I've been having extreme restless legs (even during the day), paresthesia, and my legs often ache by the end of day. Tests normal. What's the cause?

I'm 35, male, overweight but not obese. For months, I've been having extreme restless legs (even during the day), paresthesia, and my legs often ache by the end of day. Symptoms are worse when standing and are centered on the back of my legs, roughly from the ankle to the calf (the rt leg worse than the left). No swelling or visible signs. A nerve conduction test and MRI on my back/neck ruled out nerve problems. Because of this and my age, my doctor won't consider it to be a vein problem.

Answers from doctors (1)


More About Doctor Vein Specialists

Published on Jul 24, 2018

Although not recognized as associated conditions by many physicians, as a vascular surgeon focusing my last 12 years to venous disease exclusively, I have seen many patients whose main complaints were those of RLS who also had venous insufficiency documented by ultrasound.

I routinely suggest an organized trial of compression hose in this group of patients. Those who have marked improvement of their RLS symptoms with hose therapy are good candidates for endovenous ablation. Patients with RLS have basically the same symptoms as patients with venous insufficiency. RLS has no absolute set of diagnostic criteria other than the symptoms--no lab test, no nerve test. Basically it is a diagnosis of exclusion, and the one disease that has generally not been considered or excluded is venous insufficiency.

So, my recommendation is to seek a venous evaluation by a recognized vein expert in your area. If you have insufficiency, try hose for 1-2 weeks during the day, every day, from 8-5. See how your legs feel after a few days. If you notice no difference in your symptoms of RLS after a full week, then it is doubtful in my opinion that venous ablation would benefit you. If you have significant improvement in your symptoms of RLS, then I would strongly consider ablation on whichever leg is worse symptomatically or by duplex criteria.

Answered by Vein Specialists (View Profile)

Although not recognized as associated conditions by many physicians, as a vascular surgeon focusing my last 12 years to venous disease exclusively, I have seen many patients whose main complaints were those of RLS who also had venous insufficiency documented by ultrasound.

I routinely suggest an organized trial of compression hose in this group of patients. Those who have marked improvement of their RLS symptoms with hose therapy are good candidates for endovenous ablation. Patients with RLS have basically the same symptoms as patients with venous insufficiency. RLS has no absolute set of diagnostic criteria other than the symptoms--no lab test, no nerve test. Basically it is a diagnosis of exclusion, and the one disease that has generally not been considered or excluded is venous insufficiency.

So, my recommendation is to seek a venous evaluation by a recognized vein expert in your area. If you have insufficiency, try hose for 1-2 weeks during the day, every day, from 8-5. See how your legs feel after a few days. If you notice no difference in your symptoms of RLS after a full week, then it is doubtful in my opinion that venous ablation would benefit you. If you have significant improvement in your symptoms of RLS, then I would strongly consider ablation on whichever leg is worse symptomatically or by duplex criteria.

Published on Jul 11, 2012


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