Understanding Plantar fasciitis/ Heel pain

Plantar fasciitis or Heel Pain

Plantar fasciitis is a disorder that results in pain in the heel and bottom of the foot. Heel pain is the most common musculoskeletal complaint of patients presenting to orthopaedic and podiatric practitioners throughout the country.  The pain is usually most severe with the first few steps taken in the morning or following a period of rest. Pain is also frequently brought on by bending the foot and toes up towards the shin and may be worsened by a tight Achilles tendon. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).

 The plantar fascia is a broad band of fibrous tissue that starts at the bottom of the heel and extends out to the toes. The tissue is not very flexible and is placed under significant tension during walking and running. The tension is concentrated at the heel bone or calcaneus and is believed to be the cause of pain.The condition typically comes on slowly. In about a third of men and women both legs are affected.
 Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning. As you get up and move more, the pain normally decreases, but it might return after long periods of standing or after rising from sitting. The pain is usually worse after exercise, not during it. There is rarely a specific injury.

The problem is frequently referred to as "heel spurs." In fact, only about 50 percent of patients with heel pain have a spur. The spurs occur above the fascia in one of the muscles, and although spurs can occur with heel pain, they are not considered the cause.

Plantar fasciitis is more common in runners. In addition, people who are overweight and those who wear shoes with inadequate support have an increased risk of plantar fasciitis.

Symptoms and causes                              

Stubbing pain in bottom of foot  (from heel to toes).
Plantar fasciitis affects these regions of the plantar region of your foot:

1.  Heel
2.  Arch and mid portion of the foot

There are some common causes of plantar fasciitis

• Poor arch support or flat-footed , which is usually caused by improper footwear.
•   Obesity or a sudden weight increase.
•   Walking barefoot.
•   Sudden increase in physical activity, such as jogging, running and  more.
•   Short-term unusual physical activity.
•   Muscles weakness of foot and ankle.
•   Arthritis.
•   Tight calf muscles.
  

How do we confirm whether we have plantar fasciitis?

X-rays will sometimes show a bone spur or a heel spur which is a calcium deposit causing a bony protrusion on the underside of the heel bone. it is a small hook-shaped bone growth, on the underside of your heel bone. (That’s why plantar fasciitis is also called heel spur syndrome.)
You can see in the below picture:-


 But not every heel spur is painful. A foot and ankle specialist (podiatrist) can diagnose plantar fasciitis. The specialist will test for pain by putting direct pressure on the center of the bottom of your heel and along the plantar fascia. If you have had the condition for a long time, side to side squeezing of the heel may be painful.

Heel spurs occur when calcium deposits build up on the underside of the heel bone, a process that usually occurs over a period of many months. Heel spurs are often caused by strains on foot muscles and ligaments, stretching of the plantar fascia, and repeated tearing of the membrane that covers the heel bone. Heel spurs are especially common among athletes whose activities include large amounts of running and jumping.

Complications

Ignoring plantar fasciitis may result in chronic heel pain that hinders or restrict your regular activities. Changing the way you walk to minimize plantar fasciitis pain might lead to foot, knee, hip or back problems.

Treatments of plantar fasciitis

Nonsurgical management of plantar fasciitis is successful in 90 per cent of all cases.
Treatments of plantar fasciitis are:-

• Physiotherapy includes some stretching  exercises that are design to improve flexibility in the calf muscles, Achilles' tendon, and the plantar fascia.
• Plantar fasciitis is treated by measures that decrease the associated inflammation and avoid reinjury.
• Local ice massage applications both reduce pain and inflammation. 
• Anti-inflammatory medications, such as ibuprofen (Advil) or cortisone injections, are often helpful.
• Sports running shoes with soft, cushioned soles can be helpful in reducing irritation of inflamed tissues from plantar fasciitis.
• Custom orthotic shoe inserts are used to reduce the excess motion of the foot and decrease strain to the plantar fascia.

Infrequently, surgery is performed on chronically inflamed plantar fascia (plantar fasciosis) if conservative treatments fail. Newer treatments for these cases such as cobaltion, PRP, prolotherapy, ESWT, and micro-debridement are utilized as well.

