Monday - Friday: 9.30 am to 5.30 pm,
Saturday - 9.00 am to 5.30 pm
Unit 3, Wilmington Cl, Watford WD18 0AF

MACS PAIN CLINIC

Tel: 07868118976
Leg & Foot Pain

LEG & FOOT PAIN

LEG & FOOT PAIN

Leg and/or foot pain is a common after a trivial injury, but could also arise from common pathologies from the spine in the lower back or in the pelvis. This pain could give rise symptoms varying from minor discomfort to excruciating pain and disabilities in mobilisation leading on to sickness absenteeism. Most leg pains following injury would settle down in a few days or weeks with simple analgesia and physiotherapy, but some of them can persists for longer periods leading on to chronic pain. The foot is made up of 26 bones, 33 joints and more than a hundred muscles, ligaments and tendons to maintain the two crossing arches needed for balance and mobility. The ankle joint connects the foot to the lower leg, but the plantar fascia and fat pads are equally important and could be sources of foot pain. Some of the leg and foot pains can be difficult to manage and would need the input of specialist pain consultants and other professionals from the multidisciplinary team.

Common Conditions treated at Pain Clinics:

Meralgia

Trochanteric Bursitis

Deep gluteal /Piriformis Syndrome

Plantar fascitis

Post total knee replacement neuropathic pain

Referred pain from spine

Myofascial pain

Peripheral neuropathy

SYMPTOMS & SIGNS

Sudden onset pain is usually due to trauma resulting in fracture or dislocation or development of infection/inflammation or problems with the blood supply/ drainage from the leg. Most of the radiating and neuropathic pain arises from pathology in the lower back (please refer to notes on spinal pain) as well as joint pain from ankle, knee, hip and sacroiliac joints. Hip and knee joints are common sites for osteoarthritis and can cause pain and stiffness. Foot and ankle pain need careful assessment to identify whether the pain is arising from local causes or radicular pain from spinal causes; this could be accompanied by tingling, numbness and neuropathic pain. Referred pain from urinary bladder, uterus & cervix as well as ano-rectal region could be referred to the leg and buttock. The feet are a common site for development of peripheral neuropathy and associated pain due to a variety of causes; this could manifest as burning, tingling, pins & needles, electric shock sensations, dull ache, itching and numbness. Pain and numbness associated with weakness of the legs and/or bowel and bladder disturbances need urgent medical evaluation to rule out serious pathology.

  • CAUSES FOR LEG & FOOT PAIN

The first step in managing leg pain is to identify whether the cause of the pain is localised to the leg ror if it is referred from other areas, the most common site being the lower back and pelvis.

