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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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History Of Knee Surgeries. X-ray Shows Arthritis. Taking Gabapentin For Pain. Need Diagnosis

Hi! I will tell you my background. I had three knee surgeries in one year (right knee two meniscus, left total knee replacement). This was three years ago, I was having a lot of pain w right knee and back (due to walking differently). I inquired about having another replacement and dr said he wouldn't do anything until I checked out my back. The back dr at the time only took an x ray and said I had arthritis but the back pain was from the knee. I developed severe feet pain which they diagnosed as plantar fac. I went to pt and still terrible pain. Had two cortisone shots in each foot, followed by MRI and wearing a boot. Went for nerve test and said I had pinched nerve in back and neuropathy. Also saw nerologist who thinks it could be peripheral neuropathy. Had MRI of back - nothing severe but pain mgmt dr felt pain coming from spine. I had an epidural three weeks ago, started gabopenten at the same time. I have little relief. I can hardly walk or stand. My dr took blood work yesterday for rheumatoid arthritis. Two orthopedist who specialize in feet said I also have tarsal tunnel. I need help to get a diagnosis. Should I go for another test? I'm 52 years old and am obese but try to stay active until this. I work full time but I feel sick from pain. I appreciate your feedback. Thank you!
Wed, 31 Jul 2013
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Orthopaedic Surgeon, Joint Replacement 's  Response
Hi, thanks for writing to HCM.

Based on your description, you have multiple symptoms related to different problems.

This is to let you know that menisectomy of knee always predisposes to early degeneration of the joint. If you get severe pain in the knee joint while doing activities of daily living, then its high time for a total knee replacement to your right knee.

As your MRI scan of Lumbar spine shows no significant lesions, a trial of conservative management can be tried as follows -
* avoid lifting heavy weights
* avoid forward bending activities
* Use a lumbosacral back support
* Intermittent pelvic traction
* 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.

Regarding your foot pain, there is no single test to diagnose the foot conditions. All are essentially clinical diagnosis. The treatment for tarsal tunnel syndrome would be
* Analgesic & anti inflammatory medications
* Ankle-foot arthosis with foot in neutral inversion & eversion
* A steroid injection which is usually effective & with a success rate of 75%
* As a last step, surgical release and nerve exploration will yield good results.

Hope this information is helpful. Good day
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History Of Knee Surgeries. X-ray Shows Arthritis. Taking Gabapentin For Pain. Need Diagnosis

Hi, thanks for writing to HCM. Based on your description, you have multiple symptoms related to different problems. This is to let you know that menisectomy of knee always predisposes to early degeneration of the joint. If you get severe pain in the knee joint while doing activities of daily living, then its high time for a total knee replacement to your right knee. As your MRI scan of Lumbar spine shows no significant lesions, a trial of conservative management can be tried as follows - * avoid lifting heavy weights * avoid forward bending activities * Use a lumbosacral back support * Intermittent pelvic traction * 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. Regarding your foot pain, there is no single test to diagnose the foot conditions. All are essentially clinical diagnosis. The treatment for tarsal tunnel syndrome would be * Analgesic & anti inflammatory medications * Ankle-foot arthosis with foot in neutral inversion & eversion * A steroid injection which is usually effective & with a success rate of 75% * As a last step, surgical release and nerve exploration will yield good results. Hope this information is helpful. Good day