Diagnose Your Heel Pain :- 

Answer these 7 question to diagnose your heel pain.  Please keep an eye on your responses.


1. Is your heel pain worse when getting up after a period of rest or with the first steps of the morning?

1. Yes
2. Sometimes
3. Rarely
4. No

2.  Do you have pain in both heels?

1. Yes
2. Sometimes
3. Rarely
4. No

3.  Do you have burning pain in your heels?

1. Yes
2. Sometimes
3. Rarely
4. No

4.  Do You have pain during the night or when you’re off your feet?

1. Yes
2. Sometimes
3. Rarely
4. No

5.  Does your heel pain increase in relation to the amount of time you’re on your feet?

1. Yes
2. Sometimes
3. Rarely
4. No

6.  Does your heel pain worsen throughout the day?

1. Yes
2. Sometimes
3. Rarely
4. No

7.  Does arch support therapy or orthotics make your heel pain worse?

1. Yes
2. Sometimes
3. Rarely
4. No

Tally your score.  Yes = 3, Sometimes = 2, Rarely = 1, No =0

Total point score?______________

If your heel pain score is less than 12 then most probably you've got isolated Plantar Fasciitis.

If your heel pain is 12-15 then it is quite likely you have both Plantar Fasciitis and Neurologic Problems causing your heel pain.

If your heel pain score is 15 or greater then you probably have Neurologic Heel Pain.

There are other causes of heel pain but they’re quite unusual.  Most heel pain can be categorized into either plantar fasciitis or neurologic heel pain.



Related topics:-

• Arthroscopic surgery
• ACL injury (tear) and reconstruction
• How to get rid of shoulder joint pain
• Options you need to know before joint replacement
• Understand how severe knee pain you are suffering
• Know how to prevent yourself from OSTEOPOROSIS

Arthroscopic surgery

ARTHROSCOPY

What is Arthroscopy ?

Arthroscopic surgery of the knee is an innovative surgical procedure in which the knee joint is viewed by inserting a tube(which is attached with a small camera) into the knee that is called arthroscope,that contains optical fibers and lenses, through tiny incisions in the skin into the joint to be examined.  Knee arthroscopy gives a view of what’s inside the knee joint and allows knee surgeon to diagnose any problems.The arthroscope is connected to a video camera and the interior of the joint is seen on a television monitor. The size of the arthroscope varies with the size of the joint being examine.

If procedures are performed along with examining the joint with the arthroscope, this is called arthroscopic surgery.There are lots of procedures that are performed in this way. If a procedure can be done arthroscopically rather than traditional surgical techniques, it usually reduces tissue trauma, may result in less pain, and may promote a faster recovery.


For what diseases or conditions is arthroscopy performed:-

• Torn floating cartilage (meniscus)
• The cartilage is trimmed to a stable rim or occasionally repaired Torn surface (articular) cartilage 
• Removal of loose bodies (cartilage or bone that has broken off) and cysts 
• Reconstruction of the Anterior Cruciate ligament (ACL) 
• Patello-femoral (knee-cap) disorders 
• Diagnostic knee purposes

Arthroscopy can be helpful in the diagnosis and treatment of many noninflammatory, inflammatory,

 and infectious types of arthritis as well as various injuries within the joint.

Noninflammatory degenerative arthritis, or osteoarthritis, can be seen using the arthroscope as
 frayed and irregular cartilage. A new procedure for the treatment of younger patients with an isolated
 injury to the cartilage covering the bone ends within a joint uses a "paste" of the patient's own cartilage cells.
The cells are harvested and grown in the laboratory and are then reimplanted at a later date in the knee with the use of an arthroscope.

In inflammatory arthritis, such as rheumatoid arthritis, some patients with isolated chronic joint swelling can sometimes benefit by arthroscopic removal of the inflamed joint tissue (synovectomy). The tissue lining the joint (synovium) can be biopsied and examined under a microscope to determine the cause of the inflammation and discover infections, such as tuberculosis. Arthroscopy can provide more information in situations which cannot be diagnosed by simply aspirating (withdrawing fluid with a needle) and analyzing the joint fluid.

