### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hello for the past couple of years I have problems with the arch in my foot on and off and a about a year ago my right keen stated having pains and later on it when to my left keen .it s rare for them to both hurt at the same time but it Wil happened every now and then. Also when I wake up in the mornings my arch in my foot will hurt so much to the point that I have to set down and wait for the pain to go down. And the pains in my keens and feet aren t on and off any more .they have stated happening very day. For example right now I can t stretch out my right keen at all when I try to I get this awful feeling in my keen, it s like a bubble that s being crushed and explodes a sense of altering pain that that travels through my keen and other parts of my leg.

### output:

Hi, thank you for providing the brief history of you. A thorough neuromuscular and musculoskeletal assessment is advised. As you have pain in the knees which keeps altering and also in the feet then a thorough clinical examination of the knee and feet is advised. Now something to understand here is when one side of the knee is having injury the brain itself acts as a protection and diverts 70% of weight to the other side of body and that is how the pain gets shifted from one side to the other. Also, the pain is having change of nature which may be due to neuropathic issues which needs a proper assessment. If the SLR Test is positive clinically than it might be related to the pinched nerve, if this test is negative then the issue is muscular. Also, if you have a bubbling sensation than understand of the vascular system is needed. If any skin color changes are present in the lower limbs a vascular hemodynamics is compromised which is leading to pain factor. If this is not present then have to come back to knee. Usually when knee is Injured the clinical assessment is focussed to the knee only and may be an MRI to understand the soft tissue Injury as well. Performing a patella grinding test will help understand the muscle strength status. Any injury in the knee will lead to patella grinding test positive and the muscles will be weak as well. After a thorough clinical assessment, physical therapist will be able to assist you in strengthening the muscle groups and regain the mobility. Iny clinical experience after a thorough clinical assessment patient is advised to undergo physical therapy and majority of them respond well to physical therapy. RegardsJay In Chat Doctor. 