Why do you experience leg weakness when climbing stairs. What are the common symptoms of muscle weakness in legs. How does peripheral artery disease cause sudden weakness in legs. What treatment options are available for leg weakness and related conditions.

Understanding Leg Weakness: More Than Just Fatigue

Experiencing weakness in the legs while climbing stairs or walking can be concerning, especially if it’s a new sensation. While temporary fatigue from exercise or prolonged standing is normal, persistent weakness may indicate an underlying condition. It’s crucial to differentiate between general tiredness and a loss of muscle function, as the latter could signify a more serious issue.

Leg weakness can manifest in various ways, including:

• Difficulty climbing stairs
• Trouble walking for extended periods
• Sensation of heaviness in the legs
• Numbness or tingling
• Muscle spasms or twitching

If you experience sudden, severe weakness that affects your ability to move, particularly on one side of the body, seek immediate medical attention as this could be a sign of a stroke.

Common Symptoms Associated with Leg Weakness

When assessing leg weakness, it’s important to consider accompanying symptoms that may provide clues to the underlying cause. These can include:

• Numbness or tingling sensations
• Warmth, flushing, or swelling in the legs
• Muscle spasms or involuntary twitching
• Burning or prickling sensations
• Back pain
• Unsteady gait
• General fatigue
• Pain in the arms, hands, or fingers

These symptoms, combined with leg weakness, can indicate various conditions, including peripheral artery disease (PAD). If you’re experiencing any of these symptoms, consulting with a vascular specialist is recommended for proper diagnosis and treatment.

Potential Causes of Chronic Leg Weakness

Chronic leg weakness can stem from numerous conditions, ranging from localized issues to systemic disorders. Some potential causes include:

Sciatica

Sciatica results from compression of the sciatic nerve, which runs from the lower back through the legs. This condition can cause weakness, numbness, and pain in the affected leg. What causes sciatica? Common culprits include herniated discs, spinal stenosis, or bone spurs. While sciatica often resolves on its own, treatment options are available to manage symptoms and promote recovery.

Neuromuscular Conditions

Several neuromuscular disorders can lead to leg weakness, including:

• Amyotrophic Lateral Sclerosis (ALS)
• Multiple Sclerosis (MS)
• Guillain-Barré Syndrome
• Fibromyalgia
• Cerebral Palsy
• Muscular Dystrophy
• Polymyositis

Each of these conditions has unique characteristics and requires specific diagnostic approaches and treatment plans. If you suspect a neuromuscular disorder, consult with a neurologist for a comprehensive evaluation.

Peripheral Artery Disease (PAD)

PAD is a common vascular condition affecting millions of Americans. It occurs when arteries narrow due to plaque buildup, reducing blood flow to the extremities. How does PAD cause leg weakness? The reduced blood flow can lead to a symptom called intermittent claudication, characterized by pain and weakness in the legs during physical activity that subsides with rest.

Peripheral Artery Disease: A Closer Look

Peripheral Artery Disease is a prevalent condition affecting 8 to 12 million people in the United States. PAD is characterized by the narrowing of arteries due to atherosclerosis, which restricts blood flow to the lower extremities. This reduced circulation can lead to various symptoms, including leg weakness, especially during physical activities like climbing stairs.

Key Facts About PAD:

• Affects 8-12 million Americans
• Caused by atherosclerosis (plaque buildup in arteries)
• Reduces blood flow to legs and feet
• Can lead to intermittent claudication
• Increases risk of heart attack and stroke

Understanding the mechanism behind PAD-related leg weakness is crucial for proper diagnosis and treatment. How exactly does PAD cause sudden weakness in legs? The restricted blood flow results in insufficient oxygen supply to leg muscles during exertion, leading to fatigue, pain, and weakness. This symptom, known as intermittent claudication, typically improves with rest as the oxygen demand decreases.

The Connection Between Vascular Health and Leg Weakness

Vascular health plays a crucial role in overall well-being, particularly in leg function. Conditions affecting blood circulation, such as PAD and Deep Vein Thrombosis (DVT), can significantly impact your ability to perform everyday activities, including climbing stairs.

Deep Vein Thrombosis (DVT)

DVT is a serious condition characterized by the formation of blood clots in deep veins, typically in the legs. How does DVT differ from PAD in terms of leg weakness? While PAD causes weakness due to reduced arterial blood flow, DVT can lead to leg pain, swelling, and in severe cases, pulmonary embolism if the clot breaks free and travels to the lungs.

Recognizing the symptoms of DVT is crucial:

• Swelling in one or both legs
• Pain or tenderness in the leg
• Warm skin on the affected area
• Redness or discoloration of the skin

If you suspect DVT, seek immediate medical attention as it can be life-threatening.

Diagnostic Approaches for Leg Weakness

Accurately diagnosing the cause of leg weakness is essential for effective treatment. Healthcare providers may employ various diagnostic tools and techniques to identify the underlying condition:

Physical Examination

A thorough physical exam allows doctors to assess muscle strength, reflexes, and sensations in the legs. They may also check for signs of swelling, discoloration, or temperature changes that could indicate vascular issues.

Imaging Studies

Different imaging techniques can provide valuable insights into the causes of leg weakness:

• X-rays: To check for bone abnormalities or arthritis
• MRI: Detailed images of soft tissues, nerves, and blood vessels
• CT scans: Can reveal vascular issues and other structural abnormalities
• Ultrasound: Used to assess blood flow and detect blood clots

Blood Tests

Blood work can help identify systemic conditions that may contribute to leg weakness, such as diabetes, thyroid disorders, or electrolyte imbalances.

Nerve Conduction Studies and Electromyography

These tests evaluate nerve and muscle function, helping diagnose conditions like peripheral neuropathy or neuromuscular disorders.

Ankle-Brachial Index (ABI)

This non-invasive test compares blood pressure in the ankles to that in the arms, helping diagnose PAD.

