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Dull burning pain in bilateral calf region. HbA1C, TSH, T3, T4, all in normal ranges. Low Cholesterol, LDL and high HDL

Jan 2013
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Answered by

Internal Medicine Specialist
Practicing since : 2003
Answered : 1658 Questions
Hello Doctor,

Since I didn't get and answer for my follow up question and I am will to get a second opinion. I am writing you once again about the same inquiry. Thank you for sparing your time for sharing your opinion.

Dull burning pain(sensation of tiredness) increased by inactivity in bilateral calf region
Inability to gain weight on same area
Easy scar formation, late scar healing and keloid formation on same area.

All of my symptoms are lasting for at least 10 years(I am 29)

I am adding my previous correspondence and two photos of scaring for additional information.

Hello Doc,

I have a burning feeling in my legs when I stay stand up or even walk for more than 30 minutes. Funny side of the story is that I am a dancer and it hurts less when I dance for hours. Also I am a professional athlete but nothing happens when I run for 20 miles. I can not really understand this paradox. (If it also helps I can not gain weight to my legs, especially the calf region)

Thanks for posting your query.

This burning feeling in legs can be due to parasthesia skin which is due to dysfunctioning of neurons. Numbness, burning and tingling are abnormal sensations that can occur anywhere in your body, but are often felt in your hands, feet, arms, or legs.

It can be due to diabetes, hypothyroidism, peripheral vascular disease, vitamin B12 deficiency, neujrological causes or malnutrition. Other causes are motor neurone disease, or autoimmune disorders like multiple sclerosis or lupus erythematosus. A diagnostic evaluation by a doctor is necessary to rule these out.

Get your blood sugar and thyroid hormones levels evaluated. You can take some vit B12 for some days and see if the symptoms improve. If the symptoms persist then get the above mentioned possibilities ruled out from a neurologist.

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.

Wishing you good health.

Dr ........,

I appreciate your answer, which at some point went beyond my comprehension. So here is my follow up questions,

1. This feeling of burning( I can also describe it as a tired sensation slightly feel like burning) comes more from deeper in my calf. For example when I am in the OR standing up, it starts to hurt after thirty minutes. And no where in my hands, arms or anywhere else in my body feels this sensation. Do you think it can still be due to skin parasthesia? Just do add a point it also comes with me from my childhood.

2. My HbA1C, B12, Glu, TSH, T3, T4, are all in normal ranges.

3. Therefore DM, B12 def, hypothyroidsm will be very unlikely. As I said I have a very balanced diet with my dietician I eat very well in variety that I could hardly be malnutritioned. I have no accompanying MS or SLE related symptoms or neurological symptoms of other parts in my body unless you were thinking about polynoropathy involving my lower bilateral extremities, it can hardly be the chance.

In resolution if Peripheral vascular disease was the only one left in your diagnosis checklist(unless you are still considering about a neuronal problem), could you forward my question to the appropriate branch Doctor or answer yourself?

My best regards.


Thanks for writing back.

Calf pain that show up during physical activity, such as standing or walking, are usually a sign of arterial insufficiency(peripheral artery disease). That means the arteries aren't able to supply the calf muscles with enough blood and oxygen to XXXXXXX their needs. This usually arises from atherosclerosis—hardening of the arteries. Atherosclerosis can occur for many reasons such as smoking, diabetes, and high cholesterol.

As you have got most of the tests which have come out normal, the only one left is a venous and arterial doppler of the legs. In case that also comes out normal then a combination of vitamin and levocarnitine should help you.

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.

Wishing you good health.

Great Doctor,

Now I feel much closer to my diagnosis. Perhaps the problem with it could be you have missed some points in my question,

1 As I mentioned earlier on contrary it relieves with physical exercise (remember nothing happens if I run 20 miles but when I am standing)

2 Besides since it comes with me from childhood, I never smoked, I am 29 y/o athlete, I have no DM, low Cho, LDL and high HDL wouldn't you agree that it can't be atherosclerosis

Did your answer relate the fact of inability to gain in calf region as well?

Are you still suggesting doppler as my last resort?

Best Regards
Posted Fri, 24 May 2013 in Medicines and Side Effects
Answered by Dr. Mayank Bhargava 12 hours later
Welcome to XXXXXXX forum.

Let me know your other associated symptoms along with mentioned.
Do you have back ache/ loss of control over urination & defecation?
Do you have family history of delayed scar healing or keloid formation?
Are you getting relief in your symptoms after sitting?

With the available described details, there could be possibility of peripheral vascular disease and lumbar canal stenosis (as symptoms are confined to lower limbs).
Possibility of lumbar canal stenosis appears to be high as symptoms are getting worse on standing. This feature is very specific for lumbar canal stenosis.

Possibility of peripheral artery disease (PAD) appears to be less in front of lumbar canal stenosis as you are a non smoker (PAD is more common in smokers), symptoms get worsen on walking (while you are able to walk 20 miles).

If you are suffering from the same symptoms since childhood and suppose you are suffering from peripheral artery disease then there must be atrophic changes in lower limbs. There must be shiny skin, loss of hairs, gangrenous skin changes in lower limbs (I have gone through the attached pictures and all these defined features are lacking in your case).

So with the available details there appears to high possibility of lumbar canal stenosis.
As such there appears to least correlation between keloid formation, delayed scar formation and present symptoms.
There appears to be least possibility of motor neuron disease (involve motor fibres not the sensory fibres), DM, Lupus.

You should consult with XXXXXXX medicine specialist/ neurologist and should go for thorough check up.
You should also go for peripheral artery palpation thoroughly by general surgeon.

In my personal opinion, you should go for color doppler studies of both lower limbs, nerve conduction studies, and CT/ MRI scan lumbo-sacral spine for better clarification.

Treatment depends on exact diagnosis.
Meanwhile, you should take methylcobalamin, pregabalin/ gabapentin for suspected neuropathic symptoms.

Hope that helps.
Let me know your other query.
Take care,
Dr. Mayank Bhargava
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