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Leg Pain

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Definition

  • Pain in the legs (hip to foot)
  • Includes hip, knee, ankle and toe joints
  • Includes minor muscle strain from overuse
  • Muscle cramps are also covered
  • The pain is not caused by an injury

Causes

  • Main Causes. Muscle spasms (cramps) and strained muscles (overuse) account for most leg pain.
  • Muscle Cramps. Brief pains (1 to 15 minutes) are often due to muscle spasms (cramps). Foot or calf muscles are especially prone to cramps that occur during sports. Foot or leg cramps may also awaken your child from sleep. Muscle cramps that occur during hard work or sports are called heat cramps. They often respond to extra fluids and salt.
  • Muscle Overuse (Strained Muscles). Constant leg pains are often from hard work or sports. Examples are running or jumping too much. This type of pain can last several hours or up to 7 days. Muscle pain can also be from a forgotten injury that occurred the day before.
  • Growing Pains. 10% of healthy children have harmless leg pains that come and go. These are often called growing pains (although they have nothing to do with growth). Growing pains usually occur in the calf or thigh muscles. They usually occur on both sides, not one side. They occur late in the day. Most likely, they are due to running or playing hard. They usually last 10 to 30 minutes.
  • Low Calcium Level. Low calcium and vitamin D levels can cause minor bone pains. Pain is mainly in the legs and ribs. Children on a milk-free diet are at risk.
  • Osgood Schlatter Disease. Pain, swelling and tenderness of the bone (tibia) just below the kneecap. The patellar tendon attaches to this bone. Caused by excessive jumping or running. Peak age is young teens. Harmless and goes away in 1 - 2 years.
  • Viral Infections. Muscle aches in both legs are common with viral illness, especially influenza.
  • Serious Causes. Fractures, deep vein thrombosis (blood clot in leg). Also, neuritis (a nerve infection) and arthritis (a joint infection).
  • Septic Arthritis (Serious). A bacterial infection of any joint space is a medical emergency. The symptoms are severe joint pain, joint stiffness and a high fever.
  • Toxic Synovitis of the hip is a harmless condition. It can imitate a septic arthritis of the hip. The symptoms are a limp, moderate pain and usually no fever. Toxic synovitis tends to occur in toddlers after jumping too much.

Pain Scale

  • Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
  • Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
  • Severe: The pain is very bad. It keeps your child from doing all normal activities.
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When To Call

Call 911 Now

  • Not moving or too weak to stand
  • You think your child has a life-threatening emergency

Go to ER Now

  • Can't stand or walk

Call Doctor or Seek Care Now

  • Fever and pain in one leg only
  • Can't move a hip, knee or ankle normally
  • Swollen joint
  • Calf pain on 1 side lasts more than 12 hours
  • Numbness (loss of feeling) lasts more than 1 hour
  • Severe pain or cries when leg is touched or moved
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Walking is not normal (has a limp)
  • Fever and pain in both legs
  • Bright red area on skin
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Cause of leg pain is not clear
  • Leg pain lasts more than 7 days
  • Leg pains or muscle cramps are a frequent problem
  • You have other questions or concerns

Self Care at Home

  • Muscle cramps in the calf or foot
  • Strained muscles caused by overuse (exercise or work)
  • Growing pains suspected
  • Cause is clear and harmless. (Examples are tight new shoes or a recent shot)
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Care Advice

  1. What You Should Know About Leg Pain:
    • Strained muscles are common after too much exercise or hard sports.
    • Examples are hiking or running.
    • Weekend warriors who are out of shape get the most muscle pains.
    • Here is some care advice that should help.
  2. Muscle Cramps Treatment:
    • Muscle cramps in the feet or calf muscles occur in a third of children.
    • Stretching. During attacks, stretch the painful muscle by pulling the foot and toes upward. Stretch as far as they will go to break the spasm. Stretch in the opposite direction to how it is being pulled by the cramp.
    • Cold Pack. Use a cold pack. You can also use ice wrapped in a wet cloth. Put it on the sore muscle for 20 minutes.
    • Water. Heat cramps can occur with hard sports on a hot day. If you suspect heat cramps, have your child drink lots of fluids. Water or sports drinks are good choices. Continue with stretching and using a cold pack.
    • Prevention. Future attacks may be prevented by daily stretching exercises of the heel cords. Stand with the knees straight. Then, stretch the ankles by leaning forward against a wall. Place a pillow under the covers at the foot of the bed at night. This gives the feet more room to move at night. Also, be sure your child gets enough calcium in the diet. Daily vitamin D3 may also help.
  3. Strained Muscles from Overuse - Treatment:
    • Pain Medicine. To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed.
    • Cold Pack. For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth. Put it on the sore muscles for 20 minutes. Repeat 4 times on the first day, then as needed. Caution: Avoid frostbite.
    • Heat Pack. If pain lasts over 2 days, put heat on the sore muscle. Use a heat pack, heating pad or warm wet washcloth. Do this for 10 minutes, then as needed. Caution: Avoid burns. For stiffness all over, use a hot bath instead. Move the sore leg muscles under the warm water.
  4. Growing Pains Treatment:
    • Most often, the pains are mild and don't last long. No treatment is needed.
    • Massage. Rub the sore muscles to help the pain go away.
    • Pain Medicine. If the pain lasts more than 30 minutes, give a pain medicine. You can use either acetaminophen (such as Tylenol) or ibuprofen (such as Advil). Use as needed.
    • Prevention. Research has shown that daily stretching can prevent most growing pains. Stretch the quads, hamstrings and calf muscles. Also, be sure your child gets enough calcium and vitamin D in their diet.
  5. What to Expect:
    • Muscle cramps usually last 5 to 30 minutes.
    • Once they go away, the muscle returns to normal quickly.
    • A strained muscle hurts for 3 to 7 days. The pain often peaks on day 2.
    • Following severe overuse, the pain may last a week.
  6. Call Your Doctor If:
    • Muscle cramps occur often
    • Fever, limp, or a swollen joint occurs
    • Pain caused by work or sports lasts more than 7 days
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2019 Schmitt Pediatric Guidelines LLC.
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