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What is the treatment for extreme pain in right leg while suffering from lower back pain?

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Orthopaedic Surgeon
Practicing since : 1994
Answered : 9091 Questions
My 44 year old son has been suffering for at least 2 years with extreme pain down his right leg. His toes nails are blue excruciating pain down the right leg. About 10 years ago he shot himself with a nail gun in the left knee,was operated on to remove nail, however the last couple of months the pain is also travelling down his left leg too, with both feet feeling very cold and toenails blue. He has also suffered from low back pain for a number of years. He has had xrays on his knee but nothing shows. He has repeatedly taken pain killers and gone to the hospital ER in the middle of the night because of the pain. Can you suggest what might be wrong and what he needs to do. I'm thinking the doctors should be looking at the lower spine for pinched nerves or something. Your opinion I await. XXXX
Posted Sat, 4 Jan 2014 in Bones, Muscles and Joints
Answered by Dr. Praveen Tayal 1 hour later
Brief Answer: Nerve related cause likely. Detailed Answer: Hello, Thanks for posting your query. The excruciating pain down the right leg with blue toes that is affecting the left leg also is likely to be due to a nerve related problem. The possibilities that need to be evaluated are- 1.Vascular problem - The pain may be caused by claudication caused by peripheral arterial disease (PAD), narrowing of the arteries that carry blood to the leg muscles. 2.Peripheral neuropathy- This can occur from direct nerve irritation or from a medical illness like diabetes, thyroid imbalance, etc.Chronic illnesses like alcoholism, cancer, and vitamin deficiencies may also result in nerve pain that often affects both legs. There are some illnesses that cause leg weakness that may be associated with complaints of leg pain, like Guillain-Barré syndrome and multiple sclerosis. 3. Muscle pain: Muscle pain or myalgia is a common cause and may be due to overuse (mild trauma) or associated with the generalized aches and pain of an infection. If I were his doctor, I would first check his peripheral pulses and if that is normal, I would order blood tests for diabetes and thyroid problems. Vitamin b12 levels can also be checked. If all the tests are normal, MRI scan would be the last choice test. I am sure your neurologist would consider all these tests to diagnose your condition and treat it accordingly. I hope this answers your query. In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out. Wishing you good health. Regards. Dr. Praveen Tayal.
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