Common knee joint injuries for which arthroscopy is considered includes :-

•  cartilage tears (meniscus tears),
•   ligament strains and tears, and
• cartilage deterioration underneath the kneecap (patella).

Arthroscopy is commonly used in the evaluation of knees and shoulders but can also be used to examine and treat conditions of the hips, wrist, ankles, feet, spine, and elbows.

Finally, loose tissues, such as chips of bone or cartilage, or foreign objects, such as plant thorns or needles, which become lodged within the joint can be removed with arthroscopy.


What is done in Arthroscopic surgery?

Most knee arthroscopy procedures are done on an outpatient basis and can be performed under local,
regional or general anesthesia. During the procedure the orthopedic surgeon will make very small incisions in the knee and fill the knee joint with a sterile water solution, allowing for a clear view of the knee.The surgeon will then insert the arthroscope and begin to look for any signs of injury or degeneration.
Once such areas have been identified, the surgeon may remove or repair bone or cartilage, or reconstruct a torn ligament.When the procedure is over, the surgeon will close the incision. The entire procedure may last anywhere from 30 minutes to over an hour.

How long is the recovery time after arthroscopy?

Although patients are up and walking just hours after surgery, it typically takes 2-3 weeks after knee
arthroscopy to return fully to daily activities and it can take three months or longer for athletes to return to sports.
For several days after arthroscopy, patients will commonly be asked to rest and elevate the joint while
applying ice packs to reduce pain and swelling. After surgery, an exercise program is gradually started that strengthens the muscles surrounding the joint and prevents scarring (contracture) of surrounding soft tissues.
The goal of the exercise is to recover stability, range of motion, and strength of the joint rapidly and safely, while preventing the build-up of scar tissue. This program is an essential part of the recovery process for an optimum outcome of this procedure.

Over the years, higher quality fiberoptic equipment has allowed the development of miniature arthroscopes. This has allowed the examination of smaller joints with arthroscopy. Arthroscopy has become an integral tool for orthopaedic surgery and its role will continue to expand as further improvement in arthroscopes and arthroscopicinstruments continues.



Arthroscopic Knee Surgery FAQ’s :-


Q: What are the possible complications can be face by the patient of knee arthroscopy?

A: Complications are uncommon, but possible. Infections are the most common complication but
can be prevented with antibiotics. Other complications are blood clots, excessive swelling or bleeding, and damage to blood vessels or nerves. Such complications occur in less than 1 percent of all arthroscopic procedures.

Q: Is bleeding after arthroscopic knee surgery normal?

A: Mild bleeding through the incision areas is normal. The area must be kept dry and covered, and
reinforced with sterile gauze. If bleeding persists, contact your doctor.

Q: How pain can be manage after knee arthroscopy?

A: Patients are prescribed pain relieving and/or anti-inflammatory medications.Patients may also use
over-the-counter pain relief medications in place of prescribed medications for mild pain.

Q: Will I need physiotherapy after arthroscopic knee surgery?

A: Physiotherapy is important after surgery in order to regain range of motion. Patients may work
with a physiotherapist to regain a full and active range of motion.

ACL injury (tear) and reconstruction

ACL injury :-

 
  Anterior cruciate ligament is the one of the most commonly injured ligaments of the knee, which also called ACL .
In the general population ACL tear is very common. It most probably occure in the  people who participate in high-risk sports, like basketball, football, skiing, and soccer etc. However,ACL injuries are very commonly seen with road traffic accidents also.

As sports activities increase day by day from last few decades, the number of acl injuries increases.
This injury has received a great deal of attention from orthopedic surgeons over the past 15 years,
and now become one of the most successful surgeries in the field of Arthroscopic surgery today.

ACL, is one of four ligaments that are important for the stability of the knee joint. A ligament is a structure which is made of tough fibrous material and connects bone to a bone. There are over 250,000 ACL injuries per year in india.

Structure of knee bone :-

The structure of the knee joint is formed by - the femur, the tibia(shin bone), and the patella (knee cap).