Treatment Options for Leg Weakness and Related Conditions

The treatment approach for leg weakness depends on the underlying cause. Here are some common treatment strategies for various conditions:

Peripheral Artery Disease (PAD)

Treatment for PAD aims to improve circulation and reduce symptoms:

• Lifestyle changes: Quitting smoking, regular exercise, and a heart-healthy diet
• Medications: Antiplatelet drugs, statins, and blood pressure medications
• Minimally invasive procedures: Angioplasty, stenting, or atherectomy to open blocked arteries
• Surgical interventions: Bypass surgery for severe cases

Sciatica

Managing sciatica often involves a combination of approaches:

• Physical therapy to strengthen core and back muscles
• Pain medications and anti-inflammatories
• Hot and cold therapy
• Epidural steroid injections for severe cases
• Surgery for persistent or severe symptoms

Neuromuscular Disorders

Treatment varies depending on the specific condition but may include:

• Medications to manage symptoms or slow disease progression
• Physical and occupational therapy
• Assistive devices to aid mobility
• Lifestyle modifications
• In some cases, specialized treatments like immunotherapy

Deep Vein Thrombosis (DVT)

DVT treatment focuses on preventing clot growth and reducing the risk of pulmonary embolism:

• Anticoagulant medications (blood thinners)
• Compression stockings to improve circulation
• In severe cases, thrombolytic therapy or surgical interventions

Lifestyle Modifications to Improve Leg Strength and Vascular Health

Regardless of the underlying cause, certain lifestyle changes can help improve leg strength and overall vascular health:

Regular Exercise

Engaging in regular physical activity can strengthen leg muscles, improve circulation, and enhance overall cardiovascular health. What types of exercises are beneficial for leg weakness? Consider low-impact activities such as:

• Walking
• Swimming
• Cycling
• Yoga or tai chi

Start slowly and gradually increase intensity as your strength improves. Always consult with your healthcare provider before starting a new exercise regimen, especially if you have a diagnosed condition.

Healthy Diet

A balanced diet rich in nutrients can support vascular health and muscle function. Focus on incorporating:

• Lean proteins
• Whole grains
• Fruits and vegetables
• Healthy fats (e.g., omega-3 fatty acids)
• Adequate hydration

Limiting sodium, saturated fats, and processed foods can also contribute to better vascular health.

Smoking Cessation

Smoking is a major risk factor for vascular diseases like PAD. Quitting smoking can significantly improve circulation and reduce the risk of complications. How does smoking affect leg weakness? It constricts blood vessels, reduces oxygen supply to tissues, and accelerates atherosclerosis, all of which can contribute to leg weakness and fatigue.

Stress Management

Chronic stress can negatively impact vascular health and overall well-being. Incorporating stress-reduction techniques such as meditation, deep breathing exercises, or hobbies can be beneficial.

Regular Check-ups

Routine medical check-ups allow for early detection and management of conditions that may contribute to leg weakness. This is particularly important for individuals with risk factors for vascular diseases or those with a family history of related conditions.

When to Seek Medical Attention for Leg Weakness

While some causes of leg weakness may resolve on their own or with lifestyle modifications, certain situations warrant immediate medical attention:

• Sudden, severe weakness, especially if accompanied by other stroke symptoms
• Weakness following an injury or fall
• Progressive weakness that worsens over time
• Weakness accompanied by severe pain, swelling, or discoloration
• Symptoms that significantly impact daily activities or quality of life

Early intervention can often lead to better outcomes and prevent potential complications. If you’re experiencing persistent leg weakness or related symptoms, consult with a healthcare provider for a comprehensive evaluation.

Understanding the various causes of leg weakness, particularly when climbing stairs, is crucial for maintaining overall health and mobility. Whether the underlying cause is a vascular condition like PAD, a neuromuscular disorder, or another medical issue, proper diagnosis and treatment can significantly improve quality of life. By recognizing symptoms, seeking timely medical attention, and adopting healthy lifestyle habits, individuals can take proactive steps towards better leg strength and vascular health.

Why You Experience Weakness in the Legs While Climbing Stairs

The feeling of weakness in the legs isn’t unusual when you’ve been exercising, have spent all day on your feet, or are feeling under the weather. However, if you’ve recently noticed this feeling of weakness while climbing stairs or walking around your neighborhood, then it could indicate one of several underlying conditions. Leg numbness, weakness, coldness in your lower legs, feet can be a symptom of PAD Disease. It’s important to recognize some of the tell-tale signs of PAD, so you can improve your overall vascular health.

If you think you may have PAD, schedule a consultation with one of the trusted vascular doctors at USA Vascular Centers. Our doctors are experts in diagnosing PAD, and they will be able to help you figure out the cause of your leg pain. 

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Common Symptoms of Muscle Weakness in Legs

There are several types of leg weakness, and it helps to know which symptoms can signify that something more serious might be going on. First, there is a difference between experiencing a fatigued sensation in your lower extremities, as though your legs are tired, and losing muscle function. 

If you experience sudden weakness in the legs that makes you unable to move, seek emergency assistance right away. This is especially true if you fall, injure yourself, and then experience an inability to move your legs. 

Sudden weakness in the legs, especially on one side of the body, can signify a stroke. If you suddenly lose the ability to move one or both legs (paralysis), call an ambulance right away. Stroke symptoms can also include blurred vision, severe headache, high fever, sudden bowel incontinence, and loss of muscle control in the face. 

For general tiredness, weakness, or pain in the legs, pay attention to any additional symptoms. Do your legs feel tingly and numb, too? Are they warm to the touch, flushed, and swollen? Are you having muscle spasms where your leg twitches for no apparent reason? Are you experiencing a burning or prickling sensation? 

Take note of symptoms in other areas of your body, too. Back pain, unsteady walking, general achiness or fatigue, and pain in the arms, hands, or fingers are signs that something is off. Along with weakness in the legs, these can all be symptoms of different conditions, including PAD. One of our highly skilled vascular doctors can treat any potential PAD issues.   

