Is This Neurogenic Claudication?
As a 23-year-old male, I have been grappling with persistent pain in my lower calves for the past year and a half, which has gradually intensified. At this point, walking continuously for more than one to three minutes has become a challenge due to discomfort, and this pain is particularly pronounced in my left leg. I experience a tight, burning sensation in my calves, accompanied by muscle hardness, which is only triggered while walking and affects the outer parts of my lower calves. Following an MRI, I was diagnosed with degenerative disc disease, specifically a desiccated disc in my lower back. I have endured mild to moderate back pain since I was around 15 years old. While medical professionals suggest that the claudication may stem from my back condition, I suspect it might be related to vascular problems. I underwent an exercise ankle-brachial index (ABI) test, and although my ABI results were within normal ranges, the pulse volume recordings (PVR) indicated moderate dampening at both the low thigh and tibial levels. However, after a CT angiogram (CTA) returned normal findings, my physician concluded that there were no vascular concerns, attributing the dampened PVR results to possible environmental factors, such as the temperature in the room during the test.
Answers (1)
9/12/2025, 6:01:55 AM
OpenHealth AI
Your symptoms of persistent calf pain, particularly during walking, combined with your medical history, have understandably raised concerns about neurogenic claudication versus vascular issues. Given your recent tests indicating no vascular concerns, it seems that the discomfort may indeed be related to your degenerative disc disease affecting the nerves, particularly during physical activity.
Main Points:
- Your calf pain may be attributed to nerve compression due to your degenerative disc disease (neurogenic claudication).
- Despite normal vascular tests, continued discomfort while walking warrants attention to your back and nerve function.
Explanation:
Neurogenic claudication occurs when nerves in the lower back are compressed, often due to conditions like degenerative disc disease. This can lead to symptoms such as tightness, burning sensations, and muscle hardness in the calves, especially during activity like walking. Your reports of pain primarily on the outer parts of your lower calves, worsening with activity, align with this condition. Although your ABI and CTA results are normal for vascular health, the dampened PVR could suggest some nerve involvement rather than vascular insufficiency.
Next Steps:
-
Physical Therapy: Start a tailored physical therapy program focused on strengthening core and back muscles and improving spinal alignment. This can alleviate pressure on the affected nerves.
-
Activity Modification: Gradually increase your walking tolerance. Shorter, more frequent walks may prevent exacerbation of symptoms. Consider walking in a controlled environment where temperature and surface are regulated.
-
Pain Management: Use over-the-counter pain relief (e.g., ibuprofen or acetaminophen) as needed, based on your tolerance and symptoms.
-
Posture Awareness: Practice good posture, especially while sitting or standing, to reduce pressure on your lower back and improve nerve function.
-
Follow-Up: Keep a symptom diary to track any changes in your pain level and mobility, which can be helpful for your healthcare provider. Consider discussing the possibility of additional imaging or consultation with a spine specialist to further evaluate nerve involvement if symptoms persist.
Monitoring your progress and adjusting your approach based on symptom changes will be crucial in managing your condition effectively. Please let me know if you need further information or clarification on any points!
Related Questions
Seeking Clarity on a Pediatric Surgical Experience
One of my earliest recollections involves surgical gauze wrapped around my genitals and being cautioned to exercise caution regarding my circumcision. This incident dates back to around 1972, when I was roughly three years old. My brother, who was eleven at the time, corroborates this memory and recalls that the bandage remained in place for "a few weeks." His recollection is a bit unclear, but he does remember seeing me running around without pants and with a gauze dressing. He believes the dressing wasn't overly bulky and doesn't recall any stent being used. However, I am aware that his memory may not be completely accurate based on other conversations we've had. He recalls being informed that I underwent surgery for an undescended testicle, yet was never made aware of a circumcision being involved. Later, a physician indirectly confirmed that I had undergone an early orchidopexy. This memory piques my curiosity, particularly since my parents have never brought it up with me. I have knowledge of having glanular/coronal hypospadias, and the details of my situation appear to align with images I’ve encountered depicting partial hypospadias corrections. This leads me to wonder if my circumcision might have actually been related to hypospadias surgery. Unfortunately, any tangible proof of these events was lost when I underwent gender confirmation surgery as a trans woman three decades ago. It's conceivable that the standard circumcision procedure typically performed at birth could have been postponed, given that I was born slightly premature and had significant Rh disease and hypoxia. But could it have been deferred until I reached the age of three? I have made attempts to obtain my medical records, but unfortunately, they have been destroyed over the years. While I understand that definitive answers may be elusive, I would greatly appreciate any insights or thoughts on this matter.
