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Whom should we consult about severe pain in the ankles that doesn't allow one to sleep?

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Posted on 6 days ago
Question: Hello, my mother (60yr) is suffering from diabetes type 2 (around 20yr) and since past some times, she could not sleep unless someone presses the calf area of leg. It keeps aching sharp and due to this, she could not sleep unless it is pressed for some time. What may gone wrong and which expert we need to consult. She also have chronic gastritis with metaplasia , knee osteoarthritis grade 3.
doctor
Answered by Dr. Shinas Hussain (1 hour later)
Brief Answer:
It could be POVD or diabetic neuropathy.

Detailed Answer:
Hello,
Thanks for the query.

The two probable differential diagnosis based on your description is 1. Peripheral occlusive vascular disease (POVD) and 2. Diabetic neuropathy. POVD is the more probable one.
POVD develops due to occlusion of major blood vessels of the lower limb so that blood circulation is impaired and lack of oxygen leads to the development of pain. When you massage the calf muscles there will be a transient improvement of circulation will be there and the patient feels better. Diabetes and old age are risk factors for POVD.

Diabetic neuropathy can also present like these but feeling of numbness and tingling will be there along with pain. It is due to the weakness of nerves by uncontrolled diabetes.

Better to consult a general physician first and get evaluated. Do an arterial doppler to assess the blood flow. Check blood sugar level and cholesterol status. If required he will refer you to a vascular surgeon.

Wishing all the best.
Thanks


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Shinas Hussain (7 days later)
Hello,

We checked with vascular expert and after having dopplar ultrasound, found no abnormality or issue in vein/ artery.

Further, there is no numbness or tingling in legs and the pain is localized primarily in calf area and not other areas.

To add, diabetes was little uncontrolled month back like in range of 300 fasting (hba1c at 11) and with proper follow up and medic and insulin injection twice, it has come down in range of 100 - 120 fasting. And also, for knee osteoarthritis, physiotherapist has suggested few exercises which we are currently following. Also, there is little bowing due to arthritis.

Please advise what best course of action which can be taken in order to bring down or eliminate the calf pain and have sound sleep (as due to pain, sleep is also impaired).
doctor
Answered by Dr. Shinas Hussain (19 hours later)
Brief Answer:
It could be then a neuropathic pain. Better to consult a neurologist.

Detailed Answer:
Hello,
Thanks for the follow-up.

As you have ruled out vascular causes for pain, the next possibility is the neuropathic pain due to weakening nerves. Uncontrolled diabetes can also provoke neuropathic pain.

Do consult a Neurologist and get evaluated further.

She can take prescription based analgesics like Gabapentin for pain. A low dose of clonazepam at bedtime may help to get good sleep.

Wishing all the best
Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Shinas Hussain

General & Family Physician

Practicing since :2015

Answered : 23624 Questions

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Whom should we consult about severe pain in the ankles that doesn't allow one to sleep?

Brief Answer: It could be POVD or diabetic neuropathy. Detailed Answer: Hello, Thanks for the query. The two probable differential diagnosis based on your description is 1. Peripheral occlusive vascular disease (POVD) and 2. Diabetic neuropathy. POVD is the more probable one. POVD develops due to occlusion of major blood vessels of the lower limb so that blood circulation is impaired and lack of oxygen leads to the development of pain. When you massage the calf muscles there will be a transient improvement of circulation will be there and the patient feels better. Diabetes and old age are risk factors for POVD. Diabetic neuropathy can also present like these but feeling of numbness and tingling will be there along with pain. It is due to the weakness of nerves by uncontrolled diabetes. Better to consult a general physician first and get evaluated. Do an arterial doppler to assess the blood flow. Check blood sugar level and cholesterol status. If required he will refer you to a vascular surgeon. Wishing all the best. Thanks