  • Most commonly injury of lower limb muscles, ligaments, and tendons – sprains, strains, tears – cause acute onset pain following a injury. These usually settle down soon , but could lead on to myofascial pain syndrome which causes muscle spasms and tenderness affecting walking and running. The common muscle groups affected are the vastii, adductors and hamstrings in the thigh, soleus, gastrocnemius muscles and plantaris in the calf and the gluteal muscles in the buttock area. Soft tissue damage of the tendons and ligaments could occur due to repetitive stress injury due to intensive workouts or jogging/ running due to the impact forces.  These can result in muscle spasm and cause exquisitely tender points in the muscle and soft-tissue known as myofascial trigger points.
  • Joints in the Spine: Some of the most common causes for referred pain in the leg arises from the facet joints in the spine, narrowing of the neural foramen due to disc prolapse or age-related changes (sciatica) as well as irritation of the lumbosacral spinal nerves of plexus due to various factors that affects the different joints in the spine. Spondylolisthesis (misalignment of one vertebral body over the adjacent one) and un-natural curvature of the spine to the side (scoliosis) are examples of spinal problems that could cause leg pain due to its effect on spinal nerve roots.
  • Lower limb joints: Pains in the hip, knee, ankle and small joints of the foot are common sites of arthritis and degenerative changes. Some of these problems are difficult to diagnose due to varying presentations, but pain and stiffness are common manifestations.  The Sacroiliac joint is the large joint that connects our hips to the spine and is a common source of radiating pain down the buttock and legs.
  • Cramping of the leg or calf are very painful episodes lasting from a few minutes to hours. It is worse at night especially in the elderly and could be due to various underlying causes.  Cramps and pain that gets worse on walking could be due to narrowing of the spinal canal or due to poor blood supply to the legs.
  • Neuropathic pain in the leg: The lower limb is a common site for nerve pain; this could be on one sided or on both feet and legs.
  •      Examples of one-sided pain – shingles, post-herpetic neuralgia, mononeuritis, meralgia paraesthetica, multiple sclerosis.  However, most common causes could be due to problems within the lower lumbar spine as part of degenerative changes.
    • Conditions that could affect both feet and legs are peripheral neuropathies due to diabetes mellitus, HIV, vitamin deficiencies and alcohol misuse. Early signs of a central disc prolapse can also cause similar symptoms.
    • Post-surgical pain could be neuropathic pain in the legs after any surgery, but are common after knee joint replacements, varicose vein surgery and in infected wounds after surgery.
    • Post-amputation pain could be due to phantom limb pain or pain from a neuroma in the amputation stump.
  • Peripheral vascular disease causes poor blood circulation due to narrowing or blockade of arteries and could result in pain, discolouration and if untreated might result in gangrene and amputation. Claudication pain that is described as cramp-like affects when walkig and improves on taking rest.
  • Varicose veins causes pooling of blood in tortuous veins and could give rise to chronic pain
  • Deep vein thrombosis (DVT) is a blood clot developing in the deep veins of the leg and some are at a higher risk. It can block the blood supply to the lungs (pulmonary embolism) and hence is a life threatening condition if not treated.
  • Compartment syndrome occurs following an injury or surgery to the leg resulting in swelling of the tissues and build-up of high tissue pressures, which unless managed urgently could compromise the viability of the limb.
    Pain in the foot could be due to local causes or it could be referred from other areas of the limb or from the spine.
    • Rupture of Achilles tendon happens usually as a sports injury, but could take several weeks to get better.
    • The foot has several joints and tendons which could give rise to pain due to a variety of causes.  These need proper assessment.
    • Fractures of the bones in the foot are not uncommon due to stress fractures as well due to osteoporosis or osteopenia.
    • The small joints of the foot are affected in rheumatoid arthritis, psoriatic arthritis and the big toe is often the site of very painful gouty arthritis.
    • Bunions, Bursitis, Morton’s neuroma, plantar fasciitis, calcaneal spur are other reasons to have localised foot pain.
  • Referred pain: This is mainly arising from the spine particularly due to a L5-S1 pathology due to disc prolapse or spondylolisthesis.
  • Complex regional pain syndrome (CRPS) is a severe pain condition afftecting the foot and leg following a trauma or prolonged immobilisation of the foot. CRPS can affect other areas like hand, face etc. CRPS is thought to be caused by malfunction of certain aspects of nerves and nervous systems. This is a serious condition and needs to be identified early and managed by a multidisciplinary team.

Frequently Asked Questions

Q: What are the side-effects of injections?

A:

Each injection can have different side-effects. Please refer to appropriate injections information leaflet in the section of treatments.

Q: How can injections help in pain management?

A:

In situations where the pain is disabling severe and not allowing you to do the day-to-day chores, medications have proven inadequate to reduce the pain; injections are targeted to be given either under x-ray guidance or ultrasound guidance at the presumed sources of pain. Injections mainly consist of local anaesthetic with or without steroid. This works as anti-inflammatory at the source of pain.

Injections are not a permanent cure. Injections help by reducing the intensity of pain. The aim is to reduce pain and break the cycle of pain, allow you to carry out rigourous physiotherapy and help and healing. We may have to repeat injections in order to achieve the goals.

There are other injections available when nerves can be ablated (burnt) or we can apply what is called a radio-frequency lesioning at lower temperatures. These treatments have intermediate to long-term benefits and also work to reduce inflammation. These can be offered if the initial injection does not last long enough to follow on with strengthening Physiotherapy. These injections are not operations or permanent treatments. They are used to improve your condition of pain in order for you to carry out rehabilitative strengthening physiotherapy and come out of the vicious cycle of pain.

Q: What can I do if I do not want medications for my pain control or medications have not helped, or I get too many side-effects from medications?

A:

We can offer you Non-injection interventions such as acupuncture. We can introduce you to other means of self management of pain such as using a TENS machine . We have a modalities to offer at our clinic for example Medical yoga therapy, deep electrical muscle stimulation, TENS treatment. If the pain is unbearable, not responding to medications, or you do not want to try the non-invasive modalities ; we could offer you injection therapies.

Q: What will happen then ?

A:

You will have a detailed consultation, examination and then be given information and advice about your condition. We may also organise investigations. We may be able to prescribe you medication and give you details about how to manage pain and other interventional options can be discussed.

Q: Who will be seeing me?

A:

You will be reviewed only by MACS clinic senior Pain Consultants for your condition.

Q: If I am unable to get a GP appointment or don’t want to wait for any appointments how can I get in touch with you?

A:

You could phone us On (020) 7078 4378 or 07868118976; from 9 am to 6 pm; to book an appointment. You could also email us on info@macsclinic.co.uk or you could also get in touch with us on our website www.macsclinic.co.uk

Q: I am concerned about my pain. What should I do?

A:

If your pain is very severe, not responding to over-the-counter painkillers you should contact your GP and get an appointment for review. If you are in severe disabling pain, unable to carry out any routine tasks, you could book an emergency appointment with your GP or go to the local A&E for a review.

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