Q. I am a chronic smoker, and I have lower limbs pain immediately on standing up. Kindly help me.

Answered by
Dr. Bn Bhagat
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Jul 21, 2021

Hi doctor,

About a month ago, I felt pain in the back of my calves when I stood up and walked. Over the past month, this pain (stinging and about level two) goes to the front of my calves, front and back of my thighs, sometimes reaching all the way to my buttocks and lower back. My regular doctor is baffled by this and recommends physical therapy. I would like to know more about what this condition is before I proceed. Kindly give your opinion.



Welcome to

Sorry for the problem you are facing. Let me try and proceed towards the condition, if possible, by asking you few questions.

1) Is the pain unilateral or bilateral that is in one or both limbs involved?

2) Is the pain occurs after walking a certain distance beyond which it is very difficult to walk and subsides after taking a rest?

3) Or is the pain present even at rest and at the initiation of walking or movement?

4) Any chronic history of smoking, diabetes, hypertension, or atherosclerosis?

5) Any tingling or pins and needles like paresthesia in the affected limb?

6) Do you feel any pain or stretching in the mentioned area while raising the leg while you are in a supine position?

7) Any swelling or edema or visible blood vessel swelling do you notice?

8) Any color change of the affected limb?

Please answer the above questions to guide you accordingly.

Hi doctor,

Thank you.

The pain has devolved in such a fashion that both limbs (front and back, calves and thighs) and my buttocks and lower back are affected. The pain occurs immediately upon standing up and continues while walking. It also makes ascending stairs increasingly difficult. The pain subsides immediately once I sit down. Yes, I am a heavy smoker. I have been diagnosed as pre-diabetic and take 1500 mg/day of Metformin to lower my blood sugar. No history of hypertension or atherosclerosis. I did have a heart attack four years ago. Yes, it is a pins and needles stinging type of pain. There is no swelling or edema, or visible blood vessel swelling. There is no color change of the affected limb. Kindly give your opinion.



Welcome back to

Chronic arterial disease is one of the differential diagnoses. Your medical history also points towards it, but it should be investigated first. To rule out this, you need to do a duplex USG (ultrasonography) scan lower limb, whether the pain is due to the above condition or not. Ankle-brachial pressure index also guides towards it.

I hope this was helpful.

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