 Four main ligaments within the knee that connect the femur to the tibia and ACL is one of that ligaments.
The knee is essentially a hinged joint that is held together by - 

• Medial collateral (MCL),  
• Lateral collateral (LCL),
• Anterior cruciate (ACL) and
• Posterior cruciate (PCL) ligaments.

 The ACL runs diagonally in the middle of the knee joint, preventing the tibia from sliding out in front of the femur as well as providing rotational stability to the knee.

The weight-bearing surface of the knee is covered by a layer of articular cartilage. On either side of the joint, between the cartilage surfaces of the femur and tibia, are the medial meniscus and lateral meniscus. The menisci act as shock absorber and work with the cartilage to reduce the stress between the tibia and the femur.

What happened when you got ACL injury:-

When a person got  ACL injury, Immediately after the injury, patient usually experience pain and
swelling and the knee feels unstable and patients often have a large amount of knee swelling, a loss
of full range of motion, pain or tenderness along the joint line and discomfort while walking.
this instability caused by the torn ligament leads to a feeling of insecurity and giving way of the knee,
especially when trying to change direction on the knee. The knee may feel like it wants to slip backwards.
The ACL injury is a problem because this instability can make sudden, pivoting movements difficult.
 An ACL injury may also make the knee more prone to develop meniscal and articular cartilage injuries, which can be cause that is turn into the pain in the knee and early arthritis.
The pain and swelling from the initial injury will usually be gone after two to four weeks, but the knee may still feel unstable. The symptom of instability and the inability to trust the knee for support are what require treatment. Also important in the decision about treatment is the growing realization that long-term instability leads to early arthritis of the knee.

In short, symptoms of acl tear are following:-

•  Sudden giving way of the knee
•  Hearing a 'pop' at the time of injury
•  Sudden swelling of the knee joint after an injury
•  Pain in the knee when walking

If an ACL tear is suspected, you will have to return for follow-up evaluation with your orthopaedic surgeon.

Evaluation of ACL tear:-

The mechanism of injury occurs the ACL injury is partially or fully torn. An injury to a ligament is also known as a sprain.The treatment is influence by the severity of the sprain. Severe sprain (complete tear) of the ACL is a problem as the knee has lost one of its main stabilizers.
For an athlete, an injury to the ACL can make continued participation difficult. Many sports require a
functioning ACL to perform common maneuvers such as cutting, pivoting, and sudden turns.
perhaps, Patients is able to function in their normal daily activities without a normal ACL, but in sports activities may prove difficult. Therefore, athletes often decide to undergo surgery in order to get back to their previous level of competition.

ACL tear is non-operated or operated:-

Some patients who experience ACL tears are able to resume normal daily activities without surgical
reconstruction of thier ligament. There are some important factors to consider in making the decision as to whether or not operative treatment of an ACL tear is needed.
The decision whether or not to operate on an ACL tear is dependent on several factors. These factors includes-

•  the age of the patient,
•  the activity level of the patient (both recreational and occupational),
•  the expectations of the patient,
•  the ability and willingness of the patient to participate in post-operative rehabilitation,
•  the degree of instability of the joint and any other associated injuries to the knee (e.g. other ligamentous or menisci problems).

What is the surgical treatment for ACL reconstruction?


ACL tears are not usually repaired using suture to sew it back together, because repaired ACLs
 have generally been shown to fail over time.Therefore, the torn ACL is generally replaced by a substitute graft made of tendon. The grafts commonly used to replace the ACL include:

Patellar tendon autograft (autograft comes from the patient)  Hamstring tendon autograft
Quadriceps tendon autograft
Allograft (taken from a cadaver) patellar tendon, Achilles tendon, semitendinosus, gracilis, or posterior tibialis tendon.
Patients treated with surgical reconstruction of the ACL have long-term success rate. The goal of the ACL reconstruction surgery is to prevent instability and restore the function of the torn ligament, creating a stable knee.
This allows the patient to return to sports. There are certain factors that the patient must consider when deciding for or against ACL surgery.

