Q: I had a major accident ten years back which finally led to the removal of the right femoral head and partial removal of the right acetabulum, due to avascular necrosis. This required a griddle stone surgery and the hip joint has not been replaced till now because of the fear of infection. My right sciatic nerve was also damaged and this has resulted in very limited foot movement. The right leg is now short by about 3.5 inches. I suffer from chronic lower back ache and sitting, standing or walking become uncomfortable very fast. The pain also extends to the legs, which become tired very easily. Since I need to work for long hours on the computer or teach standing in class, I heavily depend on Proxyvons and frequently, but not daily, a fortwin/norphin painkiller. Now, even they cannot hold back the pain for more than a few hours. The only comfortable position is lying down. I am truly frustrated with this situation and need urgent advice as to what to do.

A:The leg shortening can be reduced by a raised shoe. Shortening itself usually does not provoke back pain but when it is as marked as you describe it can. Even reducing the shortening by half will help significantly. However the pain at rest will not be addressed by reducing limb shortening. The lumbar spine itself needs to be investigated. You may have incurred a crush fracture at the time of the accident. If the pain persists in spite of the above, you need to attend a pain management programme. Taking strong painkillers over a long time reduce their effect and after a while can actually increase your vulnerability to pain. Other approaches should then be explored.