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Doctors' Answers to "Frequently Asked Questions" - Leg Pain

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Charlie Horse Problems [posted 12/08/98]
Question: I've just started taking Detrol, and am to begin taking Elmiron in a week. My question is: I've just developed extremely painful charlie horses in my calves and severe cramping in my feet during the night. This has started since I've been taking Detrol. Is this a side effect of Detrol, or what could be causing these cramps?

Answer: Probably the Detrol.

Leg Pain & Possible Circulation Problems [posted 11/24/98]
Question:  I'm a 54 yr old woman who has been suffering from severe leg pain the last 6 months. The pain is worse at night when legs are up, it runs throughout the entire legs, from hips to ankles. I do not exercise and spend all day in my store standing. Most pain is in knees. Climbing steps has become almost impossible. Its a dull pain, tingling at times, cold feeling within the legs. The pain never ceases. I have seen many doctors who have told me stress or possible circulation. Im taking tendral which isnt working. I'm also taking vitamin E and potassium. Can you offer any advice for me?

Answer:  There are two possibilities. First, the nerves are damaged. This can be a peripheral neuropathy (diabtetes and the like) or mechanical pressure on the nerve usually in the lumbar spine (spinal stenosis). Secondly, it could be decreased circulation. Both are easily tested by a CT of your lumbar spine, nerve conduction studies of the legs and non-invasive arterial studies performed by a vascular lab. Any moderate size city would have the ability to diagnose these. See a neurologist and /or a vascular surgeon and you'll have your answer. Currently, it doesn't sound like anyone is clear about your diagnosis.

Leg Pain & Rapid Heartbeat [posted 11/10/98]
Question:   I am 36 years old, 5'5", and 125 pounds. Two years ago, I had my left ovary removed due to endometriosis. Prior to my surgery, after lying down for several minutes my heart would begin to beat wildly and my legs would ache. My heart would resume beating normally after a few minutes but my legs would continue to ache until I was able to fall asleep. Since the surgery this condition has improved dramatically, but I still have episodes of both rapid heart rate and leg ache occurring several minutes after lying down and subsiding after two or three minutes. I have reported this condition to my doctor and have had an EKG which is normal. Should I be concerned?

Answer: I would do a Holter monitor during the time you produce this sensation. Off hand, I don't have a clue.

Swollen Legs & Blisters [posted 10/22/98]
Question: My mother has been afraid of doctors and refuses any kind of medical treatment.She recently has developed swelling in the legs and feet and water blisters have developed and are bursting and draining water. Her legs are very tight and she can not bend them at the knees and the skin is begining to dry out and flake off and she is scratching them and causing open wounds..it is similar to a bad sunburn and I am at a loss as to what to do..I know that this could be a sign of congestive heart failure and am very concerned about what to do..she refuses to let me take her in for treatment but I feel that I must do something..please help

Answer: Could be fluid or an infection, both need a doctor.

Leg / Foot Tingling [posted 8/6/98]
Question: Recently my right foot and lower leg has started tingling. It's almost the same sensation of being asleep. I also have a thyroid disease (hypo), but I assume this is not connected. Also, it is not a constant feeling, but comes and goes.

Answer: Usually, this means a nerve compression/pressure from the spinal cord to the leg. The most common cause would be a disc. However, you'll need an examination to determine the source of the problem.

Leg Pain [posted 7/27/98]
Question: Over the past 2 or 3 weeks I have experienced pain in the back of both legs where the knee bends. Not really at rest, but when I begin moving around it feels like I could move wrong and mess it up. I have never had this before. I am not really that physically active so as to have gotten hurt during competition. I rollerblade, but haven’t for a good 2 months. The only thing I can think of is that I will often times spend time in a crouched position and maybe have stood up too fast. I'm 31 years old. Does this sound familiar?

Answer: Actually, this sounds like symmetrical arthritis. There are basically two subdivisions of arthritis. Symmetrical and non-symmetrical. Symmetrical tends to be seen in inflammatory arthritis - lupus, rheumatoid, etc. If it does not abate with NSAIDs, I would definitely seen a physician for an evaluation. Trauma and other joint problems tends to affect one joint at a time. The involvement of identical joints on both sides of the body (symmetrical arthritis) is quite different.

