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Most of us know someone with arthritis. An interesting follow-up question is why so many people suffer from 'Arthur-Itis'. What is causing the pain of arthritis, and what kind of malady is it? And why does it so often afflict the knee joint?
But this article is not meant to be a discussion of all the different problems that sometimes are called arthritis, or whether some painful part is suffering from actual arthritis. So many problems, and so many types of pain, are mis-labeled as this common malady. What makes it even more confusing is that there are so many types of arthritis. The word "arthritis" just means joint inflammation, and there are so many conditions which can cause a joint to become sore and inflamed.
One type that's becoming more commonly recognized is traumatic arthritis. But we may not be talking about the kind involving an accident which damages the joint. A stereotypical example would be the old football injury, in which three large, hulking lineman collide with a running back's knee. A single traumatic event can fracture the bones that compose a joint, or damage the smooth glassy material that covers the surface of a joint, called cartilage, which will obviously cause it to function poorly, from that day on, progressively worsening with time.
There is another type of traumatic arthritis that many of the public are not generally aware of. This is not a reference to the systemic, inherited disease of osteoarthritis, but to wear-and-tear arthritis, in which a joint moves chronically and repeatedly out of position, causing stress to specific areas of the joint. A key factor in this discussion is time, or actually repetition. Localized, excessive force on the joint can lead to the development of the biochemical process known as inflammation, which has some very damaging consequences when it becomes a chronic, recurring process.
Several recent studies have looked at a particular joint, the knee, and the development of this type of arthritis due to foot positioning. After all, we know well that poor foot alignment can affect the rest of the body. Understandable since the foot is the foundation for the body. Studies have looked at how a flattened foot, which is often a poorly functioning foot, can alter the mechanics of the knee, leading to pain and degradation of the cartilage, as well as other soft tissue structures in the region. With time, this well-localized process will eventually lead to bone changes, including spurring around the joint, and weakening of the bones of the joint.
Podiatric physicians have recognized for years that the prescribing and use of effective functional foot orthotics can have a profound effect on knee pain. Certainly, getting a pair of comfortable AND effective orthotics is a rather tricky and intricate process. But when done correctly, many people with chronic knee pain get some degree of relief of their knee pain, especially those with a flattened foot architecture.
As is the case with many studies, the authors in several of these discussed the limitations of their study. Designing a research study involving humans, which encompasses or eliminates every variable is quite impossible. But one particular piece of research drew a pretty emphatic conclusion concerning this relationship. They go so far as to recommend that any physician encountering an individual with one-sided knee pain, and a flattened foot structure, consider the prescribing of foot orthotics, especially when you think about their non-pharmacologic, non-invasive nature.
I would go one step further. We, as health care providers, need to question how many knee replacement surgeries can be avoided each year, especially when considering the recovery time, costs, and potential complications. Perhaps all individuals presenting with knee pain due to early onset chronic, arthritis, and a planar foot type should be treated with prescription custom foot orthotics. Even if successful only half the time, the benefits and cost saving would be tremendous. Of course, this would require that we provide proactive health care. And this is not the forte of our healthcare system. But it certainly makes you think.
Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with an upcoming expansion to the Hancock-Houghton area. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.