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:
Deep gluteal /Piriformis Syndrome
Post total knee replacement neuropathic pain
Referred pain from spine
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.
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.
Each injection can have different side-effects. Please refer to appropriate injections information leaflet in the section of treatments.
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.
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.
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.
You will be reviewed only by MACS clinic senior Pain Consultants for your condition.
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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