Why do my legs and hips hurt at night

Is leg pain at night often interrupting your sleep?  It could more than a normal sign of getting older.  Pain in your legs and feet at night, or when trying to sleep, is often a symptom of peripheral artery disease (PAD).

Peripheral artery disease leg pain can occur anywhere in your leg, but the most common places to feel pain are in the muscles of your calf, thigh or buttocks. The pain can range from mild to so severe you can barely walk a very short distance. PAD is a progressive disease. For some people, pain only occurs during the daytime. Others have pain when resting or at night.

Peripheral Artery Disease and Leg Pain at Night

The leg pain or muscle cramping caused by PAD is known as claudication. Symptoms of claudication can be triggered by activity, especially walking or climbing stairs. However, once you stop and rest for a few minutes, it’s not uncommon for the pain to subside.

Nighttime leg pain could be a sign of the worst form of PAD – critical limb ischemia (CLI). With CLI, the pain attacks in your legs or feet can persist for minutes to hours.  Leg pain at night can be a sign of a serious condition, and only a healthcare professional can diagnose you with PAD.

What is Peripheral Artery Disease?

Peripheral Artery Disease is a circulatory disease in which blocked arteries reduce blood flow to the extremities, most commonly, the legs and feet. PAD is a relatively common condition – in fact, an estimated 8.5 million people, and nearly 15% of people over the age of 70, in the United States have been diagnosed with it. i,iii  

What Causes Peripheral Artery Disease?

PAD is caused by atherosclerosis, or of the arteries. Hardening of the arteries is a condition that causes both coronary artery disease, which can lead to heart attacks, and PAD, which, if severe enough, can lead to amputation of a limb, or even death.2 And like coronary artery disease, PAD is a serious condition.

So…What is Atherosclerosis?

Atherosclerosis is a condition that’s common in older people in which fatty deposits accumulate inside the arteries, creating blockages. Theses blockages are made up of fats and cholesterol, and is referred to as plaque. As plaque builds up in the artery, the walls of the blood vessels begin to thicken, impeding blood flow.ii

It’s uncertain exactly what causes atherosclerosis, but many scientists and doctors believe that damaged arteries cause the plaque to form. Damage to arteries can be caused by:

• High cholesterol
• High blood pressure
• Smoking iv

Other Signs of PAD

Know the warning signs. Leg pain is not the only symptom,  there are a number of other signs that could indicate that you have PAD, including:

• Cramping or aching after walking or climbing stairs that subsides with rest
• Numbness or weakness in your legs
• A cold feeling in your lower leg or foot
  
• Sores that won’t heal on your legs, feet or toes
• A weak pulse in your ankles or legs
• Shiny skin and/or a bluish tint to your legs
• Loss of hair on your legs
• Slow growing toenails v

Just like with other cardiovascular conditions, there are things you can do to help manage PAD, such as:

• If you smoke, quit
• Exercise if your doctor says it’s okay
• Lower your cholesterol level
• Eat a healthy diet, including foods low in saturated fat
• Avoid over the counter cold medications that include pseudoephedrine (Advil® Cold & Sinus, Aleve-D® Sinus & Headache, Claritin-D®, Sudafed®, Tylenol® Cold, Zyrtec-D®, others) because they constrict your blood vessels and may increase your PAD symptoms. v

If you think you may have peripheral artery disease, don’t put off seeing your doctor to discuss testing and PAD treatment options if needed.  The sooner you get diagnosed, the sooner you and your PAD specialist can determine if you are a candidate for minimally invasive treatments to slow down or stop progression of the disease.  Things can get  serious if PAD is left untreated, including amputation, stroke or death.  Finding PAD early can lower your risk of heart attack or stroke and save your limbs.

Is pain in your legs causing you to have restless sleep? Is it preventing you from falling asleep easily? It’s a very common and frustrating issue, and not something you should just put up with. 

Your legs carry the load of your body throughout the day, but that doesn’t mean they should be causing you pain, especially at night.

Stabbing pain, dull aching or a strange tingling sensation are common complaints heard by our podiatrists. These are often symptoms of an issue, rather than the issue itself, and a medical professional can help to diagnose and treat your troublesome legs.  

We’ve compiled a list of common issues that could be causing your aching legs at night, and come up with helpful suggestions that can help to manage your symptoms. If you continue to experience pain, book in to see one of our podiatrists. 

Musculoskeletal pain

1. Cramps

When your muscles are fatigued, certain body movements can trigger cramps. If you’re experiencing cramps at night, this could be from restlessness and turning over in bed. This triggers the muscle causing it to cramp. Interestingly, they can also be caused by a lack of movement, specifically if you hold a position for a long period of time. 

Dehydration and a lack of salts in your body fluids are also common causes of cramps. If you’re exercising and using all of the water sources in your body, this can change the salt levels in your fluids. This change in levels results in altered signals sent between the nerves and muscles, causing your muscles to twitch or cramp. 

