flat feet - a disease of the foot, characterized by a decrease in its arches. There are longitudinal and transverse flat feet depending on the lowered arch. Often there is a combined longitudinal and transverse flatfoot. With weakly flat feet( I degree) patients are concerned about the heaviness in the legs, increased fatigue of the lower extremities, soreness when pressing on the foot or middle of the sole, the gait loses its plasticity. With increasing severity of the disease, there are constant and more intense pains in the feet and legs, swelling of the feet and ankles towards the end of the day, the gait changes significantly, individual shoe making is required, since it is not possible to wear mass production shoes. When examining the foot of the spine, the skin of the soles under the heads of metatarsal bones, the "halus valgus" is formed - deformations of the foot in the region of the metatarsophalangeal joint of the big toe.

Hallux valgus - pronounced stage of flatfoot

3. Heart Diseases .Severe cardiac pathology( cardiomyopathy, myocardial dystrophy, heart disease and other diseases that lead to the development of heart failure) can be accompanied by heaviness in the legs and edema. However, heart complaints come to the fore: pain in the heart, tachycardia( rapid heartbeat), or bradycardia( slowing of heart contractions), irregularities in the heart, shortness of breath. The examination pays attention to the pallor of the skin, "mitral blush" with mitral stenosis, capillary pulse in aortic insufficiency, cervical and peripheral veins swelling, acrocyanosis( blue limbs).Edema in heart failure is symmetrical, cold mainly on the shins and ankles of walking patients and in the tissues of the lumbar and sacral region in the recumbent. When examining patients, clinical and laboratory signs of heart pathology are revealed. It should also be remembered that the complication of chronic venous insufficiency of the lower limbs can be thrombophlebitis with a separation of thrombus and its migration through the body.

4. In diseases of the kidneys such as acute and chronic glomerulonephritis, diabetic glomerulosclerosis , chronic renal failure, heaviness in the legs appears at the initial stages of swelling development. Swelling skin pale, dense, normal temperature. Dyspnea, as a rule, does not happen. Patients complain of skin itching, weakness, decreased appetite, thirst, increased blood pressure. When examining such patients, anemia, swelling up to the anasarca( total swelling of the subcutaneous tissue) and damage to other organs and systems( uremic gastritis, pericarditis, uremic encephalopathy) are identified in the terminal stage. Violated the coagulating system of blood, reduced immunity.

Diagnosis with gravity in the legs

Laboratory and instrumental examination.

1. the general analysis of blood( reduction of hemoglobin and erythrocytes, decrease of platelets, accelerated ESR, leukocytosis in diseases of the kidneys);
2. biochemical blood test: increase in uric acid with gout, increased cholesterol levels in atherosclerotic vascular lesions;electrolytes, urea, creatinine( kidney pathology);
3. general urine analysis - the appearance of protein( proteinuria), erythrocytes( hematuria) in kidney disease;
4. Reberg-Toreeva test-evaluation of the excretory function of the kidneys, the glomerular filtration rate( GFR) is calculated;
5. blood glucose( norm 3.3-5.5 mmol / l, increase in glucose indicates possible diabetes mellitus);
6. serological analysis: rheumatoid factor in rheumatoid arthritis;
7. X-ray examination - specific changes are revealed, characteristic for a specific pathology of the musculoskeletal system;
8. computerized planography - examination of the foot in case of suspicion of flat feet;
9. electrocardiography - evaluation of the heart;
10. biochemical markers of myocardial damage( troponin, KFK-MB) with suspected myocardial infarction;
11. USDG( duplex scanning) of vessels of the lower extremities is carried out for the detection of vascular pathology at the initial stages;
12. Heart ultrasound;
13. FCG( phonocardiography) - performed in the pathology of the valvular heart apparatus;
14. Coronary angiography - an assessment of the condition of the coronary arteries of the heart;
15. angiography of the vessels of the lower extremities - allows assessing the degree of narrowing of the arteries in atherosclerosis of the vessels of the lower extremities, clarifying the localization and dimensions of the floating thrombus with thrombophlebitis, etc.;
16. Magnetic resonance imaging( MRI) and computed tomography( CT) can quickly and reliably identify disorders of the nervous system, heart, kidneys, etc.;
17. Rheovasography of the arteries of the lower extremities is carried out with suspicion of obliterating atherosclerosis of vessels of the lower extremities, obliterant thrombangeite, etc.;
18. The shoulder-and-ankle index( FPI, the ratio of pressure in the arteries at the ankle to pressure in the brachial artery, normal 1-1.2), a decrease in this indicator suggests a narrowing in the arteries of the lower extremity.

Treatment of heaviness in the legs

Because the heaviness in the legs is a symptom of a large number of diseases affecting different systems of organs, dissimilar in origin and manifestations, hence the methods of treating them will be different. Only a doctor, after assessing all manifestations of the disease and the results of laboratory and instrumental examinations, will be able to make an accurate diagnosis and prescribe adequate treatment.

However, independently you can normalize your body weight, observe a set of exercises designed to combat hypodynamia, perform shin massage, assess the nature of nutrition and try to avoid foods high in cholesterol, refuse to wear high-heeled shoes, wear orthopedic insoles and comfortablefootwear for the prevention of flat feet.

To which doctor should I consult if there is seriousness in my legs

Therapist. You may need the help of doctors: a cardiologist, a vascular surgeon, an orthopedist, a nephrologist.

Physician therapist Kletkina Yu. V.