What Causes Chronic Weakness in the Legs?

Now that you know more about what symptoms to watch for, you’re probably wondering what causes weakness in the legs. The answer is multifaceted. In some of the more serious cases, stroke or injury causes numbness and weakness in the legs. However, there are many additional conditions that can cause the muscles in your extremities to feel fatigued. 

Sciatica, for example, is a condition in which something is pinching the sciatic nerve, which runs from the lower back down through the calves. Many patients suffer from sciatica due to a herniated disc, narrowing of the spine (spinal stenosis), or a bone spur. With time, sciatica typically resolves independently, although treatment can also help.  

There are several serious neuromuscular conditions that can cause numbness and weakness in the legs. Amyotrophic lateral sclerosis,1 which you may know by its common name, Lou Gehrig’s disease, causes muscle weakness in the legs, muscle spasms, twitching, slurred speech, and cognitive changes. Multiple sclerosis can cause leg weakness, slurred speech, and vision issues. Other neuromuscular conditions to ask your doctor about include Guillain-Barre syndrome, fibromyalgia, cerebral palsy, muscular dystrophy, and polymyositis, all of which can cause numbness and weakness in the legs. 

If you experience pain and weakness in the legs while walking, but notice that it disappears afterward, you may be experiencing intermittent claudication. Intermittent claudication is a major symptom of peripheral artery disease (PAD).

What is Peripheral Artery Disease?

Peripheral artery disease is a common condition affecting 8 to 12 million people in the United States. PAD is a vascular disease in which the arteries narrow due to plaque buildup, or atherosclerosis. This reduces the amount of oxygenated blood traveling to the lower extremities.

How Does PAD Cause Sudden Weakness in Legs

Vascular diseases like PAD, or other conditions that affect blood circulation in your body, can cause weakness in the legs while walking or climbing stairs. PAD and deep vein thrombosis (DVT) are two conditions that may make exercising, daily activities, and climbing stairs close to impossible. DVT is a life-threatening condition that occurs when a blood clot develops in a deep vein within the legs. If you think you may have DVT, immediately go to the emergency room. 

Intermittent claudication is another term that is often associated with PAD. Is It describes chronic pain in the legs caused by decreased blood flow. Pain caused by claudication can range from a dull, aching pain to severe cramp-like stabs in the buttocks, thighs, or calves. As with other conditions that cause weakness in the legs, intermittent claudication often occurs while walking or exercising and disappears while at rest.  

Difficulty Climbing Stairs

Because PAD is a progressive disease and symptoms tend to get worse over time. One symptom of PAD is difficulty climbing stairs, severely reducing mobility. The decrease in circulation within the lower extremities can cause the legs to feel heavy or tired. The sensation of physical heaviness can make lifting your legs to climb stairs close to impossible.

PAD symptoms tend to reduce or stop completely when you are at rest. Many people who have symptomatic PAD refrain from exercising or moving around because this feeling of fatigue, heaviness, or pain deters them from being active.

Why Conditions Like PAD Are Often Ignored

These two vascular conditions are often ignored because many people typically attribute their symptoms to aging. When people cannot exercise without pain, they think getting older is to blame rather than a sign of something more. A common misconception is that leg pain is associated with arthritis. Unlike arthritis, the cramping is typically focused on the muscle area, not joints.

Another reason why these two conditions are left untreated is because they don’t always exhibit symptoms. Many people don’t realize they have PAD or DVT until they are in the later stages when blood clots detach or plaque buildup clogs the entire artery. It’s important to manage high blood pressure and cholesterol, adopt healthy eating and exercise habits, as well as get checked for venous insufficiency and plaque buildup if you have a family history of these two conditions.

It’s essential to diagnose and treat vascular diseases like PAD as early as possible. It’s important to note that left untreated, PAD can lead to serious health concerns like stroke, heart attacks, and even amputation.

Diagnosis the Cause of Weakness in Legs While Walking 

It’s important to discuss symptoms you’ve been experiencing including weakness in your legs with your doctor. This can help guide your doctor in making an accurate diagnosis. If your main symptom is weakness in the legs while walking, along with other PAD symptoms such as shiny skin, slowed toenail growth, and loss of hair on the legs, your physician may refer you to a vascular doctor.  

At USA Vascular Centers, our accomplished vascular doctors are highly skilled in diagnosing PAD. They use two diagnostic tests to detect the presence of atherosclerosis in the vascular system: an ankle-brachial index (ABI) test or an angiogram. 

During an ABI test, your doctor will take the blood pressure in your foot and in your arm and then compare the two. An angiogram involves injecting contrast dye into your vascular system through a tiny incision in the groin. Using X-ray imaging and the contrast dye, your vascular doctor can detect blockages in your arteries. 

If your doctor determines that you have PAD, they may recommend lifestyle changes to help slow the progression of the disease. In some cases, advanced treatment will be necessary to help improve your quality of life and reduce the risk of PAD-related complications.

Treatment for Muscle Weakness in Legs and PAD

When treating muscle weakness in the legs, the management depends on the cause. Treating the cause of the pain and fatigue may help ease your symptoms. Your regular physician can help you navigate those diagnoses. For peripheral artery disease, our doctors at USA Vascular Centers perform three minimally invasive procedures to help treat PAD: angioplasty, stent placement, and atherectomy. 

During an angioplasty, your doctor will insert a thin, balloon-tipped needle into the skin near the affected artery. Using a guidewire, the doctor will thread the needle through the artery until it reaches the blockage. Here, the balloon will inflate, compressing the plaque against the artery walls and making room for blood to flow more normally.

A stent placement is an angioplasty with an additional step. Instead of simply using a balloon to widen the artery, the doctor will place a small mesh stent inside the artery to keep it open permanently. 

