Diabetes is a complex disease affecting many parts of the body. High blood sugar causes damage to blood vessels and organs over time, which can lead to diabetes complications.
When blood sugars are kept within a healthy range, the risk of these complications is reduced.
People with diabetes may experience leg pain and cramps at times. Diabetes doesn’t necessarily cause leg pain and cramps by itself, but complications due to chronic high blood sugars can lead to leg pain.
Following a diabetes care plan and working with a healthcare provider can help reduce the prevalence of diabetes complications, as well as helping to prevent these complications from occurring at all.
What is diabetic leg pain?
Diabetic leg pain can present as pain, burning, tingling, or numbness in the legs. It can also affect the feet and lead to serious wounds such as foot ulcers if not properly treated.
Leg pain can be a result of several conditions. Most commonly, the culprit is peripheral neuropathy, which involves damaging the nerves in the legs and feet from high blood sugar.
Other potential causes of diabetic leg pain include peripheral vascular disease (PVD) and peripheral artery disease (PAD). Peripheral vascular disease and peripheral artery disease are closely related, as PAD is a form of PVD.
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Why does diabetes cause leg pain?
Diabetic peripheral neuropathy affects about 50% of people with diabetes and is the most common form of diabetic complication.
Over time, high blood sugar causes damage to the nerves that help control the legs and feet. When the nerves of the legs and feet are damaged, it can result in pain and burning in the legs, as well as leg cramps.
People with diabetes can be more likely to develop the arterial disease than people without diabetes.
Peripheral artery disease occurs when the blood arteries, not including those of the heart and brain, become narrowed from plaque buildup.
The narrowing of these arteries causes decreased blood flow, which causes pain. Peripheral artery disease can affect the neck, arms, and abdominal area, but most commonly affects the feet and legs.
Other risk factors for peripheral artery disease include:
- Being at a higher body weight for height – considered “overweight” or “obese” based on body mass index (BMI)
- Not being physically active
- Smoking
- Having high blood pressure (hypertension)
- Having high “bad” (LDL) cholesterol
- Family history of heart disease, stroke or PAD
- History of coronary artery disease or stroke (including heart attack, angina, angioplasty or bypass surgery)
The prevalence of peripheral artery disease in people with diabetes is estimated to be about 30% in people over the age of 50.
People with diabetes tend to have higher levels of inflammation and are more likely to have constriction of arteries, as well as increased blood thickening, which can increase the risk of arterial blockages.
People with diabetes tend to have higher levels of LDL or “bad” cholesterol, as well as higher rates of hypertension (high blood pressure). High blood pressure and cholesterol levels can lead to hardening of the arteries and artery damage, which can result in leg pain.
Symptoms
People with diabetes don’t necessarily get leg pain just because they have diabetes.
Instead, another condition is usually causing the pain, such as peripheral neuropathy or peripheral artery disease.
Some symptoms of underlying problems resulting from diabetes include:
- Sharp, jabbing or throbbing pain
- Gradual increase of tingling or prickling in the hands and/or feet, spreading to arms and legs
- Extreme sensitivity to touch
- A feeling of “restless legs,” which is a form of peripheral neuropathy
- Pain during activities which shouldn’t cause pain, such as moving under a blanket
- A feeling of wearing gloves or socks when you’re not
- Painful cramping in one or both of your hips, thighs or calf muscles after certain activities, such as walking or climbing stairs (claudication)
- Leg numbness or weakness
- Coldness in your lower leg or foot, especially when compared with the other side
- Sores on your toes, feet or legs that won’t heal
- A change in the color of your legs
- Hair loss or slower hair growth on your feet and legs
- Slower growth of your toenails
- Shiny skin on your legs
- No pulse or a weak pulse in your legs or feet
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When other nerves are also damaged from diabetes, people may experience additional symptoms such as:
- Heat intolerance
- Excessive sweating or not being able to sweat
- Bowel, bladder or digestive problems
- Changes in blood pressure, causing dizziness or lightheadedness
Nerve conduction studies, blood tests, imaging studies, nerve biopsies, and other tests are used to diagnose peripheral neuropathy.
To diagnose arterial disease, diagnostic tests such as ankle/brachial index (ABI), pulse volume recording (PVR), and vascular ultrasounds can be used.
Complications
Having leg pain or cramps with diabetes can be very disruptive to normal life.
Aside from being frustrating, uncomfortable, and painful, the issues causing this leg pain can worsen in intensity.
The damage from having high blood sugar usually intensifies the longer someone has diabetes. People with newly diagnosed diabetes may “feel fine” and not have any outward appearance of complications, but these tend to develop throughout a person’s lifetime.
Some complications from nerve or artery damage from diabetes include:
- Burns and skin trauma: losing the feeling in the feet can lead to injuries that the person doesn’t feel because the nerves are dying.
- Infection: having diabetes increases the risk of dangerous infections. High blood sugar inhibits the body’s ability to heal properly, which can turn a small cut into a big problem. Not being as aware of pain can mean the person doesn’t get medical attention as soon as they need to.
- Falls: weakness and loss of sensation can lead to an increased risk of falls.
- Death of limbs: also called critical limb ischemia, this condition starts as a wound that isn’t healing and can progress to gangrene, requiring amputation of the limb.
- Stroke and heart attack: arterial vessels narrowing and hardening can be a sign of a similar process happening in other vessels. If a large enough clot forms near the brain or heart vessels, a stroke or heart attack can occur.