Rehabilitation program :-

ACL reconstruction is usually not performed until several weeks after the injury. This time allows the
 inflamed and irritated knee to quiet. As the swelling and inflammation decrease, the range of motion of the knee improves. Resolution of swelling and stiffness prior to ACL reconstruction surgery improves the post-operative function of the joint.
Once I have surgery, when can I play again?

ACL reconstruction surgery needs a four to six months rehabilitation program post-operatively. This is usually broken up into three phases with activities increasing with the strength of the healing ligament. It is extremely important to be compliant with the post operative rehabilitation. Engaging in higher stress activities when the tissues are not yet healed and the muscles are not fully functioning can lead to early failure of the ACL. Most athletes are able to return to running at 8 weeks, plyometrics and agilities by 12 weeks and sport at four to six months. Return to sport is evaluated on an individual basis and will ultimately be determined by the surgeon.

How to get rid of shoulder joint pain

Shoulder pain

 There are some general information about shoulder pain and simple exercises

that may help.

Simple exercises

Pendulum exercise

 Stand with your good hand
resting on a chair. Let
your other arm hang down
and try to swing it gently
backwards and forwards
and in a circular motion.
Repeat about 5 times.
Try this 2–3 times a day.







Shoulder stretch
 Stand and raise your shoulders. Hold for 5 seconds. Squeeze your
shoulder blades back and together and hold for 5 seconds.
Pull your shoulder blades downward and hold for 5 seconds. Relax and
repeat 10 times.




Door lean

 Stand in a doorway with
both arms on the wall
slightly above your head.
Slowly lean forward until
you feel a stretch in the
front of your shoulders.
Hold for 15–30 seconds.
Repeat 3 times. This
exercise isn’t suitable
if you have a shoulder
impingement.

Door press

a) Stand in a doorway with  your elbow bent at a right
angle and the back of your wrist against the door
frame. Try to push your arm outwards against the
door frame. Hold for 5 seconds. Do 3 sets of 10
repetitions on each side.

b) Use your other arm and, still with your elbow
at a right angle, push your palm towards the
door frame. Hold for 5 seconds. Do 3 sets of 10
repetitions on each side.

How does the shoulder work?

The shoulder is the most mobile joint in the
body. The main shoulder joint is a ball-and socket
joint, which allows a very wide range
of movement. The joint is surrounded by
a tough fibrous sleeve called the capsule,
which helps to hold the joint together. A group
of four muscles and their tendons make
up the rotator cuff, which controls movement
and also helps to hold the joint together.
There’s another smaller joint where the top
of the shoulder blade meets the collarbone.

What causes shoulder pain?

  There are many causes of shoulder pain, but most cases will only affect a small area and
are relatively short-lived. Shoulder pain may also be part of a general condition such as
rheumatoid arthritis or osteoarthritis.
Shoulder pain isn’t always caused by a problem in the shoulder joint – problems in
the neck can cause pain that’s felt over the shoulder blade or in the upper outer arm.

What can be done to help?

If your pain has a particular cause, like arthritis, treating that condition may help.
Following the self-help tips and exercises here will also help, but if your pain isn’t
improving after about 2 weeks then you should speak to your doctor.

Medication

Painkillers such as paracetamol and ibuprofen may help and you should
use them if you need to. It’s important that you take them regularly and at the
recommended dose to help you control the pain and allow you to continue exercising.
Don’t wait until your pain is severe before taking painkillers. You can also rub antiinflammatory
cream directly onto the painful area.
You shouldn’t take ibuprofen or aspirin if you’re pregnant or have asthma, indigestion
or an ulcer until you’ve spoken to your doctor or pharmacist. Medication can have sideeffects
so you should read the label carefully and check with your pharmacist if you have
any queries.


Physiotherapy

If your shoulder pain is affecting your activity and is persisting, ask your GP about referral
to a physiotherapist. Physiotherapy can help you to manage pain and improve your
strength and flexibility. A physiotherapist can provide a variety of treatments, help you
understand your problem and get you back to your normal activities.

