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presenting case of my wife for expert opinion -- History - suffering from bilateral idiopathic AVN of femoral heads since 1984. operated for THR of R side in 1990. revision THR in 2003. Re revision THR in 2013 of R side. THR of L side in 2012 Hysterectomy in 2011 Hemi thyroidectomy in 2014 KCO DM , HT for last 6-7 years , under control with Rx. 59 years, non obese Now the main complaint is pitting oedema on R leg and feet, with pain on planter surface R foot near heads of meta tarsals.. My query is whether oedema is due to surgical effect or any medical cause Advise on investigation and Rx along with physiotherapy

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seems to be lack of exercise for last couple of months. getting relief by active exercise thanks to all those , responded to my query.
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affected of lymphatic system, or else thyroid edema its occure. loss of lordosis or degeneration changes at l4-5 level suggest to reduce swelling or pain by hot and cold application and after strengthening or stretching lowerlimb muscle with precaution of available ROM. (ex. cant flex hipjoint more then 90 degree). firts to achieve the functional ROM and after start strengthening with clos chain and open chain exercise with core muscle strengthen also.
Valuable opinion Sir
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Exercises are very well explained by @Nirav Viradiya sir, Please add contrast bath ***Fill two tubs that you can fit your legs deeply into it, one with very hot water and one with very cold water.The basic recipe is to soak your legs in the hot water for 3 minutes and then switch immediately to the cold and soak for 1 minute. Repeat this 3 times Always start with hot water and end with the cold. When switching between hot and cold you may wish to add more hot water on the second or third round. If you add more hot water be sure to keep one hand stirring while adding the hot water so you don’t increase the temperature too much and burn yourself as your legs will be desensitized from being in the cold water.****
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At this age it is better to check all causes. RFT LFT CBC ESR Uric acid levels FILARIAL SEROLOGY VENOUS DOPPLER BOTH LEGS Edema itself can produce pain in the distal limb. It is okay in the morning and worse in the evening She has degenerative disc disease in lumbar spine Mild spine tilt due to limb length discrepancy THR on both sides are in good position. The right THR for revision needed extensive exposure. One cause of edema in such cases can be due to loss of lymphatics and drainage. A stockinette in day time will help Encourage knee and ankle movements Advise sitting with leg straight
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WELCOME. SIR ALONG. WITH. ACTIVE. EXERCISES..... ADVISABLE..... ALL. ROUTINE. RELEVANT. BLOOD. AND. URINE. INVESTIGATIONS.......ARE. REQUIRED...... .... BECAUSE. OF. ...CUTANEOUS.. HEPATIC. AND. RENAL. MANIFESTATIONS. OF. .... HTN. AND. DM
seems to be lack of exercise for last couple of months. getting relief by active exercise thanks to all those , responded to my query.
@Nirav Viradiya i agree sir explain very well great
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Agree@Nirav Viradiya
Thank you doctor
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