| Differential |
What would point to it in the history |
Management in brief |
| Intermittent claudication — peripheral arterial disease (this case) | Cramping calf pain at a fixed, reproducible distance, relieved within minutes by standing still; worse uphill and in the cold; smoker with atherosclerotic risk factors | Conservative: smoking cessation, supervised exercise programme, clopidogrel and high-intensity statin, risk-factor control. Surgical: angioplasty ± stent for short lesions, bypass for long occlusions — only if lifestyle-limiting and exercise has failed |
| Chronic limb-threatening ischaemia | Rest pain relieved by hanging the leg out of bed, ulceration or gangrene, ABPI usually <0.5 | Urgent vascular referral: analgesia, imaging → revascularisation (angioplasty or bypass); amputation if unreconstructable |
| Acute limb ischaemia | Sudden onset, the 6 Ps — pain, pallor, pulselessness, perishing cold, paraesthesia, paralysis | Vascular emergency: oxygen, analgesia, IV heparin, immediate vascular referral → embolectomy, thrombolysis or bypass within hours |
| Spinal (neurogenic) claudication | Relieved by bending forward/downhill, associated back pain, numbness or weakness | Conservative: physiotherapy, analgesia, weight loss. Surgical: lumbar decompression / laminectomy if disabling or progressive neurology |
| DVT | Unilateral calf swelling, redness and warmth; may have chest pain/SOB if embolised | Wells score and D-dimer → duplex ultrasound; anticoagulation. Thrombolysis or thrombectomy only for phlegmasia / limb-threatening iliofemoral DVT |
| Sciatica | Shooting pain down the back of the leg to the foot, with a history of back pain | Conservative: analgesia, stay active, physiotherapy. Surgical: microdiscectomy for persistent or progressive radiculopathy |
| Musculoskeletal injury | Clear history of trauma, localised tenderness | Conservative: rest, analgesia, physiotherapy. Surgery rarely required — e.g. for a complete tendon rupture |
| Osteoarthritis (hip/knee) | Joint-localised pain, stiffness, not classically exercise-distance-dependent | Conservative: weight loss, physiotherapy, analgesia, intra-articular steroid. Surgical: joint replacement when conservative measures fail |