For an atherectomy, the doctor uses a tiny blade to cut the plaque out of the artery. When you schedule a consultation with one of our vascular doctors, they will take your medical history, assess your symptoms, provide a diagnosis, and then consult with you to share their suggestions for the best minimally invasive treatment.  

Both before and after PAD treatment, you will want to follow your doctor’s instructions for lifestyle changes that can help prevent PAD from getting worse. It’s important to stop smoking, start an exercise plan, and modify your diet to help control the disease. Medication may also be needed to help lower your blood pressure or cholesterol and prevent blood clots from forming.

Your Next Step – Schedule a Consultation with USA Vascular Centers

If you have difficulty climbing stairs or are experiencing leg, thigh, calf, or buttock pain, schedule an appointment with one of our compassionate vascular doctors to determine if PAD could be the reason. Our empathetic doctors will guide you through the diagnostic and treatment process with utmost care and expertise, helping you get back to doing the things you love with the people you love.

Don’t wait for your symptoms to worsen. Give us a call at 888.773.2193 or schedule your appointment online.

Sources Cited

1. “Amyotrophic lateral sclerosis (ALS). ” Mayo Clinic, the Mayo Foundation for Medical Education and Research, 15 October 2021, https://www.mayoclinic.org/diseases-conditions/amyotrophic-lateral-sclerosis/symptoms-causes/syc-20354022. Accessed 26 January 2022.

What It Means When You Have Trouble Walking Up Stairs

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By Ribhu/June 9, 2021 7:50 pm EST

Walking up and down the stairs is a standard part of people’s daily routine. It’s known to improve cardiovascular health, build endurance, strengthen muscles, and more. However, no matter how much you exert yourself on stairs, it’s not so easy to get used to it — climbing stairs, after all, can be a tiring exercise. After a point, even the sight of stairs can be exhausting.

But don’t panic already if you find yourself short of breath while ascending stairs. It’s common to breathe heavily after walking up a short flight of stairs. Even people in good shape find their breath drawn out of their lungs after ascending a few stories.

A typical medical term for being winded up after taking the stairs is exertional intolerance. So what’s the reason for this exertional intolerance? The body undergoes exertion because it’s at rest before you climb a flight of stairs, which means that the heart rate is low. Besides, your muscles are cold, and they are not ready for sudden activity. So as soon as you start walking up the stairs, your body gets into the shape of single-leg squats, which is a great cardiovascular exercise. But again, your body’s not quite ready for it, and this is why the heart rate increases significantly, and you start struggling for breath.

What does having trouble walking up the stairs say about your health

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There are different types of shortness of breath — some are temporary while others are chronic. Dyspnea is another medical term for shortness of breath. So if you find yourself short of breath after taking a single flight of stairs, there might be a chance of some underlying health issues.

Medical NewsToday reported that disturbance or damage to the pulmonary or respiratory system can cause dyspnea. This is because, in conditions like asthma and pneumonia, the respiratory airway is constricted, causing impairment in the oxygen exchange, leading to shortness of breath after minimal exertion like climbing a flight of stairs. 

It is common to suffer from shortness of breath after climbing stairs if your cardiovascular health is poor. The cardiovascular system is responsible for circulating blood throughout the body. If the heart muscles become weak, it fails to pump blood to the rest of the body, resulting in fluid and pressure-buildup that causes dyspnea.

But what about feeling weak after climbing stairs?

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Shortness of breath is not the only horror surrounding stairs. There’s also fatigue and weakness in the legs. While leg weakness can be expected for people who work out regularly, it may have a more significant meaning for those who feel weak after climbing stairs.

According to Livestrong, leg weaknesses after climbing stairs should not be disregarded as a side-effect of aging, as it may indicate other underlying health conditions. For example, people who suffer from neurological conditions like Addison’s disease and amyotrophic lateral sclerosis may also suffer from heaviness in their legs after climbing stairs. In addition, knee osteoarthritis is also known to cause difficulties in climbing stairs and other daily activities that put pressure on the joints.

If you have pinched nerves in your legs, spinal cord, or lower back, you may suffer from leg weakness after walking up the stairs. According to NCBI, nerve entrapment in the hip region causes leg weakness in climbing stairs by hindering a person’s ability to move the quadriceps muscles. If you find yourself short of breath often, you should see a doctor for their professional opinion.

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Weakness in the legs – causes, diagnosis and treatment

Causes of weakness in the legs

Neurological diseases

Pathology of the nervous system is a common cause of weakness in the legs. Violation of impulse conduction along the central or peripheral motor neurons leads to an objective decrease in muscle strength – flaccid or spastic paresis. Only the lower extremities are affected or the process extends to the hands. In practical neurology, the following conditions occur:

• Strokes. Local damage to the cortex of the frontal lobe provokes central monoparesis. The loss of motor functions is accompanied by an increase in tendon reflexes in the lower extremities, pathological foot signs, and spastic hypertonicity.
• Amyotrophic lateral sclerosis. Degenerative disease of motor neurons is manifested by muscle weakness in the legs (one or both). There is clumsiness in the ankle joint, stiffness of the foot, gait changes, patients stumble.
• Guillain-Barré syndrome. Acute autoimmune polyradiculoneuropathy begins with weakness of the buttocks and thighs with paresthesia of the toes. Flaccid paresis is accompanied by pain in the lumbosacral region and pelvic girdle with irradiation to the leg, signs of root tension.

Paresis of the extremities occurs in trauma, is the result of a violation of the integrity of the pathways (due to injuries, fractures, after surgery). With unilateral damage to the spinal cord at the level of the lumbar segments, weakness occurs in one leg (lower monoparesis). When the peroneal nerve is damaged, patients note the drooping of the foot, the gait takes on the appearance of a “rooster” or “chasing”.