Prevention
Managing blood sugars is the primary goal when treating people with diabetes. Keeping blood sugar levels under control helps minimize the chance of complications occurring.
Having a well-formulated diabetes self-management plan is essential for everyone with diabetes.
Working together with your healthcare provider and following-up for necessary tests as often as is recommended is a key part of preventing diabetes leg pain.
In addition to practicing healthy lifestyle habits and taking steps to manage blood sugars, other things may help reduce the risk of developing nerve or artery problems from diabetes. Some healthy habits to adopt include:
- Practicing good foot care techniques: inspecting the feet each day for calluses and other changes can help identify problems early and lead to a quicker resolution to prevent complications.
- Treating wounds on the legs and feet promptly, seeking professional medical advice whenever warranted.
- Exercising regularly.
- Stopping smoking.
- Keeping blood pressure under control; ask your doctor what your individual blood pressure target numbers are.
- Working to keep cholesterol levels at a healthy level, increased cholesterol levels can be a risk factor for arterial disease, which can lead to pain in the legs.
- Avoiding alcohol.
Management
The tips for prevention of leg pain are also helpful for those with pre-existing diabetes leg pain. However, for those who already have diabetes leg pain, other things may help ease the symptoms.
While the underlying causes of leg pain may not be reversible, such as neuropathy, proper coping techniques may make it easier for the person dealing with leg pain.
Some coping tips for people living with diabetes leg pain include:
- Set priorities. You may not be able to be on your feet for prolonged periods of time, so it’s important to decide which to-do items are on the top of your priority list. If you set too many active goals for yourself, you may become tired and frustrated. Instead, be realistic and pace yourself, especially if you begin to feel pain after being on your feet for prolonged periods of time.
- Try massage. Massaging can help increase blood flow, stimulate nerves and temporarily reduce pain.
- Take a warm bath. Warmth increases circulation, which can temporarily relieve pain.
- Get help when you need it. If there is a big physical event coming up, such as moving, enlist friends and family to help take some of the physical burdens off you.
- Elevate the legs and feet. For poor circulation, elevating the legs can help improve circulation, which can help reduce pain.
- Use a cane or other assistive device when needed.
- Alternative therapy, such as acupuncture and the use of essential oils; however, these forms of therapy may not be extensively studied for diabetes-related problems.
Treatment
When lifestyle modifications and other aspects of managing diabetes aren’t enough to control the symptoms of diabetic leg pain, there are other treatments available to treat the underlying causes.
Medications and additional treatments may be prescribed to treat peripheral neuropathy, such as:
- Cyclooxygenase-2 inhibitors
- Pain relievers
- Corticosteroid injections
- Anti-seizure medications, such as gabapentin or pregabalin
- Antidepressants, such as amitriptyline
- Cymbalta, a serotonin-norepinephrine reuptake inhibitor
- Topical treatments, such as capsaicin cream
- Physical therapy to help strengthen weaknesses
- Plasma exchange or intravenous immune globulin, which may help certain people with inflammatory conditions
- Surgery to relieve pressure on nerves
Medications for peripheral artery disease include:
- Cholesterol-lowering medications called statins
- Medications for high blood pressure
- Medications for preventing blood clotting, such as Plavix
- Symptom-relief medications such as cilostazol, which helps to increase blood flow
For peripheral artery disease, surgical treatments may be needed to help treat the affected blocked arteries. The common surgical treatments for PAD include:
- Angioplasty: a small tube (catheter) with a balloon tip is threaded into the affected artery. The balloon is inflated to re-open the artery and stretch the artery to increase blood flow.
- Bypass surgery: surgeons use a vessel from another part of the body or a synthetic vessel to bypass (go around) the damaged vessel.
- Thrombolytic therapy: for blood clots blocking arteries, doctors can inject a clot-dissolving medication in the artery at the point of the clot.
Some people also find relief from:
- Transcutaneous electronic nerve stimulation, or TENS unit – some people find relief from using a TENS unit, though the results tend to vary among individuals.
- Ergonomic splints or casts can help provide relief from pain.
- Alternative medicine such as chiropractic care, acupuncture, massage, meditation and yoga.
Conclusion
Leg pain and cramps with diabetes can be very disruptive and interfere with the quality of life.
Symptoms of diabetic leg pain include tingling, burning, loss of sensation, numbness, and many more symptoms that can vary from person-to-person.
Having diabetes doesn’t cause leg pain in itself. However, people with diabetes are more likely to develop complications that can result in leg pain.
Common diabetes complications that can cause leg pain include peripheral neuropathy and peripheral artery disease; both of these conditions have increased prevalence in people with diabetes.
A person with diabetes can reduce their risk of developing leg pain and cramps by doing their best to control their blood sugars. Having high blood sugars over a prolonged period of time increases the risk of complications such as pain.
Following a care plan, such as taking medications, eating healthfully, checking blood sugars regularly, and exercising are all important aspects of a well-rounded diabetes care plan.
Once diabetes leg pain occurs, diagnosing the underlying cause is necessary for proper treatment. Both peripheral neuropathy and peripheral artery disease can be diagnosed using certain tests, which can be ordered by a healthcare provider.
For those living with diabetes complications resulting in leg pain, additional treatment is available.
These treatments include medications, different kinds of therapy, and surgery, depending on the individual case and severity. Other coping mechanisms can help people living with leg pain, such as being realistic with physical goals and asking for help when needed.
While diabetes leg pain can be treated, the bottom line is that it’s also largely preventable with preventive care.
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