Vascular stenosis and spinal stenosis are the two most common diseases that cause leg pain in the lower extremities. The typical clinical manifestation is intermittent claudication that affects walking, and the rate of misdiagnosis and mistreatment is high clinically. The following lists the differences between the two to differentiate the diagnosis and provide the basis for choosing the correct treatment plan. I. Characteristics of vascular stenosis leg pain: vascular intermittent claudication is often unilateral limb involvement, the affected limb has a cold, numbness or a feeling of tightness on the bottom of the foot, the calf or foot muscle swelling and pain or twitching after activity, the leg pain symptoms can be relieved after standing and resting, and do not need to bend or squat like spinal stenosis leg pain to relieve the symptoms. Patients with vascular stenosis who ride bicycles will experience painful symptoms of relatively inadequate blood supply as the lower extremity moves and the demand for blood supply increases. Patients with vascular stenosis leg pain may show signs of malnutrition such as decreased skin temperature, rough skin, and thinning hair on the affected limb, and decreased or absent pulsation of the dorsalis pedis, N artery, or femoral artery. The differential diagnosis can be made by lower limb artery ultrasound and lumbar spine magnetic resonance imaging (MRI), and vigilance should be exercised to avoid misdiagnosis and mistreatment. Second, the characteristics of spinal stenosis leg pain: spinal stenosis can cause intermittent claudication of the lower extremities affecting walking, the symptoms are often aggravated when the lumbar spine is hyperextended and alleviated when the lumbar spine is slightly flexed, so such patients can ride a bicycle and will not have an attack or aggravation of leg pain due to exercise; standing, walking, especially downhill, aggravated when sitting, some lumbar disc herniation compression of nerve roots caused by leg pain, leg pain can be aggravated when coughing. On examination, such patients often have normal skin temperature and color of both lower limbs and normal dorsalis pedis artery pulsation. The diagnosis can be made clinically through lower limb artery ultrasound and lumbar spine MRI.