Diabetic leg pain can occur in different parts of the legs due to nerve damage (diabetic neuropathy) or problems with blood circulation. The location of the pain provides clues as to the underlying cause.
Nerve pain
Diabetic nerve pain is also called diabetic neuropathy. It happens when high blood sugar levels damage nerves in the body. Symptoms depend on which nerves are affected.
With peripheral neuropathy, the nerves in the arms, legs, hands, and feet are damaged. This can cause numbness, tingling, burning, or sharp pain in these areas.
Here are some common locations for diabetic nerve pain in the legs and feet:
- Feet – Pain, burning, tingling, numbness, or sensitivity may occur in the toes, balls of the feet, heels, arches, or soles.
- Calves – Tight, aching, or “charley horse” pain may occur in one or both calves, especially at night.
- Shins – Sharp, stabbing, electric shock-like pain may occur anywhere along the shinbone (tibia).
- Thighs – Numbness or pain may radiate down the thighs from the lower back.
- All over – Some people have pain diffusely in both legs.
The pain is often described as “stocking-glove distribution,” meaning it affects both legs in a pattern like the end of a stocking or glove. It often starts in the feet and can gradually spread up the legs.
Why does it hurt there?
High blood sugar injures the walls of the small blood vessels that supply the nerves. Damaged nerves misfire and cause painful symptoms. The longest nerves are damaged first, which is why pain often starts in the toes and feet.
Circulation problems
Diabetes can damage blood vessels and restrict blood flow to the legs and feet. This is called peripheral artery disease (PAD). Reduced circulation can cause pain in the calves or thighs while walking.
Common locations of circulatory diabetic leg pain include:
- Calves – Tight, cramping, or aching pain that comes and goes may occur in one or both calves when walking. This is called intermittent claudication.
- Thighs or buttocks – Aching, cramping pain may happen in the thighs or buttocks.
- Feet – Pain at rest in the toes or balls of the feet can be a sign of PAD.
Why does it hurt there?
Walking requires increased blood flow to the muscles that control the feet, calves, and thighs. In people with PAD, hardened, narrowed arteries can’t supply enough oxygen-rich blood to meet the muscles’ demands. This causes painful cramps and achiness that go away with rest.
PAD may also cause pain due to chronic poor circulation in the feet, even while at rest. This ischemic pain tends to be worse at night.
Distinguishing features
There are some key differences between nerve pain and circulatory pain that can help pinpoint the location:
| Nerve Pain | Circulatory Pain |
|---|---|
| Often described as prickling, sharp, burning | Typically an aching, cramping sensation |
| Usually worse at night | Typically worse with activity, better with rest |
| May be accompanied by numbness | Rarely associated with numbness |
| Commonly occurs in feet/lower legs | Most often occurs in calves, thighs, or buttocks |
Nerve damage and PAD often coexist in people with diabetes. Having features of both types of pain may provide clues that both nerve fibers and blood vessels are affected.
When to see a doctor
It’s important to discuss new, persistent, or worsening leg pain with your doctor. Getting an accurate diagnosis is key to getting proper treatment. Seeing a doctor right away is especially crucial if you have:
- Sudden, severe pain
- Numbness or loss of sensation
- Leg or foot ulcers, sores, or abscesses
- Coldness, paleness, or bluish discoloration of the legs or feet
These can indicate an infection, injury, blood clot, or other serious complication that requires urgent medical care.
Diagnosis
To determine whether nerve or circulation problems are causing leg pain, the doctor will ask about your symptoms and medical history. They will conduct a physical exam to assess nerve function and blood flow.
Diagnostic tests may include:
- Pinprick test – Checks whether sensation is decreased
- Reflex checks – Tests nerve reactions
- Vibration test – Assesses sensitivity to vibration
- Blood pressure readings – Measures blood pressure in the ankles and arms
- Doppler ultrasound – Evaluates blood flow
- Angiography – Views blood vessels using dye and x-rays
- Nerve conduction study – Measures how fast nerves transmit impulses
These tests can help confirm diabetic neuropathy or PAD and evaluate the severity. Blood tests may also be done to check cholesterol, blood sugar, kidney function, and electrolytes.
Treatment
Treatment focuses on reducing pain, preventing complications, and improving circulation. Options may include:
- Medications – Pain relievers, antiseizure drugs, antidepressants, and creams provide neuropathy relief. Blood thinners and cholesterol medications can improve PAD.
- Better blood sugar control – This helps prevent progression of neuropathy and circulatory problems.
- Physical therapy – Stretching, strengthening exercises, and modalities like ultrasound may provide pain relief.
- Foot care – Preventive foot care reduces risk of wounds, ulcers, and amputation.
- Surgery – Procedures can improve circulation for PAD. Nerve decompression can help relieve pinched nerves.
Treatment is most effective when started early. Close monitoring and actively managing diabetes are key to preventing and managing complications.
Self-care tips
You can take steps at home to manage diabetic leg and foot pain:
- Check feet daily and wear proper footwear to prevent injury
- Try over-the-counter pain relievers like acetaminophen or NSAIDs
- Massage feet and legs to improve circulation
- Avoid hot baths or heating pads which can burn numb feet
- Elevate legs and avoid crossing them for long periods
- Manage blood sugar levels through healthy eating, activity, and medication
- Don’t smoke as it constricts blood vessels
- Exercise regularly to lower blood sugar and boost circulation
See your doctor if self-care strategies and over-the-counter pain relief aren’t helping. Specific treatment can prevent worsening damage and disability.
Outlook
Diabetic leg and foot pain can result from neuropathy, circulatory issues, or both. The location of pain provides insight into the underlying problem.
While painful and disruptive to daily life, diabetic nerve damage and PAD can be improved with proper treatment and lifestyle changes. Catching and controlling these complications early is important to help maintain mobility and quality of life.
Working closely with your medical providers can help determine the cause of pain and ensure appropriate treatment. With proper diabetes management and care for your legs and feet, you can reduce complications and discomfort.
Conclusion
Diabetic leg and foot pain stems from nerve damage and circulatory impairment caused by chronically high blood sugar. Nerve pain typically starts in the feet while circulation issues commonly cause cramping in the calves, thighs, or buttocks. Diagnostic testing can reveal whether neuropathy, PAD, or both are contributing to lower extremity pain. While diabetic leg pain can be challenging to live with, the right treatment helps control symptoms and prevent further progression. With diligent foot care, blood sugar management, and medical care, people with diabetes can improve leg pain and maintain mobility.
