Restless Legs Syndrome
What is restless legs syndrome?
Restless legs syndrome (RLS), sometimes called Willis-Ekbom disease, is a neurological condition that causes a strong or irresistible urge to move the legs.
Symptoms usually develop when you are resting, particularly in the evening or at night, and movement temporarily makes them better. It can significantly interfere with sleep.
Although the legs are most commonly affected, some people also experience similar sensations in the arms or other parts of the body.
What does restless legs syndrome feel like?
People describe RLS in many different ways.
You may experience:
An overwhelming urge to move your legs
Tingling or crawling sensations
Throbbing
Itching
Burning
Pulling or fizzing sensations
An uncomfortable feeling deep inside the legs
Aching or pain
The sensations commonly begin or become worse when sitting or lying still and improve, at least temporarily, when you walk, stretch or move your legs. Symptoms are usually more noticeable in the evening or at night.
Is restless legs syndrome the same as leg cramps?
No.
A night-time leg cramp causes an involuntary and often painful tightening of a muscle.
Restless legs syndrome is different: the main feature is an urge to move, accompanied by unpleasant sensations which usually improve with movement.
Other problems such as peripheral neuropathy, joint or muscle pain, leg swelling and positional discomfort can sometimes produce similar symptoms, so persistent symptoms may need assessment.
What causes restless legs syndrome?
For many people there is no identifiable underlying cause. This is sometimes called primary or idiopathic restless legs syndrome.
RLS is thought to be associated with the way the brain handles iron and dopamine, and it can run in families.
It can also occur alongside conditions including:
Iron deficiency or iron-deficiency anaemia
Pregnancy
Kidney disease
Certain neurological conditions
Some medicines
Pregnancy-related symptoms usually improve after the baby is born.
Can medicines make restless legs worse?
Yes. Certain medicines can cause or worsen restless-leg symptoms in some people.
If symptoms begin after starting or changing medication, discuss this with your GP or pharmacist.
Do not stop prescribed medication yourself, as the medicine may be important for another condition. Your medication can instead be reviewed to see whether an alternative is appropriate.
Iron and restless legs
Iron deficiency is an important possible cause of RLS.
Your GP may arrange blood tests if your symptoms suggest restless legs syndrome or there is reason to suspect iron deficiency.
If iron deficiency is found, treating it may improve the symptoms. However, iron deficiency can itself have an underlying cause, including blood loss, so it is important that it is investigated appropriately.
Do not routinely take high-dose iron supplements for restless legs unless you have been advised to do so by a healthcare professional.
What can I do to help?
Mild symptoms can often be improved with simple measures.
Try:
Exercising regularly during the daytime
Going to bed and waking at a similar time each day
Keeping your bedroom quiet, dark and comfortable
Having a warm bath before bed
Using a heat pad on the legs
Walking or stretching when symptoms occur
Gently massaging the legs
Reducing caffeine, particularly after midday
Avoiding alcohol close to bedtime
Avoiding a large meal or strenuous exercise late at night
Avoiding daytime naps if they interfere with sleep
Seeking help to stop smoking if you smoke
Some people also find that mentally absorbing activities such as reading, puzzles or games help when they are forced to remain seated.
When should I see my GP?
Speak to your GP if:
Symptoms regularly stop you sleeping
They are becoming more frequent or severe
Symptoms are affecting your everyday life
They are affecting your mood or mental wellbeing
Self-care measures have not helped
You develop symptoms after starting a new medicine
The diagnosis is uncertain
Your GP may review your medication and arrange investigations such as blood tests where appropriate.
How is restless legs syndrome treated?
Treatment depends upon the severity and whether an underlying cause can be identified.
If iron deficiency or another medical condition is contributing to the symptoms, treating that condition may improve RLS.
Where symptoms remain troublesome, prescription medicines may be considered. These can include medicines such as gabapentin or pregabalin, and in selected circumstances medicines that affect dopamine.
These treatments are not suitable for everybody and should be prescribed and monitored by an appropriate clinician.
Why does treatment sometimes need reviewing?
Some medicines used for RLS can occasionally cause a phenomenon known as augmentation.
This means symptoms paradoxically become worse over time — for example:
Starting earlier in the day
Becoming more intense
Developing more quickly when resting
Spreading into the arms or other areas
If this happens, speak to the clinician prescribing your medication rather than simply increasing the dose yourself.
Is restless legs syndrome dangerous?
RLS itself is not usually dangerous, but severe symptoms can cause substantial sleep disruption.
Long-term poor sleep can affect concentration, mood, work and general quality of life, so persistent symptoms deserve proper assessment rather than simply being accepted as something you have to live with.
Restless legs and your podiatry assessment
Patients sometimes mention restless, uncomfortable or painful legs during their podiatry appointment.
At Blackfords Footcare, we can assess the feet and lower limbs for other possible contributors to leg symptoms, including neurological, vascular and musculoskeletal findings.
However, restless legs syndrome is primarily a neurological condition and diagnosis and medical treatment normally sit with your GP or an appropriate specialist.
If your symptoms suggest RLS, particularly where they are disrupting sleep or are associated with other unexplained symptoms, we may recommend that you discuss them with your GP.