Concerns About Potential Peripheral Artery Disease (PAD)
For the past three to four years, I have been dealing with a persistent numbness in my left foot. Initially, I suspected it might be due to a pinched nerve or perhaps something similar, but the sensation has never completely returned. As time has gone by, I've encountered additional worrying symptoms: - My feet have started to develop a purple hue, particularly evident when I sit in positions that put pressure on my legs or when I take a shower. This discoloration has become one of the most alarming signs of my condition. - The growth of my toenails has slowed considerably, and they now appear uneven and ridged. - Additionally, my feet have a temperature that feels significantly colder than the rest of my body, and they no longer grow hair as they once did. I do not smoke and I’m not diabetic; however, I have high cholesterol and received an elevated result on a lipoprotein test. The prospect of PAD is frightening to me, as it seems synonymous with a grim future. I have been referred to a cardiologist, but they are reluctant to conduct an Ankle-Brachial Index (ABI) test since I am under 35. I want to remain hopeful and believe I don't have PAD, yet I struggle to identify any other plausible explanations for these symptoms. What could be potential alternatives to consider, if any exist?
Expectorated Large Tissue with Blood
At 28 years old, I experienced a fever the previous night, after which I had no other cold symptoms. To my surprise, today I coughed just once and expelled a significant piece of tissue mixed with blood. Following this alarming incident, I sought medical attention at an urgent care facility because I developed a headache immediately afterward and felt a peculiar "butterfly" sensation in my chest. The healthcare professionals did not conduct any laboratory tests or imaging studies, instead opting to prescribe antibiotics for what they suspected might be an infection. Is this an appropriate response to my situation? This is quite concerning.
Persistent Shin Discomfort
For the past year, I have been grappling with ongoing discomfort in my shins. Despite consulting multiple physiotherapists and doctors, I have yet to find a solution to my problem. My routine has included extensive strength training targeting my hips, glutes, calves, and lower leg muscles. I've also taken steps to improve my running form and have experimented with various recovery techniques, such as foam rolling and using massage devices. No matter what I try, the pain persists, specifically on the inner side of my lower legs. Initially, I suspected that I was suffering from shin splints. However, given my varied attempts at treatment and the lack of improvement, I am starting to believe that the issue might be something different. Even mundane activities, like walking around at home, have become increasingly uncomfortable, not to mention my inability to ride a stationary bike without experiencing pain. If anyone has any insights or recommendations that could assist me in alleviating this issue, I would be extremely grateful. Thank you for your help! I'm a 20-year-old male, standing at 5 feet 8 inches and weighing 70 kilograms.
Concerns About Potential Misdiagnosis
Hello everyone, I recently stumbled upon this subreddit and felt it would be the ideal platform to share my experience. I initially posted something similar under r/Asthma but soon realized that this community might be more appropriate for my concerns. To provide some context, I’m a 25-year-old woman with no personal history of smoking, although I have been heavily exposed to secondhand smoke throughout my life. There is a family history of asthma and COPD on my side. I was diagnosed with asthma during childhood but seemed to outgrow it as I got older. Throughout my younger years, I frequently battled respiratory and sinus infections, and in my teenage years, I suffered a severe case of walking pneumonia. Following that episode, my breathing worsened significantly, prompting my doctor to reinstate the asthma diagnosis and prescribe albuterol inhalers without performing any additional tests except for an X-ray to confirm the pneumonia had resolved. Over the years, I’ve noticed a gradual worsening of my symptoms. Each primary care physician I've consulted has prescribed various inhalers and medications, but the relief they provide has been minimal. For years, I have dealt with a persistent dry cough described as that of a seasoned smoker, yet my doctors continuously assured me it was merely asthma, claiming that my inhalers would alleviate it. When a coughing fit does occur, it can be so intense that I end up gagging, losing control of my bladder, and feeling dizzy. Fast forward to two weeks ago: my cough intensifies with physical activity, and I have a physically demanding job. Typically, my inhaler assists me with breathing, but in this instance, it was ineffective, and emergency services were called to administer oxygen. My oxygen saturation dropped to 93% until the oxygen and my rescue inhaler were applied. I declined hospitalization after feeling better with the oxygen. I took a day off work to recuperate. I managed to see my primary care doctor afterward. Having been on Advair and albuterol for years, I was also prescribed Singulair last year due to flare-ups. In my recent visit, my doctor substituted my Ventolin (albuterol) with Airsupra and introduced Spiriva, along with short courses of Mucinex and Prednisone. At the appointment, my lungs sounded clear, and my oxygen levels were