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Writes Dr Howard Merkel, Director of the Center for the History of Medicine, University of Michigan Medical School, in his article The painful life of Cole Porter
After years of equestrian sportsmanship, in October of 1937, the composer's legs were crushed when his horse shied and rolled directly over them. The half-ton horse's fall delivered compound fractures to both of Porter's thighbones and provided the entryway for osteomyelitis, perhaps one of the most serious and difficult to treat infections known. Even today, as every doctor knows all too well, infections of the bones, which are slow to absorb even the most powerful of antibiotics, present a daunting challenge to treatment.
Over the next two decades, Cole Porter wrote many of his best known musical masterpieces. At the same time he underwent a series of excruciating operations on the bones and nerves of his legs. In one of the surgeries, the surgeon had to re-break the bones of his legs, remove the jagged ends, splice the Achilles' tendons, and remove 8 inches of his tibia bones to perform a bone graft over the fractured areas. Most vexing, however, was continued evidence of staphylococcal infection in the poorly healing bones and severe pain from scar tissue pressing on the nerves that made tortuous even something as light as the touch of a sheet.
In 1956, Porter's physical condition plummeted. In 1958, Porter's right leg was amputated at mid-thigh. In his last years, Porter confined his once glamorous nights and days to his apartment in the Waldorf Towers. The horrible pain he experienced in both of his severely damaged limbs led to an ever-increasing reliance on alcohol and narcotic painkillers.
Injury after an accident is an obvious cause of leg pain. And in most cases it need not be as gruesome as that of Cole Porter s case.
Wear and tear of joints in the leg, overuse of legs, problems in the lower spine, blood clots in the legs all of these can cause your leg pain. The pain can thus be musculoskeletal (involving muscles and bones), neurological (involving nerves), and vascular (blood vessel related).
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Here s a list of some common causes of leg pain.
ACL injury: Anterior cruciate ligament is located inside your knee joint. A sprain or tearing of ACL causes the ACL injury. Sportspeople especially those in the sport of basketball and football are more likely to injure their ACL. Normally it occurs when changing direction suddenly, stopping suddenly, landing from a jump incorrectly, or a direct contact or collision. The typical symptoms include a popping sound in the knee and your knee gives out under you. Within 24 hours you develop pain with swelling. It may resolve by itself with adequate rest, but returning to sports may damage your knee further.
Hamstring injury: It is an injury to one or more of the muscles at the back of your thigh. These muscles help you extend your leg straight back and bend your knee. A hamstring injury can be a pull, a partial tear, or a complete tear. This too is a common injury in athletes associated with football, basketball, or running. Dancers too can get a hamstring injury. A sudden sharp pain in the back of your thigh that causes you to fall or hop on your good leg is the first symptom of the injury. This is followed by swelling in the first few hours of the injury. Over the first few days you may notice bruising or discolouration at the back of your leg beneath the knee. The weakness of the hamstring injury can persist for weeks.
Shin splints: If you have resumed your morning walk (vigorous) say after a month or changed your work-out routine, you may feel a pain or tenderness along the shin bone, which is the large bone in the front of your lower leg. This is called as shin splint and it occurs because of the overworked or increased activity of the bone, muscle and tendon tissues. The condition is commonly found in runners, dancers and military recruits. Rest or modifying the training routine can prevent re-occurrence of the condition.
Stressfractures: Stress fractures are tiny cracks in the bone, especially in the lower leg and foot, caused by overuse or repeated motions such as jumping up and down repeatedly or running long distances. It can also occur in people with weak bones, for example, in those who have osteoporosis. The pain occurs in the area of the fracture. At first the pain maybe mild that subsides with rest and gradually worsens over time. There may be swelling in the painful area as well. (Read: Fractures first aid, emergency care, treatment and prevention)
Night leg cramps: Sometimes you may wake up in the night to a painful, involuntary spasm or muscular contractions in the legs involving especially the calf muscles. This is called the nocturnal leg cramps. Although the cramps occur for no known reasons and are usually harmless, they are usually related to muscle fatigue or nerve problems.
Arthritis: Inflammation of joints causing pain and swelling of the joints is termed arthritis. Osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, and infectious arthritis are the most common types of arthritis. It is caused by a combination of factors including genetics, bacterial (and sometimes fungal and viral) infection in the synovial fluid and tissues of the joint, allergies, previous injury, autoimmune disease, or even a strenuous and physically demanding work. Obesity can also put strain on the joints and cause arthritis. (Read: 6 natural remedies for arthritis you should try!)
