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Having pain while touching legs. Extremely painful legs with minimal walking. Getting plantar fasciitis and had TKR. Need help.

DOCTOR OF THE MONTH - Jul 2013
Jul 2013
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Answered by

Orthopaedic Surgeon, Joint Replacement
Practicing since : 1996
Answered : 2148 Questions
Question
I need to know if the pain I get when even touching the inside of my thighs, between the top of my legs &the very inside of my legs would be a muscle or nerve. I am starting massage therapy next week & don't want to have nerve damage. My legs from feet to top become extremely painful with just a minimal amount of walking. I have severe fallen arches of my feet & am getting plantar fasciitis back again. I had TKR 10 months ago & am still doing exercises for that, but this pain now is the same in both legs. Thank you for any help.
Posted Tue, 10 Sep 2013 in Bones, Muscles and Joints
 
 
Answered by Dr. K. Naga Ravi Prasad 18 minutes later
Brief Answer:
Lumbar Spinal problems could be the cause

Detailed Answer:
Hi, thanks for writing to XXXXXXX

I have keenly gone through the symptoms in your description. Your description of " extreme pain in legs from feet to top after a minimal amount of walking" is highly suggestive of LUMBAR SPINE PATHOLOGY either in the form of Spinal stenosis or Disc disease.

An MRI scan of the Lumbosacral spine is needed to establish the diagnosis.

The initial management of your problem will be as follows -

* avoid lifting weights as it imparts more strain on your back
* avoid forward bending activities as it will worsen the disc protrusion
* Use a lumbosacral back support to augment your spinal muscles
* Intermittent pelvic traction to cause a regression of disc
* Maintain optimum body weight,if you are obese
* Physiotherapy to strengthen your back muscles. Physiotherapy has to be done only after the acute pain has subsided.
* Judicious use of analgesics and muscle relaxants.

A detailed clinical examination is necessary to arrive at a possible diagnosis.

Hope I have justified your query. I welcome any more clarification.

Regards
Above answer was peer-reviewed by
 
Follow-up: Having pain while touching legs. Extremely painful legs with minimal walking. Getting plantar fasciitis and had TKR. Need help. 1 hour later
I think you are quite right about spinal problems. I do have degenerative disc problems in 3 areas, most severe at L5S1, but don't think anything can be done to fix this. Would this be the cause of the leg pain in both legs & would muscle massage help this or should I get massage on my back & if so where? If these are nerves rather than muscles in my legs, would this do damage? Thank you for your prompt answer.
 
 
Answered by Dr. K. Naga Ravi Prasad 6 hours later
Brief Answer:
Conservative treatment is not Curative.

Detailed Answer:
Hi, Nice to hear from you.

At the outset, I would like to tell you that conservative management (in the form of physical therapy, medicines, epidurals) is not curative for Lumbar spinal problems.

Yes, as I have already mentioned in my previous answer, lumbar spine problems (either disc disease or spinal stenosis) should be causing the pain in both legs.

Muscle massage will not damage the nerves as they are deep seated.

To my knowledge, either Osteopathic manipulative techniques (OMT) or Chiropractic treatment may help in relieving your back pain but NOT LEG PAIN.
Only Epidural injections will provide some relief in your leg pain.

Have a great day
Above answer was peer-reviewed by
 
Follow-up: Having pain while touching legs. Extremely painful legs with minimal walking. Getting plantar fasciitis and had TKR. Need help. 2 days later
Hi! Thanks for the information you have provided. I guess I'll need to deal with my back problems - would a Physiotherapist have knowledge & any treatments to help with this? I am having continued problems with my TKR, & have started going to a Physiotherapist for help. I did my exercises faithfully twice a day starting the day following surgery & continued for 6 months until my legs became too painful. I did accidentally bend my knee back suddenly at 3 weeks trying to sit on a low toilet. Also I discovered the exercises I was given to do immediately after surgery for 6 weeks, were advanced & not to be started before 6 weeks. My TKR doesn't feel "right". Would you know of any tests that could be done to check if the TKR hasn't moved or ?. My surgeon has taken regular X-Rays & thinks it is fine. Any information would be appreciated. Thanks again, & have a good day. XXXX
 
 
Answered by Dr. K. Naga Ravi Prasad 6 hours later
Brief Answer:
Physiotherapists can educate your back muscles.

Detailed Answer:
Hi XXXXXXX Nice to hear from you.

Yes, Physiotherapists will have enough knowledge about the back musculature and they will help you in stretching and strengthening your paravertebral muscles which may aid in providing some relief of your pain.

A "Painful TKR" needs a lot of evaluation (clinical examination & appropriated investigations) apart from Xrays to know the cause of problem.

Hope this information is helpful. Have a great day
Above answer was peer-reviewed by
 
Follow-up: Having pain while touching legs. Extremely painful legs with minimal walking. Getting plantar fasciitis and had TKR. Need help. 2 days later
Hi again, Would you tell me what tests or procedures could be done to evaluate my TKR, which is metal. As I had said before, it just doesn't feel or move right, & I may have done some damage when I bent it back very forcefully. Thanks, XXXX
 
 
Answered by Dr. K. Naga Ravi Prasad 4 hours later
Brief Answer:
You need both clinical & biochemical evaluation

Detailed Answer:
Hi XXXXXXX a painful TKR needs a lot of evaluation which includes a thorough history and physical examination, as well as both laboratory and radiographic testing.

Laboratory analysis is directed to differentiate septic versus aseptic etiologies of knee pain and commonly includes assessment of white blood cell count, erythrocyte sedimentation rate (ESR), C-reactive protein and knee aspiration for cell count and cultures.

Available radiographic tools include plain radiographs, stress views, arthrography, nuclear scanning, ultrasonography, and magnetic resonance imaging.

Periodic repeat evaluations are recommended until the etiology of pain is clearly determined.

Hope I made it everything clear for you. Good day
Above answer was peer-reviewed by
 
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