Question

Like most people with ME/CFS, I often have muscle or nerve pain in various parts of my body – often brought on or made worse by activity. But I’ve recently had a more unusual and very localised pain in the calf muscles of my legs. It’s not usually present at rest and normally comes on when I have been for a longish walk – which I can still manage to do. I should add that I’m in my early sixties, am a bit overweight, also have mild diabetes, and have had ME for about 15 years.

Is this very specific type of activity-induced pain in the legs being caused by ME? Or do I need to see my GP?

Answer

You definitely need to see your doctor because while leg pain can occur in ME/CFS what you are describing sounds remarkably like intermittent claudication. This is a potentially serious vascular condition caused by narrowing of the big arteries that supply blood to the legs and has nothing to do with ME/CFS.

Intermittent claudication becomes increasing common in people who are over the age of 60, especially in those who already have heart disease. The risk is also increased by:

• Having black ethnicity
• Diabetes
• Kidney disease
• High blood pressure
• Raised blood fats/lipids
• Obesity
• Smoking

Around 20% of people over 60 start to develop narrowing in these large leg arteries, but there often aren’t any obvious symptoms early on. The first symptom is often pain in the calf muscles following walking or some other activity. Pain can also be felt in the thighs and buttocks if a different part of the artery is affected. Later on there may be other signs and symptoms including rest pain and skin ulcers.

Confirmation of the diagnosis is made by your doctor examining the pulses in the leg arteries and measuring what is called the ankle brachial pressure index (ABPI) – which provides a good estimate of how severe the artery occlusion is.

Treatment involves a combination of:

• Lifestyle changes – stopping smoking, weight reduction, leg exercises if able to do so
• Good management of diabetes and high blood pressure – where present
• Drugs – which may include anticoagulants, beta blockers and statins
• Surgery – in more severe cases

So, in conclusion, it's very important to see your doctor if you are having calf, buttock or thigh pain after exercise , especially if you are over 60 and have any of the risk factors above.