My husband suffered a TBI from a fall four years ago. In the morning he has no pain in his legs but by 1 or 2 in the afternoon he experiences pain in his legs below the knees which reduces his ability to walk.
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Answer transcribed from Brightway's interview with physical therapist Susan Little:
Without completing a full evaluation, and I'm sorry I have to say that, it's definitely difficult. The pain could be related to circulatory issues, nerve pain, or an orthopedic cause. All of those things could worsen with use or as a day goes by in the afternoon. I would certainly start by suggesting that he see his primary care physician for testing and to figure out the cause. I guess with that said, if I had to give a guess, I would think that perhaps with the little information I have, the pain may be related to swelling. What we call dependent edema may not be swelling that you can see. We've all experienced this if we've gone on a long car ride or a flight to Europe and had to sit for a prolonged period of time. You get kind of achy legs and we certainly see that in ourselves.
After a neurologic injury, movement, which is one way that we help to move that fluid out of our legs, is not as easy. With age, we have a harder time moving those fluids out of our lower extremities. I would suggest a simple thing that halfway through the day, he lies down and elevates his legs. Make sure it’s not in the old recliner where his legs are lower than his heart. The key to managing that fluid is that you do need to get your limbs higher than your heart, so lying in bed with a few pillows under your legs to simply make it easier on the body to drain that fluid might get him some relief. I would try to try starting with that and even if it doesn't work, that gives good info. Hopefully, it does work, but if it doesn't work, it gives some more information for you to share with your physician when you see them.