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Southern Ocean County Hospital would like to thank everyone who e-mailed questions for this edition of Ask-The-Expert and would like to especially thank Dr. Hager for taking part in the program.

June: Leg Pain & Peripheral Vascular Disease:
symptoms, diagnosis and treatment

Question 1
Could snug/tight fitting knee supports that slip over you knee cause damage and cause intermittent claudication? My husband has been wearing these for almost 3 years (all day long - only took them off to shower and to sleep) because he felt his knees needed them. As of this past fall, he started and continues with the classic symptoms of intermittent claudication. He walks for a short time then has to stop because of either hip or thigh or calf muscle tightening. He stops for a bit then recovers and can continue. His feet also get mottled/discolored when he sits with them down on the floor. If he elevates them on a foot stool, it clears up. For the past two weeks he has not worn the knee supports, but we haven't seen any noticeable difference. Could he have caused this damage and is it reversible? He is 44 years old, not overweight at all and doesn't have a cholesterol problem. Please respond. Thank you.

Tight knee support “may” worsen arterial disease, but that would be very unusual. Knee pain is usually related to arthritic changes in your knee joint. However, cramping pain in the thigh or calf area that is initiated when walking and resolves at rest (stop walking) could be related to artery blockage. A non-invasive test called a PUR, as well as a physician examination will help determine if he suffers from artery blockage.

Question 2
I often get leg cramps in the early morning that are so painful they sometimes wake me up, only on my right calf, could this be the beginnings of peripheral vascular disease?

Early morning calf pain that improves as the day goes on is most likely lumbar disc disease. An orthopedic evaluation would be helpful. Artery blockage causes pain in the thigh or knee with activity and will resolve with cessation of activity.

Question 3
The last 3-4 weeks I have severe aching and pain in both my legs. At night when I lay down my legs hurt. I am very active, but this pain is really getting me down making me tired. I went to orthopedic, he said I have arthritis. Why would this happen in the last month, told me to take Advil ,which help for a short time. In Oct I was in a MVA and since then I just don’t feel the same

Your orthopedic doctor may very well be right. I would recommend a complete orthopedic and probably a neurology evaluation.

Question 4
I have PVD and have had two stents put in at two different times. In addition I am presently taking pletal - I still have excruciating pain when I walk and wonder if new procedure being used by Dr. Hager would help me. I presently live in Silver Spring, Md. Is there a physician/hospital that is using this procedure in this area?

It is important to evaluate your symptoms, there could be other causes, i.e., spinal stenosis, degenerative joint disease, lumbar disc disease, etc. It is also possible that you still may have significant peripheral vascular disease that requires further tests. I would recommend you have a thorough evaluation from a vascular surgeon in your area. You may log onto Boston Scientific at www.bostonscientific.com to see if a doctor who uses this technology is available locally.

Question 6
My wife suffers uncomfortable leg twitching especially at night. She often shakes her legs violently and says it feels like there is something crawling under her skin. she thinks it is "restless legs syndrome" Are there any new drugs or therapies that she can use so I can get some sleep?

Sounds like your wife is correct. Simple treatment may include tonic water before bedtime. However, in severe cases this will not be effective and a neurological evaluation would be warranted.

Question 7
I have an area on my lower legs areas that are totally discolored, right foot is occasionally blue tinged and a dime size wound that doesn’t drain but never goes away. I wear compression stockings but they do not seem to improve the situation. Could your new procedure help problems like that? When I was reading the information about the procedure it seems to be very similar to a cardiac catherization. Is the incision done the same way? If someone has a desk job how soon after work could they return? Any input would be greatly appreciated. Thank you

You send as if you have severe venous insufficiency. The discoloration is related to your leg swelling. Nightly moisturizing and use of knee high compression stockings are the mainstay of treatment. Our new procedure is designed to treat artery blockage. There is no incision, only a needle puncture, and recovery is within 1-2 days. It is difficult to diagnose your problem with the information provided, but it may be prudent for you to have a vascular examination.

Dr. Hager's answers are informational only and should not be used as a diagnosis or for treatment. Please talk to your physician about official diagnosis of your condition and treatment.