Which Specialist to Consult for Persistent Leg Discomfort in Seniors?

Which specialty should I see?

Hello Doctor, my mother is 80 years old and generally in good health without any issues related to hypertension, diabetes, or hyperlipidemia.
Since February of this year, she has been experiencing extreme soreness around her left ankle extending to her calf (the soreness begins when she gets out of bed and persists throughout the day).
She describes the sensation as if all her body weight is pressing down on her foot, but it is not painful.
She has consulted an orthopedic doctor, a rehabilitation specialist, and has undergone acupuncture treatment, all of which were aimed at treating sciatica.
She has also received electrical therapy, traction, and taken pain medication, but her symptoms have not improved.
The symptoms fluctuate and have begun to affect her daily life.
Which specialty should she consult for further treatment? She is approximately 154 cm tall and weighs about 50 kg, with more abdominal fat and thinner legs.

Tuzi, 50~59 year old female. Ask Date: 2016/05/19

Dr. Jiang Junyi reply Neurology

Based on your description, there are many factors to consider regarding discomfort and numbness in the lower limbs.
Restless Legs Syndrome (RLS) has recently gained more attention as a symptom.
The exact cause is unclear; however, it is currently believed to be related to iron levels in the brain and dopamine, which is associated with nerve conduction, with a higher prevalence in female patients compared to males.
Additionally, conditions such as end-stage renal disease, pregnancy, and iron deficiency anemia can also lead to such symptoms.
It is advisable to consult a neurologist for examination and discussion.
Wishing you good health and peace.

Reply Date: 2016/05/19

More Info

When dealing with persistent leg discomfort in seniors, especially in a case like your mother's where the symptoms have not improved despite consulting various specialists, it is essential to take a comprehensive approach to diagnosis and treatment. Given her age and the nature of her symptoms, there are several potential underlying causes that may need to be explored further.

1. Consult a Geriatrician: A geriatrician specializes in the health care of older adults and is well-versed in the complexities that come with aging. They can provide a holistic assessment of your mother's health, taking into account her medical history, current medications, and lifestyle factors. This specialist can help identify age-related issues that may not be apparent to other specialists.

2. Neurologist: Since your mother has already been treated for conditions like sciatica, it might be worthwhile to consult a neurologist. They can evaluate for neurological conditions that may cause leg discomfort, such as peripheral neuropathy, which can result from diabetes, vitamin deficiencies, or other systemic issues.

3. Vascular Specialist: Given that your mother experiences discomfort in her legs, it may also be beneficial to see a vascular specialist. Conditions such as peripheral artery disease (PAD) can cause symptoms like leg heaviness and discomfort, particularly during movement. A vascular examination can help assess blood flow and identify any circulatory issues.

4. Rheumatologist: If there is a suspicion of inflammatory conditions, such as arthritis or other rheumatological disorders, a rheumatologist can provide insight. They can evaluate for conditions that may cause chronic discomfort and inflammation in the joints and surrounding tissues.

5. Physical Medicine and Rehabilitation (PM&R) Specialist: If your mother has not seen a PM&R specialist, they can offer a different perspective on her symptoms. They focus on restoring function and improving quality of life through rehabilitation techniques, which may include physical therapy tailored to her specific needs.

6. Pain Management Specialist: If her discomfort is chronic and significantly impacts her quality of life, a pain management specialist may be able to provide interventions that can help manage her symptoms more effectively. This could include medication adjustments, nerve blocks, or other pain management techniques.

Additional Considerations:
- Comprehensive Evaluation: It may be beneficial for your mother to undergo a comprehensive evaluation that includes blood tests to check for vitamin deficiencies (such as B12 or vitamin D), thyroid function, and other metabolic conditions that could contribute to her symptoms.

- Lifestyle Modifications: Encourage your mother to engage in gentle exercises, such as walking or swimming, which can improve circulation and muscle strength. Weight management may also be beneficial, especially if she has abdominal fat that could contribute to discomfort.

- Physical Therapy: A tailored physical therapy program can help strengthen the muscles around the ankle and leg, improve flexibility, and enhance overall mobility, which may alleviate some of the discomfort.

- Medication Review: Ensure that her current medications are reviewed by a healthcare professional to rule out any side effects that may contribute to her symptoms.

In conclusion, given the complexity of your mother's symptoms and the lack of improvement with previous treatments, it is advisable to consult a geriatrician first, who can then refer her to other specialists as needed. A multidisciplinary approach will likely yield the best results in diagnosing and managing her persistent leg discomfort.

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