Osteomyelitis: It is an infection in the bone caused mainly by injuries. The infection reaches the bone through bloodstream or neighbouring tissues. The infection can begin in the bone itself. Fever, chills, pain, swelling, warmth and redness in the area of infection are the main symptoms of the disease. See a doctor as soon as possible if you have bone pain and fever or you notice signs of infection after a surgery or injury. (Read: 6 tips to prevent joint pain during winter)
Peripheral neuropathy: Damage to the peripheral nerves that send information from the brain and spinal cord to the rest of the body is called peripheral neuropathy. It causes sharp, stabbing or burning pain, gradual onset of tingling and numbness in the hands and feet, muscle weakness and even paralysis. It can also affect other parts of the body. Peripheral neuropathy is a complication of number of medical condition but diabetes is the number one complication of peripheral neuropathy. Traumatic injuries, infections, metabolic problems, heredity and exposure to toxins are other causes of peripheral neuropathy.
Trapped nerve: A nerve can be trapped, that is, compressed or pinched, in any part of the body, particularly spinal column, elbow, and back. When the nerve that supplies sensation to your outer thigh gets compressed or pinched it is termed meralgiaparasthetica. Obesity, pregnancy, tight clothing, nerve injury due to diabetes or seat belt injury after motor accident are the main causes of trapped nerve in the leg. Symptoms include burning pain, tingling and numbness in the outer thigh which intensify on standing or walking. You will experience the symptoms only on one side of the body. See a doctor if you experience these symptoms.
Sciatica: A compressed or pinched sciatic nerve causes pain that radiates along the lower back through the hip and buttock and down the leg typically on one side of the body. Along with pain it causes inflammation and numbness in the affected leg. The pain can be varied from mild ache to sharp burning sensation or electric shock-like jolt to severe discomfort, but it can resolve within weeks with conservative treatment. If you continue to have severe pain even after 6 weeks of treatment, you may require surgery to relieve the pressure on the nerve. (Read: Can I lift weights and exercise with sciatica (lower back pain)?)
Spinal stenosis: Sometimes, the narrowing of the spaces in the spinal column can put pressure on the nerves running inside the spinal cord causing pain in the lower back (lumbar spine) and neck (cervical spine). Compression of the nerves in the lower back causes pain and cramping in the lower back as well as the legs. This is caused by wear and tear in the spinal cord mostly related to aging. This condition is called spinal stenosis. Check with your doctor if you have persistent pain, numbness or weakness in your back, arms or legs.
Deep vein thrombosis: Deep vein thrombosis (DVT) is a disorder in which a blood clot is formed in the deep veins, usually in your legs. DVT develops if you don t move for a long time, for example after a surgery, following an accident, or you are confined in a hospital. It is a serious condition because the clots can break free from the veins and lodge themselves in the lungs causing pulmonary embolism which could prove fatal. Symptoms of DVT include pain in the leg often originating in the calf, soreness and cramping. There is a swelling in the affected legs or sometimes in both legs.
Paget s disease: It is a disease in which the old bone tissue is not replaced by the new tissue in the bone recycling process. So, over time, the bone becomes misshapen and fragile. The risk of the disease increases with age and commonly affects the spine, skull, pelvis and the legs. You may experience no symptoms or if you do, the most common symptom is the pain in the affected area. The bones in the legs will weaken causing you to become bow-legged. The disease progresses slowly and in the long run may cause complications such as fracture, osteoarthritis, and heart failure.
Varicose veins: Veins that become enlarged and twisted are varicose veins that mostly affect the legs and feet. Such veins can be caused by age, pregnancy, prolonged standing, straining, or anything that puts a pressure on the legs, viz. obesity. Some people with varicose veins do not have pain but if you do, the pain is burning, throbbing, muscle cramping along with swelling. The pain worsens after sitting or standing for a long time. If self-care doesn t improve your varicose vein symptoms, see a doctor. See a doctor if you develop ulcers near your ankle. That usually means you have a serious vascular disease. (Read: Varicose veins could you be at risk?)
Most leg pains can be treated with self-care and rest. But if the pain is unresolved, medical attention may be required.
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Reference:
Markel, H. (2004). The Painful Life of Cole Porter. Medscape General Medicine, [online] 6(2). Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1395752/
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