Table 1.
Differential diagnoses for lower limb exertional symptomatology
| Condition | Prevalence | Anatomical Distribution | Character of Pain | Effect of Exercise | Effect of Rest | Effect of Position | Additional Factors |
|---|---|---|---|---|---|---|---|
| Thigh and Buttock Claudication | Rare | Buttock, hip and thigh | Crampy, aching discomfort | Reproducible onset (same distance for each episode) | Quickly relieved | None | Proximal pulses may be reduced combined with normal distal pulses |
| Calf Claudication | 3% - 5% of the adult population | Calf muscles | Crampy, aching discomfort | Reproducible onset | Quickly relieved | None | May have atypical symptoms on exercise |
| Foot Claudication | Rare | Foot arch | Severe pain on exercise | Reproducible onset | Quickly relieved | None | Numbness can also be associated with pain |
| Venous Claudication | Rare | Entire lower limb affected. Worse in calf. | Tight, bursting pain | Occurs after walking | Slow to settle | Elevation enhances recovery | Signs of deep venous congestion and oedema present. May have history of iliofemoral thrombosis |
| Chronic Compartment Syndrome | Rare | Calf muscles | Tight, bursting pain | Occurs after walking | Very slow to settle | Elevation enhances recovery | Tends to affect heavily muscled athletes |
| Spinal Stenosis | Common | Buttocks and posterior aspects of lower limb. Often bilateral | Pain and weakness | Occurs with exercise and can mimic claudication | Varies but can have a prolonged recovery time | Lumbar spine flexion eases discomfort | Exacerbated by standing and extending spine |
| Nerve Root Compression | Common | Radiation of pain down lower limb | Sharp | May be induced by sitting, standing or walking | Often present at rest | Positional change can improve symptoms | History of back pain |
| Bakers Cyst | Rare | Behind knee down calf | Tenderness and associated swelling | Occurs with exercise | Present at rest | None | Usually a constant discomfort |
| Hip Arthritis | Common | Lateral aspect hip and thigh | Dull to severe ache | Can occur following a period of exercise | Not relieved quickly | Rest and minimal weight bearing helps | Symptoms can vary. Increased in patients with high BMI |
| Foot or Ankle Arthritis | Common | Ankle and foot arch | Aching pain | Variable onset following exercise | Not quickly relieved | Rest and minimal weight bearing helps | Variable. Can relate to exercise but present at rest |