Leg Pain After a DVT: Exploring Causes and Finding Relief

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Table of Contents
  1. Why Pain Occurs After a DVT
  2. Post-Thrombotic Syndrome Risk Factors
  3. Finding Relief from Leg Pain
  4. Medical Treatments
  5. Normal Pain vs. Concerning Pain

Deep vein thrombosis (DVT) is a blood clot that forms in a deep vein, blocking blood flow. Some patients experience pain after a DVT. Typically, the pain goes away once the clot has dissolved. But sometimes, leg pain can stick around for a while after a DVT, which can be frustrating. This ongoing pain is often a symptom of a condition called post-thrombotic syndrome, or PTS.

PTS causes chronic pain in some patients after a DVT. Not everyone will experience PTS – it impacts approximately 20-50% of people who’ve had a DVT.

Why Pain Occurs After a DVT

A DVT in the legs can damage the valves in veins or the veins themselves. Veins bring blood back to the heart from the tissues. The veins in your extremities, like the legs, use muscle movements to squeeze and help push the blood back to the heart. In your veins, there are valves that act like doors to prevent blood from flowing backward. When a DVT forms in the veins, it acts as a plug and blocks the normal flow of blood. This blockage allows fluid to collect in the veins.

As the fluid builds up, it raises the pressure inside the veins. The veins then begin to widen and become weak. Because of the widening, the typically closed valves can no longer shut properly. Blood flow back to the heart decreases. The fluid builds up, leading to swollen tissues, inflammation, and pain.

Some blood clots heal by turning into scar tissue. This scar tissue can also damage the valves in the vein. Scar tissue affects the valves’ ability to function correctly, causing more fluid to collect in the legs. Sometimes, the vein’s wall can become too narrow from the scar tissue. When the vein narrows, the flow of blood back to the heart is reduced, leading to increased fluid buildup, pressure, and pain.

Damage to the leg veins after a DVT can lead to chronic venous insufficiency, a condition where the veins in the legs aren’t able to effectively return blood to the heart.

Post-Thrombotic Syndrome Risk Factors

Not everyone who has had a DVT will develop PTS. Factors that increase the chance of getting PTS include:

  • Obesity
  • Female sex
  • Use of estrogen therapy
  • Recurrent blood clots in the same leg
  • A blood clot that forms in a vein in the upper leg or pelvis

Finding Relief from Leg Pain

There isn’t a cure for PTS, but there are things you can do to manage it and reduce pain.

Medical Treatments

PTS is first treated with compression therapy. Compression therapy makes the veins narrower, which helps to improve the valves’ function. When the valves close properly, blood flow returns to the heart, and leg swelling decreases. Compression therapy may include:

  • Bandaging: Short-stretch bandages help the calf muscles work better when you walk, improving blood flow back to the heart. Long-stretch bandages, like ACE wraps, can lose their tightness when you walk and need to be changed often.
  • Elastic compression stockings (ECS): Some patients use ECS to reduce swelling. These stockings come in different levels of compression or tightness. Your healthcare team can help you choose the right one. They come in knee-high or thigh-high lengths and help improve blood flow by applying steady pressure.
  • Adjustable compression wrap devices: These devices use fasteners like Velcro and allow the patient to adjust the wrap when it feels loose. 
  • Intermittent pneumatic compression (IPC): This type of therapy uses a pump to fill and empty air from hollow plastic leggings worn by the patient. IPC helps by gently squeezing the legs to push blood and fluid out of the tissues. It’s for patients who can’t use compression stockings or when the stockings don’t work.

Surgical procedures may be an option when other treatments don’t work and can improve symptoms. A damaged valve can be repaired through reconstruction, known as valvuloplasty. When a valve has severe damage, it can be repaired by transplanting a healthy valve from a different vein in the arm. If a vein is too narrow, stents can be inserted to widen the vein, increasing blood flow.

Home Remedies and Lifestyle Changes

If you have symptoms of PTS, there are some ways to manage them effectively at home. If the veins and valves are weak, blood doesn’t move back to the heart efficiently, causing more pressure, swelling, and pain. Since your legs are furthest from your heart, fluid can easily collect because of gravity. Here are some tips to reduce pressure in your legs:

  • Stay active: Walking and other activities can help the calf muscles move blood back to the heart. 
  • Use a footrest when you’re sitting: Even a little elevation can help relieve symptoms and decrease pressure.
  • Elevate your legs when lying down: Place a firm pillow under your legs to keep them above the level of your heart – but avoid putting pillows under your knees since that can block one of the main leg arteries.
  • Maintain a healthy body weight: Extra weight can increase stress on the circulatory system, raising venous pressure.
  • Don’t be in the heat for too long: Heat can cause veins to increase in size, causing more fluid to collect inyour legs, which can worsen symptoms of leg heaviness and swelling.
  • Decrease the amount of salt in your diet: Large amounts of sodium in your tissues can cause more swelling.

Normal Pain vs. Concerning Pain

Everyone feels pain differently. Patients with PTS will have some degree of moderate-to-severe pain. PTS pain symptoms can include:

  • Aches or cramping
  • Feelings of leg heaviness
  • Paresthesia, or feeling of pins and needles

A clinician should evaluate leg pain that occurs suddenly, is severe, or won’t go away. Contact your clinician if you experience other symptoms with leg pain, such as a fever, or a change in skin color or temperature (like coolness).

Ongoing pain after a DVT can be frustrating and burdensome – but there are ways to help manage the symptoms. Keep in contact with your medical team and have open conversations about how your symptoms are impacting your life.

References

Douketis J. Chronic venous insufficiency and post-thrombotic syndrome. Merck Manual Consumer Version. https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/venous-disorders/chronic-venous-insufficiency-and-post-thrombotic-syndrome. Updated December 2023. Accessed July 21, 2024.

Kahn S. The post-thrombotic syndrome. Hematology Am Soc Hematol Educ Program. 2016; 2016(1):413-418.

Leg pain. Related Symptoms, Causes and Treatments. Healthdirect. https://www.healthdirect.gov.au/leg-pain. Accessed July 5, 2024. 

Rathbun S, & Palacios F. Medical treatment for postthrombotic syndrome. Seminars in Interventional Radiology. 2017;34(01), 61–67. doi: 10.1055/s-0036-1597765

Schleimer K, Barbati M, Gombert A, et al. The treatment of post-thrombotic syndrome. Dtsch Arztebl International. 2016;113(50). doi:10.3238/arztebl.2016.0863

Waldron B, & Moll S. A patient’s guide to recovery after deep vein thrombosis or pulmonary embolism. Circulation, 2014;129(17). https://doi.org/10.1161/circulationaha.113.006285

*Originally published in The Beat — August 2024. Read the full newsletter here.

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