Leg Pain - Post-operatively
Question: My husband had a disc removed approximately 2 years ago. He was told by the surgeon after the surgery that the disc was fractured, coming out, and not going to repair itself. He now is plagued with constant sciatica down one leg and hip. (He did not have daily pain before the operation - his back just went out every other year or so.) A follow-up MRI suggested that scar tissue was the cause. Epidural steroid shots have helped the pain keep from "bleeding through" a twice daily regime of Voltaren. At this point, the Voltaren controls the pain, but he has some stomach problems and takes Zantac to help that. Do you have any suggestions to reduce the pain and get off the medications regarding exercise, chiropractic, acupuncture, magnet therapy or anything else that help him get back to normal? How about glucosamine sulfate and chondroitin? Also, he is at risk for heart disease and we wonder if he should quit the daily aspirin since he is taking the Voltaren.

Answer: Many patients will continue to have pain post-operatively with spinal surgery. One of the reasons we don't push it as a first option generally. I would try acupuncture, but realize that it may not help. Also, a TENS unit is occasionally of help (electrical stimulator). If he is taking daily Voltaren, the aspirin is superfluous. However, the aspirin is a permanent inhibitor of platelet function, and the Voltaren is only when it is present. So, stopping the NSAID (Voltaren or whatever) would give a time period of increased risk (pretty small).

Leg ulcerations and wounds that won't heal
Question: My questions are regarding my grandmother. She is under the care of a physician at this time but the condition for which she is being treated has been very slow in healing, chronically painful with little or no relieve from analgesics, and recurring. Grandmother is 69 years of age and a smoker. Her height is 5'10" and she weighs approximately 145 to 155 pounds. She had early onset of menopause (at 35). She has had a significantly large abdomen for many years. The enlargement began after menopause(grew for a long period of time but has stayed the same size for about 5 years now). She has never complained of discomfort or pain because of it. I refer to it because I feel it contributes to the problem she is having now. Since menopause and since the enlargement of her abdomen, my grandmother has had occurrences of ulcerations in her legs which has left the skin discolored, scarred, thin, and fragile. She has complained for many years of agonizing cramping in her legs while walking which persist for hours after she has gotten off of her feet. Last year she had a wound of unknown origin just above her ankle. She treated it with neosporin, zinc oxide, soap and water, and olive oil trying to get it to heal. But it did not heal for a very long time, and it increased in size from that of a dime to the size of a grapefruit. It was angry-red, weeping, and excruciatingly painful. She got no relief from any analgesic. Finally, after going to 3 doctors, one determined it was a wound caused from the bite of brown recluse spider. She was treated with oral antibiotics, (Sulfa type, I think), Tramadol Hcl, and an antibiotic ointment. The infection in the wound cleared but the pain did not and the doctor encased her leg and ankle in an therapeutic boot-like bandage. After several weeks the wound healed and the pain subsided. Two and a half months ago my grandmother bumped that area again and it went from being a slight abrasion to a large wound. It looked like she had taken a spoon and scraped out the flesh. The pain she is in is driving her mad. She returned to the doctor and was given Zithromax and Vicodin but once again there was no relief for the pain. She stopped taking the Vicodin and started taking Advil, Tylenol, Orudis, and Aspirin. Each analgesic took over an hour to dull the pain and after a couple of doses they lost their effect completely. Her doctor then prescribed Tramadol Hcl to be taken in conjunction with Vicodin, (2 hour span between the doses) and dressed the site with another therapeutic-type bandage. My grandmother is still hurting and to make things worse she is convinced she won't ever stop hurting and she is worried about the effects all of the drugs she has been taking has had on her body. She has not had symptoms of toxicity, but her worry is genuine. What can we do? Could her enlarged abdomen be contributing to her problems because of compromised circulation? How likely is it that she may have phlebitis problems and this is why her wounds are so hard to heal?

Answer: There are several reasons that a wound in the lower extremities has difficulty healing. 1. There is compromise of arterial flow to the legs. This can be remedied by several treatments and will require non-invasive arterial testing. 2. A systemic process is present like diabetes mellitus, chronic lymphocytic leukemia, etc... an SMA 20, sedimentation rate, thyroid tests and CBC will suffice here. 3. There is impairment of venous return from the legs. This sounds the most likely with your grandmother and is often the hardest to treat. Does she have fluid in her abdomen? Has she worn support stockings, etc...? I would ask the doctor about the above possibilities, and then focus on things that can be done for venous insufficiency if that is the diagnosis. However, if she has not had the above tests, I would.

Leg Pain
Question: I started out with pain and numbness in my feet, mostly in the left one. Then I could hardly walk for more than an hour; the pain was so bad that I had to sit down. For the last six months I have had severe pain all the time from my left hip and back of my leg. I only get about four hours of sleep a night because of the pain in the whole left side of my leg, hip and left foot.

