Diabetic. Having pain in the shin bone area. Can I have knee replacement surgery?
User rating for this question
Dr. K. Naga Ravi Prasad
Orthopaedic Surgeon, Joint Replacement
Orthopaedic Surgeon, Joint Replacement
Practicing since : 1996
Answered : 2148 Questions
My Mom has been to multiple doctors over the past month due to pain along the shin bone of her right leg. She has been putting more pressure on this leg due to the fact the she needs a knee replacement in her left leg which is scheduled for mid December. She was having edema in both legs and has been using compression stocking for the past month. A blood clot has been ruled out by having a a test done - "ultrasound" to see if there was a clot. The right leg was hard, swollen and slightly red in the shin bone area, extremely painful when touched (she does have a high pain tolerance so this is very concerning (she is not a complainer when it comes to pain). Family physician put her on an antibiotic to treat cellulitis - all we can see that changed is the swelling is gone - no fever was ever present. Now they are considering a stress fracture? Will see a doctor later this week. She does not tell everything to the doctor and when I mention other symptoms its like I am not saying anything. Here are a list if some of the other items I am aware of along with the aforementioned issue. Pain in right buttock which is not constant, cramping in right thigh not constant, the way she is walking she has developed 3 callouses along the ball foot (she is being treated by a foot doctor - use to have one callous that cleared up completely), has had a bunion on right foot for years but complains of pain shooting in this area, redness is very slight between shin and ankle, edema is gone, leg is harder than left leg but not nearly as bad as it was, has had previous swelling of this knee which fluid was drained and we were told nothing showed when the fluid was tested (this is odd when it happens because she can be fine one minute and not doing anything but the knee starts swelling and gets warm to the touch. She does not keep it elevated as instructed, walks on it at times when it is not necessary, her weight is 182lbs. and she is 5'1", age 74. Has Type 2 diabetes which has been under control with medication for at least 3 years. I have been researching symptoms on the internet and am puzzled and the looks on the doctors faces are like they are just taking a shot in the dark at this point. Passing her from one doctor to another - nothing seems to match my internet searches. Concerned over whether she will even be able to have knee replacement surgery. Just looking for some other opinions before we see the next doctor. I am not asking for an exact diagnoses its just my gut feeling is that it isn't a stress fracture either. Any other ideas - feel free to ask me any other questions. I tried to include as much info as I knew one would need. Thanks you!!!
Posted Thu, 5 Dec 2013 in Bones, Muscles and Joints
Answered by Dr. K. Naga Ravi Prasad 40 minutes later
Brief Answer: Might be possibly due to Osteomyelitis. Detailed Answer: Hi, thanks for writing to XXXXXXX I have gone through the entire description with keen concentration over the symptoms. Apart from the Stress fracture, I feel that the other possible cause for pain & swelling in the right shin bone could be due to Osteomyelitis (infection/inflammation of the shin bone). An xray of the involved area will pick up any osteomyelitic focus in the bone (Usually xrays will be negative for any findings within 1-2 weeks of infection). If xrays are negative, an MRI scan is useful in ruling out the infection in the bone. Also, Blood investigations like ESR & C-reactive protein levels will help in establishing the infection. As you mom is a diabetic patient, the chances of spontaneous infection in the bones (osteomyelitis) is very much likely. Pain in the right buttock and occassional crampyness in the thigh might be due to Lumbar disc disease (in which case, a protruded intervertebral disc might be pressing over the nerve root causing pain in the involved regions). Hope I have addressed your query. Happy to help further Regards
Follow-up: Diabetic. Having pain in the shin bone area. Can I have knee replacement surgery? 1 hour later
The swelling is no longer present - it just is painful when touched and especially after walking on it more than she should be. Even though there is pain she is able to walk without it getting any worse, can go up & down steps one leg at a time, and basically is self sufficient. She has been on Keflex 500 mg 4 times a day for 2 weeks but the only change that occurred was the swelling went down within 2 days. She never had a fever before or during the time the symptoms have been present. The family doctor has just continued the antibiotic because he is at a loss for a diagnosis so it is a precautionary measure. She did have an x-ray of the affected area this past Wednesday and everything appears normal (I failed to mention this previously). Is there any chance that this could be caused by nerve or muscle issues - since she has been favoring the left leg since XXXXXXX - just curious? The fact that she has never had a fever and nothing has really changed except the swelling went away and the redness decreased which all occurred within 2 days of taking the antibiotic. Otherwise everything has remained the same - no worse no better.
Answered by Dr. K. Naga Ravi Prasad 53 minutes later
Brief Answer: Nerve or Muscle issues are unlikely possibility. Detailed Answer: Hi, Nice to hear from you. Muscle or Nerve problems producing this sort of clinical symptoms is unlikely or a rarity. So, I personally will not entertain any Neuro-muscular problems as the cause of your mom's symptoms. I still want to consider Osteomyelitis as the culprit. * Presence of pain, tenderness to touch, swelling and redness goes in favour of an infection (osteomyelitis). * Absence of Fever cannot rule out osteomyelitis as the infection might have been caused by a LOW VIRULENCE organism (in which case fever is absent) * Also, the quick response in the symptoms with an antibiotic dose (Keflex) suggests indirectly that the root cause is infection. * As I already said, the xrays will be negative (normal) for 1-2 weeks after infection and as your mom is taking antibiotic now, the osteomyelitic changes in the bone may become masked and may not be visible in the xrays. * The other possibility being STRESS FRACTURE, which can be diagnosed by an MRI scan (as xrays will not show up the fracture in early stages). Hope I have justified your query. Good day