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Surgery's not the only route for his leg pain

March 26, 2007|Jeannine Stein

I am a power walker, and have been diagnosed twice by two orthopedic surgeons as having a leg hernia. I have a quarter-sized lump between my knee and ankle. The pain radiates to the instep and is so debilitating that it gets painful to pick up my leg. Sometimes I have to just sit down somewhere to allow the reddened foot to become less painful. There is nothing more frustrating than aborting one's walk due to pain.

I have been told that the only real remedy is a surgical procedure. I have also been told to tie a bandage around the area but that has not helped. I will not have surgery just to be able to power walk daily pain-free.

HOWARD

North Hills

What you have is called a nerve entrapment, according to orthopedic surgeon Dr. Glenn Pfeffer, director of the Foot and Ankle Center at Cedars-Sinai Medical Center and a spokesman for the American Academy of Orthopaedic Surgeons. Muscles deep in the leg are covered by fascia -- taut, gristly tissue that acts as a sheath. When muscles are worked through exercise, they begin to swell, and usually the fascia hold them in place. However, a congenital weakening in the fascia can allow the muscles to push through toward the skin and press against a nerve, resulting in the small bump you see and in the intense pain you feel.

"It's a small mechanical problem causing a huge interference," Pfeffer says. "For something the size of a quarter, it's about a million dollars' worth of pain."

Pfeffer doesn't recommend wrapping the area with a bandage: "It would have to be so strong to prevent the muscle from coming out that it would compress the nerve and probably make the whole problem much worse."

Surgery, he says, is usually done on an outpatient basis and involves not closing up the hole, but making it larger. "If you repair it," he explains, "you'll put further pressure on the nerve. So invariably what's done is the defect is made larger."

The result may be some swelling of the leg in that area when you exercise, but that should diminish over time, and the pain should be dramatically reduced. Some slight muscle weakening may occur following surgery, but Pfeffer says it shouldn't make a difference in your exercise.

If you don't want to go the surgery route, Pfeffer adds, you can try varying your exercise routine and try activities such as swimming or cycling that use different muscle groups and might not cause as much pain.

Jeannine Stein

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