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Spine and Back Health

Back & Leg Pain When Walking

02/24/2009

Question:

My husband suffers from constant back pain and cannot walk more than 15 feet before he has pain in legs to the point where he must sit. It is not sciatic type pain, but throbbing pain that starts in the thigh and moves down through the leg to the shin. He has arthritus in his back and has been told there is a nerve problem that may be causing his leg pain. He has had back surgery but it hasn`t helped. Can you tell us how he can stop the leg and back pain or at least get to where he can walk without pain? We need to know what type of doctor to consult for this also. Thank you.

Answer:

Hello, thank you for your question. Clearly I can’t diagnose your husband’s problem without performing a full history and physical examination and reviewing his tests. However, I can share a couple of general comments. The type of symptoms you’re describing is called “claudication”. There are usually two likely causes of this type of symptom. One is poor blood circulation in the legs. This can be tested by his physician checking for pulses in your husband’s feet, and if there is doubt about the blood flow, by ordering a test called an ABI (ankle-brachial index) in which the blood pressure is checked with blood pressure cuffs on the legs and arms. Many people who happen to have some arthritis in their backs actually suffer from this “vascular claudication” due to poor circulation. The other cause is “neurogenic claudication”, in which the problem comes from pressure on the nerves in the back. This is usually caused by “lumbar stenosis”, which refers to narrowing of the spinal canal, thus causing pressure on the nerves.

Your husband should first talk to his surgeon who did the back surgery. You need to find out whether the stenosis has been taken care of or not. Sometimes after surgery it is still there, or even comes back (you didn’t mention how long ago his surgery was). If there is no more lumbar stenosis, and no one has checked his blood flow in his legs, your regular doctor can do that, or if s/he doesn’t want to you can get referred to a vascular specialist. Good luck.

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Response by:

David J Hart, MD David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University