Leg pain is one of the most common problems all over the world and causes a lot of distress to the sufferer. The patient has normally been to a lot of doctors and been prescribed a host of pain killers, but still continues to suffer.
There are multiple causes that could be responsible for this condition but the common ones are mostly diagnosed and treated successfully. However, there are common causes that are mostly missed either due to overlook on the part of the doctor or due to lack of knowledge. They are mostly vascular causes related to the arteries or the veins.
The commonest venous cause is due to venous hypertension, mostly secondary to varicose veins. As we know varicose veins are easy to diagnose as they are obvious to the patient and the doctor. However, in obese legs these veins are not visible and so missed for years. The patient continues to suffer from severe leg pain and later develops color changes at the ankle (stasis dermatitis). If still not diagnosed he starts to develop an ulcer at the site of the previous discoloration. This only adds to his misery.
The easiest way to diagnose it is by doing a color Doppler study. The normal vein, which is 2 mm in size may have increased to over 10 mm in size causing venous hypertension and is responsible for the severe distressing leg pain followed by color changes at the ankle and ulcer.
Once the diagnosis has been made the treatment is fairly straight forward. Initially we start with elevation and stockings. At night we elevate the legs (toes above the level of the nose) while during the day in out we wear stockings before getting out of bed in the morning and doing normal activity. Remove them when we take a bath and put them on again. Again, normal activity is recommended all day. They are removed at night when we get into bed.
This sure does give relief but is by no means curative. You will still develop the complications of varicose veins namely dermatitis, ulcers, bleeding, inflammation (phlebitis) and DVT. However they may take longer to develop.
Then there is surgery which today is done by an endovenous technique where a laser fiber or radio-frequency catheter is inserted into the vein through a needle puncture and the diseased vein is obliterated. This is a minimally invasive, scarless surgery easy to perform and is very patient friendly. It is a day-care surgery where the patient does not stay in the hospital overnight and returns to work in a couple of days. The painful obese legs are no problem as the pain disappears.