between 99-100%. There was no wheezing, just persistent coughing. Returning to work the following Thursday proved challenging; within three hours, I experienced another severe coughing episode that felt as if my throat might rupture. I was gagging, tearing up, and struggling to remain upright, feeling dizzy and breathless. Several doses of my rescue inhaler provided little relief, and emergency services were contacted again; I was subsequently transported to the emergency room. My oxygen saturation was stable at 97-100%, yet I continued to feel breathless and my painful coughing persisted. Respiratory treatments seemed to exacerbate the coughing, and magnesium failed to provide relief. Both the paramedics and ER staff expressed concern when I mentioned my chronic cough that had persisted for years without improvement. Initially, emergency responders detected only a faint wheeze and diminished lung sounds on one side, although they later reported normal findings. No fluid or wheezing was noted, just continued coughing. CT scans and X-rays of my throat and chest returned normal results. After three days in the hospital, my lactic acid and CO2 levels returned to normal. Despite being treated with steroids and cough suppressants, I found no alleviation of my symptoms. I have now received urgent referrals to a pulmonologist, an ENT specialist, and an allergist, and I recently followed up with my primary care physician. Her only recommendation was cough drops and to wait for my upcoming Pulmonary Function Test (PFT). Additionally, the hospital prescribed Pantoprazole for potential GERD, which hasn't significantly helped. My follow-up blood tests revealed that while my CO2 levels improved, they still remain low, and there are no current indications of an autoimmune disorder, though I am awaiting several results. After undergoing the Pulmonary Function Test, the findings were unusual. Though I await an appointment with the pulmonologist, I reviewed the notes from my test. They indicated, "Spirometry is normal. Lung volumes demonstrate hyperinflation and air trapping. Diffusing capacity is normal. No substantial bronchodilator response observed." When I inquired with the technician who administered the test, she mentioned two possibilities: either my lungs weren't inflamed enough to demonstrate a response, which seemed unlikely considering my extensive coughing fits, or the underlying issue might be irreparable with medications. This situation has left me anxious that I may be dealing with more than just severe asthma. For years, I communicated to my doctors that my condition seems to deteriorate, and that none of the prescribed medications eased my cough, yet they continuously reassured me that it was manageable. Now, after being hospitalized, I recognize the critical need to take this seriously. I rarely experience wheezing or fluid but instead contend with a persistent cough similar to that of a long-term smoker. My cough worsens with movement, eating, drinking, taking deep breaths, lying down, waking up, laughing, excessive talking, exposure to extreme temperatures, dry or humid air, stress, and irritants such as dust, smoke, and potent odors. It feels like merely existing prompts my coughing. Although I always have a cough, the triggers mentioned intensify it. I frequently feel congestion in my throat and chest, accompanied by a tight and painful sensation. I have the incessant urge to clear out whatever feels obstructive, but nothing ever emerges. My coughing often leads to dizziness and incontinence. If I'm not actively coughing, I seem to be clearing my throat repeatedly to manage the mucus. During any illness, my cough tends to worsen, resulting in the need for prednisone. Antihistamines provide partial relief solely for nasal symptoms, without helping my throat and chest. When my rescue inhaler does work, its effectiveness lasts only for a short time before I revert to my previous condition. My lungs may feel momentarily unobstructed thanks to the albuterol, but the coughing inevitably returns until my chest aches again. An ER doctor suggested possible diagnoses of Chronic Rhinosinusitis, Post-Nasal Drip, or GERD; however, medications for allergies and acid reflux have not meaningfully addressed my coughing or breathlessness. It does not seem connected to my sinuses but rather feels like my airways are obstructed, hindering deep breaths. Until I meet with the pulmonologist, my best hypothesis has been Cough-Variant Asthma, but given the lack of response to bronchodilators in my PFT, my confidence in that is wavering. In reviewing my results, I cannot help but consider the early stages of COPD or emphysema, especially since my breathing seems to worsen over time, although my age typically mitigates those concerns given my extensive exposure. I've ordered a test for Alpha-1 antitrypsin deficiency from AlphaID to discuss with my pulmonologist just in case. I am certain I have asthma, but I’m beginning to suspect that there may be additional complications involved. For years, my primary care provider dismissed my concerns, despite my insistence that something felt off. It wasn’t until I required EMS intervention that she finally began the referral process to specialists. I find myself in a state of confusion and unease. Has anyone here experienced anything resembling my situation? I'm looking forward to consulting with the pulmonologist about my test results in the coming week or two, but I’m apprehensive that they will simply dismiss my concerns like previous practitioners have done.