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The patient's lancinating pain is clearly indicative of nerve irritation, which, contrary to Dr Singer's impression, need not result in atrophy of muscle even after many years, as patients with arachnoiditis or herniated disk will attest. Indeed, cases are on record with muscle hypertrophy caused by chronic nerve root irritation. Abnormal vessels rather than a scar might compress or irritate nerves in the stump, as is postulated by some for hemifacial spasm. Both Dr Singer and I agree that recurrent arteriovenous malformation accounts for the limb enlargement and the patient should be investigated angiographically. A properly fitted prosthesis can only benefit the patient, and Dr Singer's suggestion in this regard is well worth following.
Alter M. Pain and Enlargement of an Amputated-Leg Stump-Reply. JAMA. 1984;251(21):2793. doi:10.1001/jama.1984.03340450021012