To avoid this, we suggest making an active effort to keep hydrated and well fed. We may also recommend magnesium supplements, however this is only after our podiatrist has assessed your issue and medical history.

2. Inflammation of muscles/tendons

You may experience pain and inflammation in your muscles and tendons during the night as these muscles are healing while you sleep, especially if you have an injury. However it is not a common symptom of injury pain and may indicate a greater severity of the injury or problem at hand. Hence it is important that if this is happening to you to seek professional advice. 

A couple of at-home treatments you could try initially include anti-inflammatory medication (if you can take it), making sure you find a comfortable position while sleeping, and applying cold or heat packs to help reduce your symptoms. Please be careful in regards to heat and ice burns. 

The physical presence of a blood clot will alert you to something being wrong. Common symptoms include:

• It usually only affects one leg
  
• Abnormal redness
  
• Pain in your leg that is throbbing or cramping
  
• May be localised warmth and swelling 

It is strongly recommended that you seek help from a medical professional as soon as possible if you are experiencing any of these symptoms. 

5. Vein issues

Varicose veins are enlarged, swollen and twisted veins that are the result of poor circulation, and are particularly common in people with fluid retention issues. This means the veins aren’t working as well as they should, so over the course of the day, the pressure in your leg can increase from leaky valves or weakened vein walls. This creates an aching pain and heavy feeling in your legs, which worsens at night after a day spent mostly on your feet. 

To aide the pumping of “pooling blood” you can try the following:

• Walking and being active gets your blood moving.
  
• Calf raises when you are seated to aid compression of the veins to push the blood back up to the heart.
  
• Elevating your legs to encourage gravity to aid returning of blood flow back up your legs to your heart.
  
• Discuss your symptoms with your GP.
• Medical grade compression stockings dispensed by one of our podiatrists.

6. Artery disease

When not enough blood is getting to your feet, this lack of circulation can cause pain in your leg muscles. People often help to alleviate this pain by hanging their legs over the side of the bed or standing up, which sends blood pumping back through the feet (thank you gravity). This pain can affect one or both sides and is generally in the calves. You can also experience this pain with activity, and pain is relieved almost immediately by cessation of activity. 

Unfortunately, an increased risk of peripheral arterial disease is commonly associated with the following:

• Smokers
  
• Diabetics
  
• Cardiovascular disease
  
• High cholesterol and high blood pressure
  
• Obesity
  
• Elderly 

Our podiatrists at The Feet People can help diagnose the above circulation problems and recommend an action plan. However we do also recommend seeing your general practitioner if you’re experiencing similar symptoms, especially if you’re showing signs of a blood clot. 

Medical conditions

7. Nerve pain

You may experience nerve pain during the night as the pressure of sleeping in a particular position may aggravate or cause compression of a nerve. This pain may cause you to wake up with sharp, stabbing pain and/or numbness and tingling. This pain may not occur during your daily activities. 

Nerve pain can occur in a ‘one off case’ or be attributed to various medical conditions such as neuropathies. Neuropathies cause damage to the nerves, resulting in altered sensations or increased sensitivity.

Often movement can help with your nerve pain. Performing gentle movements to encourage the muscles to warm up through improved circulation can be an effective way to ease your symptoms. 

There are other treatment options available too, which our podiatrist or your doctor can help in finding the best option for you. 

8. Pregnancy

It’s very common to have aching and tired legs during pregnancy. This occurs because of the increased blood volume and extra strain you’re placing on your body as you carry more weight that it is not use to carrying. Your uterus is also putting extra pressure on the veins responsible for carrying blood back from your lower body. This partially blocks the blood flow, keeping the fluid in your legs and feet, which causes them to become swollen and tired.

Gentle stretching and massage can help to relieve the tightness and fatigue felt through the legs and feet (maybe from a kind partner or friend!). If this is not effective, our podiatrists can also help with these issues by prescribing specific exercises, giving advice on footwear, educating about these common issues, and offering custom orthotics to offload the high pressure areas. 

9. Gout

Gout causes intense pain and swelling around the joints (often starting in the big toe). It is triggered by a chemical reaction, causing the deposit of urate crystals in the impacted joint.

Attacks usually occur when you have been consuming certain foods and drinks that are high in purine. It will often flare up when people drink beer or red wine and rich foods such as cheeses and red meats. Seemingly, we often see a higher incidence of gout after major events like the State of Origin or Super Bowl, where people are likely to let loose on indulgent food and drink. 

As gout occurs due to an out of balance chemical reaction in the joint, it often needs specific medicine to ease the symptoms, so we recommend seeing your GP.

If chronic recurrent attacks occur you may develop secondary osteoarthritic changes in the affected joint. This is where our team of podiatrists can help you manage that painful joint. 

Many causes of lower leg pain are not serious and something that our podiatrists can address and treat. If you’re experiencing regular lower leg pain, then we recommend seeking medical advice from one of our Brisbane podiatrists or a GP. 

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