Diseases of the spine

Among the causes of weakness in the legs, an important place is given to damage to the structures of the spinal column. Compression of the nerve roots is caused by osteophytes in osteochondrosis, intervertebral hernias, destroyed vertebral bodies – due to osteoporosis, tuberculosis, metastatic process. This situation is observed in spondylarthrosis, spondylolisthesis (displacement of the vertebral segments).

Pain and weakness in the legs are typical signs of radiculopathy, and their localization corresponds to the affected nerves. A pain syndrome of the type of lumbodynia and lumboischialgia is characteristic, aggravated by movements, weight lifting. The picture is complemented by a violation of sensitivity (numbness, paresthesia), muscle atrophy, vegetative-trophic changes on the side of the lesion.

Endocrine pathology

Hormonal disorders often provoke weakness in the legs, symptoms can be caused by a violation of many types of metabolism – protein, lipid, carbohydrate, energy, electrolyte. There is damage to the muscles, myoneural connections or nerve pathways. The cause of weakness in the legs should be sought among the following conditions:

• Hypercortisolism. It is characterized by a gradual decrease in strength and atrophy of the proximal muscles of the limbs, poor exercise tolerance. Additional signs are stretch marks on the skin, arterial hypertension, weight gain.
• Addison’s disease. Manifested by pathological fatigue, a long period of recovery after exercise, cramps in the lower extremities. True muscle weakness with a drop in strength is less common.
• Hyperaldosteronism. Neuromuscular disorders with increased secretion of aldosterone are accompanied by persistent weakness, with a protracted course of the disease, atrophy of the proximal areas occurs.
• Hypothyroidism. Thyroid hormone deficiency causes weakness and pain in the legs (myalgia). The proximal muscles are involved, muscle spasms appear, the processes of contraction and relaxation slow down.
• Thyrotoxicosis. Weakness and atrophy of the muscles of the proximal extremities are observed, although the patients themselves often do not feel discomfort. The disease can be complicated by myasthenia gravis, periodic paralysis.
• Hyperparathyroidism. Characterized by damage to the femoral and shoulder muscles. Weakness and muscle atrophy are combined with the revival of tendon reflexes.

In long-term diabetes mellitus, symmetrical distal sensorimotor polyneuropathy is detected. Sensitive disorders (hypo- and paresthesias, pain) are accompanied by weakness of the small muscles of the foot over time, Achilles reflexes decrease or completely disappear. The involvement of the proprioceptive system is indicated by instability in the Romberg position.

Myopathies

Weakness in the legs due to muscle damage occurs not only in endocrine pathology. The etiological structure of myopathies is represented by immunopathological, infectious-inflammatory, metabolic disorders, including hereditary diseases. The causes of myopathic weakness in the legs are the following conditions:

• Autoimmune. Dermatomyositis or polymyositis affects the proximal muscles – weakness ranges from difficulty climbing stairs to complete immobility. Characterized by myalgia, weight loss, fever. Raynaud’s phenomenon, polyarthritis is often observed.
• Infectious. Accompanied by local or diffuse soreness, muscle swelling. Weakness in parasitic infestations (toxoplasmosis, trichinosis) can mimic polymyositis. Pseudohypertrophy of the muscles of the pelvic girdle is typical of cysticercosis.
• Electrolytic. Hypokalemia is characterized by myalgia, feeling of tired legs, weakness, symptoms of hypomagnesemia are associated with impaired neuromuscular conduction. An increase in calcium concentration provokes weakness and stiffness of movements, which is manifested by a “duck” gait.
• Exchange. Disorders of the metabolism of muscle glycogen and lipids are characterized by low tolerance to physical activity, weakness of the muscles of the pelvic and shoulder girdle. After prolonged stress, myalgia, convulsions, myoglobinuria appear.
• Mitochondrial. Fatigue and proximal muscle weakness in the legs occur against the background of progressive ophthalmoplegia. A decrease in muscle strength occurs in MERFF, MMC, NARP syndromes.

Granulomatous myositis in sarcoidosis is accompanied by slowly increasing weakness of the predominantly proximal muscles of the extremities, knots in the muscles. Any ARVI is manifested by aches and fatigue, myositis with swelling of the muscles, pain is possible. With enterovirus infection, a dermatomyositis-like syndrome is sometimes observed.

Progressive muscular dystrophies

Many muscular dystrophies begin with weakness of the leg muscles – hereditary diseases caused by mutations in the genes responsible for the synthesis of certain structural proteins. With Duchenne dystrophy, the muscles of the thighs and pelvic girdle are first affected – the gait becomes “duck”, it is difficult for children to climb stairs, to get up from a squatting position. Muscle tone decreases, pseudohypertrophy, flexion contractures occur.

The same symptoms, but with a later development and slow progression, are characteristic of Becker’s myodystrophy. The juvenile form of Erb-Roth also debuts with a lesion of the pelvic girdle, weakness of the gluteal muscles. Deep reflexes of the lower extremities gradually disappear. With Davidenkov’s myopathy, the muscles of the foot suffer: flexors, abductors. First, there are difficulties when running, then – a “cock” gait, the inability to stand on the heels.

Myasthenia

Severe weakness in the legs and fatigue are observed with myasthenia gravis. The disease is based on autoimmune aggression against acetylcholine receptors of the myoneural synapse. Symptoms increase with exertion, decrease after rest, and return again from repeated exertion. The proximal parts of the legs and arms are most often involved, while the tendon reflexes remain unchanged.

The development of myasthenia is associated with tumor and hyperplasia of the thymus, autoimmune diseases – thyroiditis, rheumatoid arthritis, lupus erythematosus. Predisposing factors include infectious pathology, surgical interventions. An important role is played by the intake of certain medications: aminoglycosides, calcium channel blockers, quinine.

Vascular disorders

Leg weakness as a symptom of vascular disorders accompanies varicose disease, endarteritis obliterans, atherosclerosis of the lower extremities. Expansion of the saphenous veins of the lower leg is accompanied by increased fatigue, a feeling of heaviness and fullness, swelling, which increase in the evening. Often there are pains along the affected veins, cramps of the calf muscles.

