Differential Diagnosis for Bilateral Leg Pain
Besides spastic claudication, the differential diagnoses for bilateral leg pain can be categorized as follows:
- Single most likely diagnosis
- Peripheral arterial disease (PAD): This is a common condition characterized by the narrowing or blockage of the blood vessels outside of the heart, leading to reduced blood flow to the legs. The symptoms of PAD, such as intermittent claudication (pain in the legs or buttocks during exercise), are similar to spastic claudication.
- Other Likely diagnoses
- Chronic venous insufficiency: This condition occurs when the veins have problems returning blood from the legs to the heart, leading to blood pooling and pain.
- Deep vein thrombosis (DVT): A blood clot in the deep veins of the legs can cause pain, swelling, and warmth.
- Musculoskeletal conditions (e.g., osteoarthritis, rheumatoid arthritis): These conditions can cause pain and stiffness in the legs.
- Nerve compression or neuropathy: Conditions such as sciatica or peripheral neuropathy can cause pain, numbness, and tingling in the legs.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Aortic dissection: A tear in the inner layer of the aorta can cause severe pain and is a medical emergency.
- Pulmonary embolism: A blood clot in the lungs can cause sudden and severe pain, and is a life-threatening condition.
- Compartment syndrome: Increased pressure within the muscle compartments can cause severe pain and is a medical emergency.
- Spinal cord compression: Compression of the spinal cord can cause pain, numbness, and weakness, and is a medical emergency.
- Rare diagnoses
- Erythromelalgia: A rare condition characterized by burning pain, heat, and redness in the hands and feet.
- Complex regional pain syndrome: A rare condition characterized by chronic pain, inflammation, and sensitivity in one limb.
- Fabry disease: A rare genetic disorder that can cause pain, numbness, and tingling in the legs.
- Vasculitis: Inflammation of the blood vessels can cause pain, weakness, and numbness in the legs.