Answer: I'm not quite sure what your question is. Generally, this type of pain is due to a compressed nerve in the lower back caused by arthritic spurs, a damaged disc etc... Initial therapy would involve an examination, x-rays of the back, and usually treatment with a non-steroidal anti-inflammatory for 2-3 weeks. Physical therapy is also of help. If there is no change, or if the physical shows severe nerve involvement, a CT of the lumbar spine and nerve conduction tests may be necessary.

Burning in Calves/Feet
Question: I am a 43 year old male. About 3 months ago I went out jogging with some friend for about 3 miles. This is the first time I have ever jogged this far in my life. All the following occurred after this and I don't know if its all related or not. At night noticed by right foot/ankle was swollen. When I got up in the morning the foot/ankle looked fine. I thought I had just twisted it and forgot about it. Must have been a week or two later I noticed after checking it one evening my right foot/ankle was swollen. Again, in the morning it was OK. There was no other pain. I continued to check and there was some degree of swelling every day. I went to family doctor and he sent me to have X-rays of foot/ankle, chest Ray, and also had blood tests done. All test came back OK. Doctor's advice: take aspirin if it hurts. About a week or so later I noticed the foot was still swelling, and I had developed burning in right foot and lower calf. Doctor again said all tests look fine and give it time and take some aspirin. Subsequently I have had burning in both lower legs below the knee and in feet toes. I then on my own had an appointment with a doctor specializing in Rheumatology. He had some blood work done and said everything looked fine. Since then I have been on various medicines like Furosemide 20 mg, DayPro 600 mg,Voltaren-XR and Nortriptyline 10mg. Two weeks after my last visit I called him due to the burning in my feet and toes and the swelling in my calves. I made an appointment to see him and from that appointment he wants to have a Nerve Conductivity test done on my lower extremities. There has never been any swelling in my left foot/ankle,just in my right ankle. There seems to be days when the swelling is slight and some when it is more noticeable. I Always seem to have some swelling on the right side of my right foot directly below the ankle bone that sticks on the foot. I would like to know if I should see a foot doctor or another bone specialist. I have had some people tell me I could have a slight bone fracture in my right foot/heel that might not show up on an X-RAY.

Answer: Two possibilities. 1.The symptoms are due to the excess running. For this see a sports medicine specialist. 2. The symptoms have nothing to do with the excess running; your doctors seem on the right track.

Hamstring injury
Question: I pulled my hamstring muscle seven weeks ago in hiking a stretch of the Appalachian Trail in Pennsylvania. The first two weeks were painful and I followed the RICE procedure and took motrin to relieve pain and swelling. I'm very active and look forward to skiing. I am a 60 year old white male with a St. Jude mitral valve replacement and taking coumadin. The value was replaced because of a candida albacans infection on the mitral valve -- not a cardiovascular condition. I am not a member of a health club and am not using weight-lifting, treadmill, weights or cycling exercises. My advisories indicate I should be following an exercise regimen to rehabilitate the hamstring and avoid re-injury.

Answer: Hamstring injuries usually take 6-8 weeks to heal-- they are very difficult to eliminate. You are limited in taking NSAIDS because of the valve (coumadin, I presume). Local heat and anti-inflammatories like BenGay, etc.. are OK. I agree with your advisees.

Leg aches
Question: What are some possible causes for when your legs to ache at night when you first go to bed for a few hours?

Answer: There are several possibilities. First, peripheral neuropathy. That is, early nerve damage, which is usually worse at night. It usually starts in the feet first and is seen in Diabetes Mellitus and other diseases. Second, nerve compression in the low back due to a disc or spinal stenosis. Third, arterial insufficiency of the legs. All these will need a medical examination to determine the cause.

Leg Pain
Question: What can I do for pain and swelling in the legs in the proximity of the knees.

Answer: It depends a great deal whether it is in the joint or the soft tissues surrounding the joint. Pain around the joint, but not in the joint could be a Baker's Cyst (a congenital problem that occasionally needs surgery) or ligament/tendon inflammation. Other possibilities are inflammation of the patella, usually chrondomalacia patella. Pain in the joint could be a torn cartilage, arthritis or a host of other problems. Usually if the pain does not improve with 8 to 9 days of NSAIDS (Motrin, Aleve, etc.) you should contact a physician for an examination.

Leg Pain
Question: When I am sleeping, I am continuously awakened by pain in my left lower leg. It is a throbbing pain and often enough to keep me awake. I have had two back surgeries, both for a herniated disks within the last four years.

Answer: I'm not sure what your question is. Nocturnal pain from disc disease is common probably due to positional factors. Perhaps a repeat EMG by your physician would be necessary to decide if you still have nerve root impingement.

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