health topics

Why Does My Lower Leg Ache at Night?

A man's painful lower legs and feet
Common causes of lower leg ache at night may include muscle cramps, muscle or tendon inflammation, bone fracture, blood clots (such as deep vein thrombosis [DVT]), varicose veins, peripheral artery disease (PAD), peripheral neuropathy, pregnancy, gout, and inflammatory arthritis.

There are many reasons the lower legs can ache at night, resulting in restless sleep overnight and fatigue throughout the day. 

10 Causes of Aching Legs

Common causes of lower leg ache at night may include: 

  • Muscle cramps
  • Muscle or tendon inflammation
    • May be caused by an injury or overuse
  • Bone fracture
    • Caused by injury to the bone
  • Blood clots, such as deep vein thrombosis (DVT)
    • Caused by blood flow in the veins becoming slowed or blocked, which may be due to:
      • Injury to the leg veins
      • Illness that affects the veins
      • Immobility
      • Obesity
      • Recent surgery 
      • Pregnancy or childbirth in the past six months
      • Broken bone in the hips, pelvis, or legs
      • Certain medications
  • Varicose veins
    • Caused by weak or damaged vein walls and valves, which may be due to:
      • Being overweight or obese
      • Sedentary lifestyle 
      • Pregnancy
      • A tumor
      • Genetics
  • Peripheral artery disease (PAD)
  • Peripheral neuropathy
    • Caused by damage to or compression of a nerve
  • Pregnancy
    • Leg ache at night during pregnancy is common and may be due to: 
      • Increased blood volume during pregnancy 
      • Extra strain on the body from carrying more weight than it is used to
      • The uterus putting extra pressure on veins that carry blood back from the lower body, partially blocking blood flow and keeping fluids in the legs 
  • Gout
  • A form of inflammatory arthritis that can be painful, due to excess uric acid in the body 
    • Often caused by eating foods with high levels of compounds called purines, such as alcoholic beverages, some seafood and shellfish, some meats, organ meats, high-fat foods, sodas with high-fructose corn syrup, and yeast

What Are Symptoms of Lower Leg Aches at Night?

Lower leg aches at night may be accompanied by symptoms such as: 

  • Pain in the leg that is throbbing or cramping 
  • Leg cramps
  • Numbness and tingling in the legs
  • Restlessness
  • Inability to stay asleep
  • Daytime fatigue
  • Aching pain in the leg bone present during the day and night
  • Abnormal skin redness on the legs
  • Localized warmth and swelling 
  • Heavy feeling in the legs
  • Bulging, bluish veins in the legs
  • Swelling in the legs
  • Itching around veins in the legs
  • Skin color changes around veins in the legs

How Are Lower Leg Aches at Night Diagnosed?

Lower leg aches at night are diagnosed with a patient history of symptoms and a physical examination. Depending on the suspected cause, testing to determine the cause of lower leg aches at night may include: 

  • Blood tests
  • Imaging tests
    • Ultrasound 
    • X-ray
    • Magnetic resonance angiography (MRA)
    • Computed tomographic (CT) angiography
  • Ankle brachial index for PAD

What Is the Treatment for Lower Leg Aches at Night?

Treatment for lower leg aches at night depends on the cause. 

If lower leg aches at night are caused by muscle cramps treatment may include:

  • Applying cold or heat packs 
  • Drinking plenty of water or sports drinks
  • Magnesium supplements 

If lower leg aches at night are caused by inflammation of muscles/tendons treatment may include:

  • Applying cold or heat packs 
  • Anti-inflammatory medication
  • Finding a comfortable position to sleep in 

If lower leg aches at night are caused by a diagnosed bone fracture treatment may include:

  • Anti-inflammatory medications 
  • Resting in a comfortable position 
  • Cast or brace

If lower leg aches at night are caused by a blood clot such as deep vein thrombosis (DVT), it is important to see a doctor right away. Treatment may include:

  • Anticoagulants
  • Thrombolytic therapy, in severe cases
  • Stenting
  • Endovascular procedures
  • Inferior vena cava (IVC) filter 

If lower leg aches at night are caused by varicose veins treatment may include:

  • Elevating the legs above the heart 
  • Compression stockings 
  • Moving around when the pain occurs, and otherwise being physically active 
  • Staying healthy weight
  • Endovenous ablation to close off a varicose vein
  • Sclerotherapy to close off a varicose vein
  • Surgery to remove severe varicose veins

If lower leg aches at night are caused by peripheral artery disease (PAD) treatment may include:

  • Aspirin or other similar antiplatelet medicines 
  • Cholesterol-lowering medicines
  • Don’t smoke
  • Surgery to bypass blocked arteries

If lower leg aches at night are caused by peripheral neuropathy treatment may include:

  • Treating the underlying cause
  • Medications to relieve nerve pain
  • Capsaicin cream

If lower leg aches at night are caused by pregnancy treatment may include:

  • Taking a warm bath before bed 
  • Gently stretching your legs
  • Drinking plenty of water well hydrated 
  • Elevating the legs when possible
  • Avoiding sitting or standing for long periods of time
  • Compression stockings if pain is due to swelling
  • Acetaminophen (Tylenol)
    • Usually considered safe for use during pregnancy but talk to your doctor first before taking any medication, even over-the-counter (OTC) medicines, during pregnancy
  • Magnesium supplements if pain is due to cramping 
    • Talk to your doctor first before taking any supplement during pregnancy

If lower leg aches at night are caused by gout treatment for gout flares may include:

  • Anti-inflammatory medications 
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) 
    • Colchicine (Colcrys)
    • Corticosteroids
  • Medications to treat clumps of uric acid crystals around a joint (tophi) and kidney stones 
References
REFERENCES:

Image source: iStock Images

https://www.thefeetpeople.com.au/learning-hub/causes-of-lower-leg-pain-at-night/

https://www.uptodate.com/contents/deep-vein-thrombosis-dvt-beyond-the-basics?search=deep%20vein%20thrombosis&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3

https://www.nhlbi.nih.gov/health/varicose-veins

https://www.cdc.gov/heartdisease/PAD.htm

https://www.nhs.uk/conditions/peripheral-neuropathy/treatment/

https://www.thebump.com/a/leg-pain-during-pregnancy

https://www.cdc.gov/arthritis/basics/gout.html