Typical signs of occlusive lesions of the arteries – rapid fatigue of the legs when walking, “intermittent claudication”. Tissue ischemia is manifested by pain, a feeling of numbness and compression in the muscles under load. After rest, the symptoms gradually disappear, but when walking is resumed, they develop again. With obliterating endarteritis, there is weakness in the left or right leg, while atherosclerosis is usually a bilateral process.

Intoxication

Sometimes the cause of weakness in the muscles of the legs is damage to the nervous and muscle tissue by toxic substances. Organophosphorus compounds and carbamates (insecticides), which inhibit cholinesterase activity, have a negative effect on the myoneural synapse. The function of nerve fibers and ganglia is disturbed by heavy metals: lead, thallium, mercury, arsenic, tellurium.

Special attention deserves alcoholic polyneuropathy, which affects mainly the lower extremities: the legs first hurt, then weakness appears. Paresis is characterized by muscle hypotension with a sharp decrease in proprioceptive sensitivity, loss of tendon and periosteal reflexes, and ataxia. Muscles atrophy quickly.

Diagnosis

Clinical examination data, supported by the results of additional methods, helps to understand which disease caused weakness in the legs. The list of diagnostic procedures is determined by a neurologist based on the information obtained during the interview and neurological examination of the patient. The following studies can be performed:

• Blood tests. In the hemogram pay attention to the indicators of red blood, leukocyte formula, ESR. Biochemical analysis allows you to detect hormonal disorders or electrolyte metabolism, muscle enzymes, specific antibodies.
• Radiography. The state of the bone structures of the spine and skull can be assessed from conventional images taken in two projections. But the study has a low resolution, does not reveal changes in soft tissues.
• Tomography. CT is the preferred imaging modality for recent strokes, tumors, hematomas, and posterior fossa fractures. Diffuse pathology of the substance of the spinal cord and brain is more accurately determined by magnetic resonance imaging.
• Myelography. The patency of the cervical canal is specified by the introduction of a radiopaque substance into the subarachnoid space. Myelography is indicated for intervertebral hernias, spinal injuries, tumors.
• Electroneuromyography. Diseases accompanied by impaired nerve conduction are diagnosed according to ENMG data. During the study, the peripheral nerve is stimulated with electrical impulses, followed by registration of the muscle response.

Ultrasonic angioscanning and rheovasography are prescribed to detect vascular diseases. Endocrinopathy requires ultrasound of the thyroid and parathyroid glands, adrenal glands, in individuals with myasthenia gravis, the size of the thymus is estimated. Diagnosis of hereditary diseases is carried out by cytogenetic, molecular genetic tests.

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Treatment

Help before diagnosis

Acute conditions, in which there is a sharp weakness in the legs, are usually provoked by strokes and injuries. Urgent measures in violation of vital functions include intubation with mechanical ventilation, stabilization of blood pressure, elimination of cerebral edema. Undifferentiated stroke therapy is carried out with cerebroprotective agents. Suspicion of spinal injury requires immobilization of the cervical spine, transportation on a rigid stretcher.

Conservative therapy

Treatment of muscle weakness in the legs is aimed at eliminating the cause and pathological mechanisms involved in its development. Therapy of acute conditions and maintenance correction of chronic diseases are carried out with medicines of various groups. With a decrease in strength in the limbs, the use of the following drugs is pathogenetically justified:

• Neuroprotectors. Used to minimize the negative impact on neurons and protect them from damage. Such properties are possessed by antioxidants (mexidol, lipoic acid), vasoactive agents (nimodipine, vinpocetine), nootropics (piracetam).
• Immunocorrectors. Diseases of autoimmune origin are treated with cytostatics (methotrexate, azathioprine, cyclosporine), immunoglobulins, glucocorticoids. Steroid drugs are indicated as anti-inflammatory, membrane-stabilizing agents for the replacement therapy of Addison’s disease.
• Detox. Binding and excretion of toxic substances from the body is provided by complexing agents (unithiol, sodium thiosulfate, calcium tetacine), infusion therapy. In severe cases, methods of extracorporeal detoxification (hemosorption, plasmapheresis) are recommended.

Myasthenia gravis requires the appointment of anticholinesterase drugs, NSAIDs, vitamins of group B are used for vertebrogenic radiculo- and neuropathies with pain syndrome. The rehabilitation program for patients with weakness in the legs includes physiotherapy, massage, exercise therapy. Comprehensive treatment of paresis involves kinesiotherapy, orthopedic correction.

Surgical treatment

The need for surgical correction with removal of the thymus arises in severe myasthenia gravis. Hematomas of the medulla are surgically eliminated, and reperfusion techniques are used for ischemic strokes (selective thrombolysis, endarterectomy, shunting). Decompression surgery is necessary to eliminate compression of the spinal roots.

Experimental treatment

There is a constant search for new methods of therapy for socially maladaptive and serious diseases. The possibilities of eculizumab in Guillain-Barré syndrome are being investigated. Riluzole has already shown efficacy in the treatment of amyotrophic lateral sclerosis, and there are recommendations for the use of rituximab in patients with myasthenia gravis. Gene and cell therapy are considered promising areas.

Weakness in the legs – causes, diagnosis and treatment

Causes of weakness in the legs

Neurological disorders

Nervous system disorders are a common cause of leg weakness. Violation of impulse conduction along the central or peripheral motor neurons leads to an objective decrease in muscle strength – flaccid or spastic paresis. Only the lower extremities are affected or the process extends to the hands. In practical neurology, the following conditions occur:

• Strokes. Local damage to the cortex of the frontal lobe provokes central monoparesis. The loss of motor functions is accompanied by an increase in tendon reflexes in the lower extremities, pathological foot signs, and spastic hypertonicity.
• Amyotrophic lateral sclerosis. Degenerative disease of motor neurons is manifested by muscle weakness in the legs (one or both). There is clumsiness in the ankle joint, stiffness of the foot, gait changes, patients stumble.
• Guillain-Barré syndrome. Acute autoimmune polyradiculoneuropathy begins with weakness of the buttocks and thighs with paresthesia of the toes. Flaccid paresis is accompanied by pain in the lumbosacral region and pelvic girdle with irradiation to the leg, signs of root tension.

