Leg pain | Sunday Observer

Leg pain

7 March, 2021

Varicose veins

Greetings from the garden of England ‘Kent’.

Currently I am in Kent visiting my family. I was held up in Sri Lanka since March, 2020 due to Covid-19 and the travel restrictions imposed as a result.

This prompted me to start the ‘London Pain Clinic’ at Horton Place, Colombo 7. As a result the clinic was opened on September 2 by Prime Minister Mahinda Rajapaksa. Covid-19 may have been a blessing in disguise as it allowed me to settle back in my motherland after 25 years. I treat this as a privilege. There’s no place like home, especially, Sri Lanka. Amid all the shortcomings which you find as in any other country there is no place like Sri Lanka. I will be back in a couple of weeks.

Leg pain is a pain condition that is common among people. The list below gives some common causes of pain in legs. I tend to see a variety of patients with sciatica, knee pain and diabetic neuropathy.

Sciatic Pain

Due to a good referral system in the U.K. the commonest leg pain I had come across in pain clinics is ‘sciatica’. The medical term for sciatica is radiculopathyor radiculitis if the pain is acute. Sciatica is the pain shooting down the legs like a current, usually on one leg. The area of the leg where pain travels down into the leg depends on the nerve compressed.

Usually, a spinal nerve coming out of the lower spine is compressed due to prolapsed inter vertebral disc, slipped vertebrae termed Spondylolisthesis (a vertebrae is slipped over the lower vertebrae). It can also be due to a bony growth (osteophyte) or a cyst pressing on a spinal nerve. Facet joints can overgrow (hypertrophy) and compress a nerve. Facet joints are the small joints that hold the vertebrae together.

Spinal Stenosis

The spinal cord extends from the brain down to the lower spine (L1) travelling inside the vertebral canal. Due to changes in the discs and vertebrae spinal cord can get tightened.

This can cause pain in the legs. This is also called neurogenic clarification. This is normally an ache rather than a shooting pain found in sciatica. This is termed neurogenic claudication and unlike the vascular claudication the pain does not subside with rest.

Peripheral neuropathy

The commonest cause is diabetes, and cause pins and needles type pain from the toes up to the knees, usually in the area of a stocking. There are other causes of peripheral neuropathy. These are the neuropathic pain conditions which result due to altered sensations in the nerve fibres.

Knee pain

Knee pain could be due to trauma, osteoarthritis or ruptured ligaments. I have discussed this in a previous article.

Deep Vein Thrombosis

Blood clots leading to severe leg pain. Urgent medical attention is necessary.

Poor blood supply to the legs

This is vascular claudication. Unable to walk far, and pain develops in the leg due to poor blood supply.


Infection in the bone due to a germ. Urgent medical attention is needed.

Meralgia Parasthetica

This is a pain in the outer aspect of the thigh due to pressure on a nerve termed lateral cutaneous nerve of the thigh.

Varicose Veins

Leg pain may be a feature.

Bone Cancer

Due to primary bone cancers or secondary deposits from a primary cancer.

Bone fractures

Hairline fractures, stress fractures or fractures due to trauma.


Obesity can cause leg pain due to obvious reasons. Pregnancy too can cause leg pain.


Clinical examination is important

Blood tests


Scans MRI, CT scans,




Not too many tests are required. But what I have seen in Sri Lanka is that patients visit multiple consultants for the same clinical issue due to a poor referral system and also due to the relative low costs to see a consultant for a section of the society.

Numerous blood tests, especially multiple scans have been instructed and carried out. I have seen some patients having back pain with five sets of MRI scans. The patient has seen four to five neurosurgeons. My advice to patients in Sri Lanka is to stick with one good specialist and trust them. A second opinion from another specialist is acceptable but not a third, fourth or fifth opinion.

Try to see a specialist in your area. Not having a proper referral system does contribute to this.


Treat the cause and the pain.

MBBS, FFARCS, Dip in pain med, FFPMCA,CCST (UK)
Consultant in Pain Medicine
London Pain Clinic
31, Horton Place
Colombo 07
Sri Lanka

Tel - 0767155716 (Hot Line)