Managing Severe Right Leg Pain: Insights from Neurology and Rehabilitation

The pain in my right foot is becoming increasingly severe?

Hello Doctor, about a year ago, I went to the hospital for an examination because I frequently felt soreness in my right leg.
After being evaluated by a neurologist, the electromyography showed weakness in my right leg, and the MRI revealed a herniated disc.
However, the doctor said it wasn't very serious, and the CT scan showed no significant issues.
I am currently undergoing physical therapy, but it hasn't been very effective.

About a month ago, I developed a small lymph node in my groin, and after consulting a general surgeon, I was told it was benign and advised to let it resolve on its own.
Since the appearance of this lymph node, I have noticed that the soreness has become more pronounced; it has shifted from the outer thigh to the groin area, and the feelings of soreness and weakness have intensified.
Just the day before yesterday, after viewing the night scenery and descending a hill, my heels and the soles of my feet became numb and sore, and I still haven't recovered.

What should I do now? I've been stretching, massaging, and rotating my ankles, but nothing seems to alleviate the discomfort...

Ms. Chen, 20~29 year old female. Ask Date: 2020/02/22

Dr. Jiang Junyi reply Neurology

Hello, based on your description, it may be necessary to consider symptoms of nerve compression due to a herniated disc, especially when hiking uphill or downhill, as the compression of the nerve roots can become more severe.
A herniated disc can also result from sudden injuries, such as twisting the waist, bending to lift heavy objects, or experiencing sudden excessive force, for example, falling from a ladder or landing directly on the spine.
If a herniated disc occurs, it may cause localized inflammatory responses leading to back pain and nerve root compression, resulting in numbness and tingling that extends to one side of the lower limb.
Additionally, since MRI is performed while lying down, the clinical manifestations may be more severe when we are standing and bearing weight than what is shown in the images.
It is recommended that you follow up with a neurologist for further examination.
Wishing you good health and peace.
Dr.
Jiang from Taoyuan Hospital cares about you.

Reply Date: 2020/02/22

More Info

Hello,
It sounds like you are experiencing a complex set of symptoms related to your right leg pain, which has been ongoing for about a year. Based on your description, it seems that you have undergone various evaluations, including electromyography (EMG) and MRI, which indicated a herniated disc but were deemed not severe by your neurologist. Additionally, the recent development of a lymph node in your groin, which was assessed as benign, appears to have coincided with an increase in your symptoms.

First, let's break down your symptoms and the possible underlying causes. The pain and weakness in your right leg, particularly in the outer thigh and groin area, could be related to several factors:
1. Herniated Disc: Although your neurologist indicated that the herniated disc is not severe, it can still cause nerve compression, leading to pain, weakness, and numbness in the leg. The nerves that innervate the leg originate from the lumbar spine, and any irritation or compression can manifest as pain in the lower extremities.

2. Muscle Strain or Overuse: If you have been compensating for the pain in your leg by altering your gait or posture, this could lead to muscle strain in other areas, including the groin and hip. This might explain the increased discomfort you are experiencing.

3. Lymph Node Reaction: The presence of a lymph node can sometimes indicate an inflammatory response in the body. While your doctor has assured you that it is benign, the inflammation could potentially contribute to discomfort in the surrounding areas.

4. Nerve Entrapment or Peripheral Neuropathy: The symptoms of numbness and tingling in your heel and foot could suggest nerve entrapment or peripheral neuropathy, which might be exacerbated by your current condition.

Given these considerations, here are some recommendations for managing your symptoms:
1. Physical Therapy: Since you are currently undergoing rehabilitation but not seeing significant improvement, it may be beneficial to discuss your concerns with your physical therapist. They can adjust your treatment plan to focus on specific exercises that strengthen the muscles around your hip and lower back, improve flexibility, and address any compensatory movement patterns.

2. Pain Management: If you haven't already, consider discussing pain management options with your healthcare provider. This could include non-steroidal anti-inflammatory drugs (NSAIDs) or other medications that can help alleviate pain and inflammation.

3. Activity Modification: Pay attention to activities that exacerbate your symptoms. If certain movements or positions increase your pain, try to modify them. For instance, avoid prolonged sitting or standing and incorporate regular breaks to stretch and move around.

4. Follow-Up Imaging: If your symptoms continue to worsen or do not improve with conservative management, it may be worth discussing further imaging studies with your doctor. This could help rule out any other underlying issues that may not have been previously identified.

5. Consultation with Specialists: If your symptoms persist, consider seeking a second opinion from a neurologist or a pain specialist. They may provide additional insights or treatment options that could be beneficial.

6. Lifestyle Adjustments: Incorporate gentle stretching and strengthening exercises into your daily routine. Focus on the hip flexors, quadriceps, hamstrings, and lower back muscles. Activities like swimming or cycling can also be beneficial as they are low-impact and can help maintain mobility without putting too much strain on your leg.

7. Monitor Symptoms: Keep a detailed log of your symptoms, including when they occur, their intensity, and any activities that seem to trigger or alleviate them. This information can be invaluable for your healthcare providers in determining the best course of action.

In conclusion, managing your right leg pain will likely require a multifaceted approach that includes physical therapy, pain management, and possibly further evaluation. It's essential to communicate openly with your healthcare providers about your symptoms and any changes you notice. With the right strategies and support, there is potential for improvement in your condition.

Take care, and I hope you find relief soon!

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