Causes of Thigh Pain

Identifying Thigh PainDr. Eric H. Williams has been able to help many patients find relief from nerve pain in the thigh, and he might have the answer for you as well. There are many possible causes of sharp, shooting, burning, tingling, searing, or shocking pain from the groin down the thigh, and Dr. Williams is experienced in determining what may be causing the problem.

Meralgia Paresthetica, Pain on Outer Thigh

Meralgia paresthetica occurs when the lateral femoral cutaneous nerve — which supplies sensation to the surface of your outer thigh — becomes compressed, or pinched. The lateral femoral cutaneous nerve is purely a sensory nerve and doesn't affect your ability to use your leg muscles.

In most people, this nerve passes through the groin to the upper thigh without trouble. But in meralgia paresthetica, the lateral femoral cutaneous nerve becomes trapped — often under the inguinal ligament, which runs along your groin from your abdomen to your upper thigh.

Common causes of this compression include any condition that increases pressure on the groin, including:

  • Tight clothing, such as belts, corsets and tight pants
  • Obesity or weight gain
  • Wearing a heavy tool belt
  • Pregnancy
  • Scar tissue near the inguinal ligament due to injury or past surgery

Nerve injury, which can be due to diabetes or seat belt injury after a motor vehicle accident, for example, can also cause meralgia paresthetica.

There are an array of conservative treatment options that might be used for the condition, but when the symptoms are severe and long-lasting, you may need surgical care. At that point, it is time to come in and see Dr. Williams for a consultation.

Posterior Tibial Nerve Entrapment

Patients with proximal tarsal tunnel syndrome usually present with diffuse, vague discomfort or pain. They may have burning, tingling, or numbness in the lower limb. Although occasionally a history of trauma is reported, most patients report a fairly deceptive onset of symptoms to Dr. Williams.

In most instances, symptoms are unilateral. Occasionally, patients may report proximal radiation of pain to the medial leg. Prolonged standing and walking tend to exacerbate the symptoms, and rest relieves them. Many patients also present with night pain that is improved with walking or massage. Our patients may note pain secondary to nerve tension when the ankle is placed in extreme dorsiflexion.

Patients with distal entrapment of the lateral plantar nerve or its branches usually present with chronic heel pain that has been present for 9-12 months. Many of their symptoms are similar to plantar fasciitis, especially the location of their pain and their startup pain. In addition to the mechanical symptoms of plantar fasciitis, they present with neurotic pain that is unrelated to weight bearing on the foot.

Most patients report that at first, their symptoms occurred only when they were bearing weight. Over time, the symptoms tended to increase, eventually occurring when the patient was seated and occasionally occurring at night.

Patients are usually asymptomatic in the mornings before taking their first step. Symptoms usually worsen with increased activity, as well as toward the end of the day and after long periods of standing, walking, or running. Prolonged standing in one place may be an aggravating factor. Most patients continue to have pain or burning (“afterpain” or “afterburn”) for 30 minutes to several hours after they are off their feet.

Tarsal tunnel syndrome is seen commonly in individuals who are in their fifth and sixth decades of life, and it is more common in women than in men. No consistent correlation with patient body weight has been identified. Most investigators have not been able to identify a significant common factor regarding occupation or underlying foot structure.

Some patients with tarsal tunnel syndrome have peripheral neuropathy or radiculopathy. Patients with peripheral neuropathy or radiculopathy may have symptoms that mimic tarsal tunnel syndrome.

Common Peroneal Nerve Entrapment

Peroneal nerve lesions at the region of the knee or distal thigh usually result in patient reports of altered ambulation secondary to paretic or paralyzed ankle dorsiflexors. Loss of sensation in the cutaneous distribution of the superficial and deep peroneal nerves may be noted, but ankle dorsiflexion weakness is often of the greatest concern to the patient.

Pain is not universal with common peroneal nerve injuries. If present, it is often related to the specific cause of the nerve compromise. If Dr. Williams taps the nerve at the fibular head during examination, it may produce pain and tingling in the sensory distribution of the peroneal nerve.

Superficial Peroneal Nerve Entrapment

With superficial peroneal nerve entrapment, though patients may present with numbness or paresthesia in the distribution of the nerve and occasionally have pain about the lateral leg, the most typical presentation is vague pain over the dorsum of the foot. This pain may be chronic, remaining present for several years, and may be associated with other foot and ankle symptoms; on the other hand, it may be acute and associated with recent trauma or surgery about the ankle.

Specific measure that put the superficial peroneal nerve at risk for direct or stretch injury include the use of the anterolateral arthroscopy portal and the use of noninvasive traction methods with straps over the dorsum of the foot. About one quarter of patients have a history of previous or recurrent ankle sprains or trauma.

Typically, symptoms increase with activity (running, walking, or squatting); they are often relieved by rest or the avoidance of a specific activity. This tendency is particularly pronounced in athletes whose symptoms are suggestive of exertional or chronic anterolateral compartment syndrome.

Bony entrapment of the superficial peroneal nerve in the fracture callus has also been reported when fractures of the fibula heal with abundant callus.

Certain positions (crossing the leg over the opposite thigh) can induce symptoms, as can tight clothing (sock elastic over the lateral leg). Pain may occasionally occur at night. Occasionally, patients report a bulging mass in the leg.

Deep Peroneal Nerve Entrapment

Patients with deep peroneal nerve entrapment commonly complain of vague pain, a burning sensation, or a cramp over the dorsum of the foot. Associated sensory changes may be noted in the first dorsal webspace. Some patients may present with neurotic symptoms (unrelenting pain at rest and during sleep) along the course of the nerve. There may be pain in the ankle region even if only the motor nerve is involved.

Symptoms may appear or worsen only with a certain shoe or boot or with certain activities. Patients with more proximal entrapment may present with frequent tripping due to foot drop or weakness of the extensor halluces longus, though such a presentation is less common.

Nerve Pain Relief in Baltimore, MD

The hope is always that your pain can be relieved or controlled with conservative (nonsurgical) care like physical therapy, injections, and medical pain management. However, if your physician or specialist has been unable to provide the relief you seek with those methods, and symptoms have been present for at least 4-6 months (with no sign of improvement), it may be time to explore other options and another opinion. 

If you are experiencing chronic nerve pain in your thigh, contact our Baltimore, MD office for a consultation. Dr. Williams may be able to provide the care you need when no one else does, so give us a call at (410) 337-5400.