Paresis of the extremities occurs in trauma, is the result of a violation of the integrity of the pathways (due to injuries, fractures, after surgery). With unilateral damage to the spinal cord at the level of the lumbar segments, weakness occurs in one leg (lower monoparesis). When the peroneal nerve is damaged, patients note the drooping of the foot, the gait takes on the appearance of a “rooster” or “chasing”.

Diseases of the spine

Among the causes of weakness in the legs, an important place is given to damage to the structures of the spinal column. Compression of the nerve roots is caused by osteophytes in osteochondrosis, intervertebral hernias, destroyed vertebral bodies – due to osteoporosis, tuberculosis, metastatic process. This situation is observed in spondylarthrosis, spondylolisthesis (displacement of the vertebral segments).

Pain and weakness in the legs are typical signs of radiculopathy, and their localization corresponds to the affected nerves. A pain syndrome of the type of lumbodynia and lumboischialgia is characteristic, aggravated by movements, weight lifting. The picture is complemented by a violation of sensitivity (numbness, paresthesia), muscle atrophy, vegetative-trophic changes on the side of the lesion.

Endocrine pathology

Hormonal disorders often provoke weakness in the legs, symptoms can be caused by a violation of many types of metabolism – protein, lipid, carbohydrate, energy, electrolyte. There is damage to the muscles, myoneural connections or nerve pathways. The cause of weakness in the legs should be sought among the following conditions:

• Hypercortisolism. It is characterized by a gradual decrease in strength and atrophy of the proximal muscles of the limbs, poor exercise tolerance. Additional signs are stretch marks on the skin, arterial hypertension, weight gain.
• Addison’s disease. Manifested by pathological fatigue, a long period of recovery after exercise, cramps in the lower extremities. True muscle weakness with a drop in strength is less common.
• Hyperaldosteronism. Neuromuscular disorders with increased secretion of aldosterone are accompanied by persistent weakness, with a protracted course of the disease, atrophy of the proximal areas occurs.
• Hypothyroidism. Thyroid hormone deficiency causes weakness and pain in the legs (myalgia). The proximal muscles are involved, muscle spasms appear, the processes of contraction and relaxation slow down.
• Thyrotoxicosis. Weakness and atrophy of the muscles of the proximal extremities are observed, although the patients themselves often do not feel discomfort. The disease can be complicated by myasthenia gravis, periodic paralysis.
• Hyperparathyroidism. Characterized by damage to the femoral and shoulder muscles. Weakness and muscle atrophy are combined with the revival of tendon reflexes.

In long-term diabetes mellitus, symmetrical distal sensorimotor polyneuropathy is detected. Sensitive disorders (hypo- and paresthesias, pain) are accompanied by weakness of the small muscles of the foot over time, Achilles reflexes decrease or completely disappear. The involvement of the proprioceptive system is indicated by instability in the Romberg position.

Myopathies

Weakness in the legs due to muscle damage occurs not only in endocrine pathology. The etiological structure of myopathies is represented by immunopathological, infectious-inflammatory, metabolic disorders, including hereditary diseases. The causes of myopathic weakness in the legs are the following conditions:

• Autoimmune. Dermatomyositis or polymyositis affects the proximal muscles – weakness ranges from difficulty climbing stairs to complete immobility. Characterized by myalgia, weight loss, fever. Raynaud’s phenomenon, polyarthritis is often observed.
• Infectious. Accompanied by local or diffuse soreness, muscle swelling. Weakness in parasitic infestations (toxoplasmosis, trichinosis) can mimic polymyositis. Pseudohypertrophy of the muscles of the pelvic girdle is typical of cysticercosis.
• Electrolytic. Hypokalemia is characterized by myalgia, feeling of tired legs, weakness, symptoms of hypomagnesemia are associated with impaired neuromuscular conduction. An increase in calcium concentration provokes weakness and stiffness of movements, which is manifested by a “duck” gait.
• Exchange. Disorders of the metabolism of muscle glycogen and lipids are characterized by low tolerance to physical activity, weakness of the muscles of the pelvic and shoulder girdle. After prolonged stress, myalgia, convulsions, myoglobinuria appear.
• Mitochondrial. Fatigue and proximal muscle weakness in the legs occur against the background of progressive ophthalmoplegia. A decrease in muscle strength occurs in MERFF, MMC, NARP syndromes.

Granulomatous myositis in sarcoidosis is accompanied by slowly increasing weakness of the predominantly proximal muscles of the extremities, knots in the muscles. Any ARVI is manifested by aches and fatigue, myositis with swelling of the muscles, pain is possible. With enterovirus infection, a dermatomyositis-like syndrome is sometimes observed.

Progressive muscular dystrophies

Many muscular dystrophies begin with weakness of the leg muscles – hereditary diseases caused by mutations in the genes responsible for the synthesis of certain structural proteins. With Duchenne dystrophy, the muscles of the thighs and pelvic girdle are first affected – the gait becomes “duck”, it is difficult for children to climb stairs, to get up from a squatting position. Muscle tone decreases, pseudohypertrophy, flexion contractures occur.

The same symptoms, but with a later development and slow progression, are characteristic of Becker’s myodystrophy. The juvenile form of Erb-Roth also debuts with a lesion of the pelvic girdle, weakness of the gluteal muscles. Deep reflexes of the lower extremities gradually disappear. With Davidenkov’s myopathy, the muscles of the foot suffer: flexors, abductors. First, there are difficulties when running, then – a “cock” gait, the inability to stand on the heels.

Myasthenia

Severe weakness in the legs and fatigue are observed with myasthenia gravis. The disease is based on autoimmune aggression against acetylcholine receptors of the myoneural synapse. Symptoms increase with exertion, decrease after rest, and return again from repeated exertion. The proximal parts of the legs and arms are most often involved, while the tendon reflexes remain unchanged.

The development of myasthenia is associated with tumor and hyperplasia of the thymus, autoimmune diseases – thyroiditis, rheumatoid arthritis, lupus erythematosus. Predisposing factors include infectious pathology, surgical interventions. An important role is played by the intake of certain medications: aminoglycosides, calcium channel blockers, quinine.

Vascular disorders

Leg weakness as a symptom of vascular disorders accompanies varicose disease, endarteritis obliterans, atherosclerosis of the lower extremities. Expansion of the saphenous veins of the lower leg is accompanied by increased fatigue, a feeling of heaviness and fullness, swelling, which increase in the evening. Often there are pains along the affected veins, cramps of the calf muscles.

Typical signs of occlusive lesions of the arteries – rapid fatigue of the legs when walking, “intermittent claudication”. Tissue ischemia is manifested by pain, a feeling of numbness and compression in the muscles under load. After rest, the symptoms gradually disappear, but when walking is resumed, they develop again. With obliterating endarteritis, there is weakness in the left or right leg, while atherosclerosis is usually a bilateral process.

Intoxication

Sometimes the cause of weakness in the muscles of the legs is damage to the nervous and muscle tissue by toxic substances. Organophosphorus compounds and carbamates (insecticides), which inhibit cholinesterase activity, have a negative effect on the myoneural synapse. The function of nerve fibers and ganglia is disturbed by heavy metals: lead, thallium, mercury, arsenic, tellurium.

Special attention deserves alcoholic polyneuropathy, which affects mainly the lower extremities: the legs first hurt, then weakness appears. Paresis is characterized by muscle hypotension with a sharp decrease in proprioceptive sensitivity, loss of tendon and periosteal reflexes, and ataxia. Muscles atrophy quickly.

Diagnosis

Clinical examination data, supported by the results of additional methods, helps to understand which disease caused weakness in the legs. The list of diagnostic procedures is determined by a neurologist based on the information obtained during the interview and neurological examination of the patient. The following studies can be performed:

• Blood tests. In the hemogram pay attention to the indicators of red blood, leukocyte formula, ESR. Biochemical analysis allows you to detect hormonal disorders or electrolyte metabolism, muscle enzymes, specific antibodies.
• Radiography. The state of the bone structures of the spine and skull can be assessed from conventional images taken in two projections. But the study has a low resolution, does not reveal changes in soft tissues.
• Tomography. CT is the preferred imaging modality for recent strokes, tumors, hematomas, and posterior fossa fractures. Diffuse pathology of the substance of the spinal cord and brain is more accurately determined by magnetic resonance imaging.
• Myelography. The patency of the cervical canal is specified by the introduction of a radiopaque substance into the subarachnoid space. Myelography is indicated for intervertebral hernias, spinal injuries, tumors.
• Electroneuromyography. Diseases accompanied by impaired nerve conduction are diagnosed according to ENMG data. During the study, the peripheral nerve is stimulated with electrical impulses, followed by registration of the muscle response.

Ultrasonic angioscanning and rheovasography are prescribed to detect vascular diseases. Endocrinopathy requires ultrasound of the thyroid and parathyroid glands, adrenal glands, in individuals with myasthenia gravis, the size of the thymus is estimated. Diagnosis of hereditary diseases is carried out by cytogenetic, molecular genetic tests.

Foot massage

Treatment

Help before diagnosis

Acute conditions, in which there is a sharp weakness in the legs, are usually provoked by strokes and injuries. Urgent measures in violation of vital functions include intubation with mechanical ventilation, stabilization of blood pressure, elimination of cerebral edema. Undifferentiated stroke therapy is carried out with cerebroprotective agents. Suspicion of spinal injury requires immobilization of the cervical spine, transportation on a rigid stretcher.

Conservative therapy

Treatment of muscle weakness in the legs is aimed at eliminating the cause and pathological mechanisms involved in its development. Therapy of acute conditions and maintenance correction of chronic diseases are carried out with medicines of various groups. With a decrease in strength in the limbs, the use of the following drugs is pathogenetically justified:

• Neuroprotectors. Used to minimize the negative impact on neurons and protect them from damage. Such properties are possessed by antioxidants (mexidol, lipoic acid), vasoactive agents (nimodipine, vinpocetine), nootropics (piracetam).
• Immunocorrectors. Diseases of autoimmune origin are treated with cytostatics (methotrexate, azathioprine, cyclosporine), immunoglobulins, glucocorticoids. Steroid drugs are indicated as anti-inflammatory, membrane-stabilizing agents for the replacement therapy of Addison’s disease.
• Detox. Binding and excretion of toxic substances from the body is provided by complexing agents (unithiol, sodium thiosulfate, calcium tetacine), infusion therapy. In severe cases, methods of extracorporeal detoxification (hemosorption, plasmapheresis) are recommended.

Myasthenia gravis requires the appointment of anticholinesterase drugs, NSAIDs, vitamins of group B are used for vertebrogenic radiculo- and neuropathies with pain syndrome. The rehabilitation program for patients with weakness in the legs includes physiotherapy, massage, exercise therapy. Comprehensive treatment of paresis involves kinesiotherapy, orthopedic correction.

Surgical treatment

The need for surgical correction with removal of the thymus arises in severe myasthenia gravis. Hematomas of the medulla are surgically eliminated, and reperfusion techniques are used for ischemic strokes (selective thrombolysis, endarterectomy, shunting).