Rest and exercise

Aim for a balance between rest and activity to prevent the shoulder from stiffening.
Pace yourself to start with and try to do a bit more each day. Try to avoid movements
that are most painful, especially those that hold your arm away from your body
and above shoulder height. It’s important to remain active, even if you have to limit
how much you do.

Posture

Don’t sit leaning forwards with your arm held tightly by your side. This position can
make the problem worse, especially if some of the pain is coming from your neck. When
sitting, keep a pillow or cushion behind your lower back with your arm supported on a
cushion on your lap.

Reducing the strain

When raising your arm or lifting objects,reduce the strain or pull on your shoulder by:
• keeping your elbow bent and in front of your body
• keeping your palm facing the ceiling.

To lower your arm, bend your elbow,bringing your hand closer to your body.

Your pain should ease within 2 weeks and you should recover over
approximately a 4–6 week period.
You should carry on with the exercises overleaf for at least 6–8 weeks to help
prevent symptoms returning.
If you have severe pain or your symptoms haven’t improved after
2 weeks, contact your doctor.

Options you need to know before joint replacement

www.jaipurjointsurgeon.com

Understand how severe knee pain you are suffering

Understand your knee pain:-

   According to the American Osteopathic Association  ,knee pain is the second major cause of chronic pain. More than one-third of men and women suffer from it. If you are suffering from persistent knee joint pain, be aware that knee pain isn’t normal. And, it’s not an unavoidable part of aging. In this article, we focus on 10 key causes of knee pain, along with treatment options which can help you get back to a normal life without pain.

 What are the causes of severe knee pain?

Classified as a hinge joint, the knee is made up of two main bones that meet to make up the hinge, the femur and tibia. Protected by the patella, which is also called the knee cap, this joint gains its support, flexibility, and range of motion from its supporting tendons and ligaments. The knee is the largest joint in your body although it may seem simple, but actually one of the most complex joints in the body. Moreover, the knee is the most common injury noted during exercise and among professional athletes.

How does the knee’s anatomy leads pain?

There are four main ligaments that are responsible for the connection of the knee:

1)The anterior cruciate ligament, ACL

2)The posterior cruciate ligament, PCL

3)The medial collateral ligament, MCL

4)The lateral collateral ligament, LCL

The ACL and PCL, if injured, often are unable to heal without surgical intervention, because of a low supply of blood. Another oft-injured part of the knee is the meniscus. The menisci are a couple of cartilage in the knee that actually works to distribute the weight of the body across the knee joint. the menisci are susceptible to injury, especially to athletes both professional and recreational. If the knee is twisted and force is applied, the menisci can tear.

There are also muscles supporting and surrounding the knee. These include the quadriceps along with the hamstrings. A group of four different muscles, the quadriceps or calves constitute the quadriceps tendon, which works to connect this muscle group to the knee cap, or patella. This connection 's what enables the knee to extend, or bring up directly in front of a person. The hamstrings work to aid in the flexion of the joint, as well as provide additional support and stability.

Which part of your knee suffering pain?

You may be experiencing knee pain in certain areas of your knee or leg. Pay attention particularly to how your pain feels and where you’re feeling pain or sensation. Therefore, you will be able to help your doctor to figure out the cause of your pain. Knee pain may present as:

Pain behind knee

Pain in back of knee

Inside knee pain

Pain on outside of knee

Knee pain when bending  

Pain below knee cap

Pain above knee

Further, pay attention to how long you’re experiencing pain. Pain that lasts longer than three months is considered chronic knee pain that may require additional treatment strategies. Acute knee pain that has a sudden onset may be related to an injury or other trauma.

10 common causes of chronic knee pain

The cause of your knee pain will depend on where you’re feeling your pain, but it may also depend on some key risks factors you may have. Knee pain can be caused by:

• Injury
• 
  
• Wear and tear conditions
• 
  
• Mechanical issues

Injury

There are several injuries that can result in knee pain, including:  

Torn ACL: Athletes who move from side to side or anyone who has a sudden change of direction can suffer from a tear in the anterior cruciate ligament.

Torn meniscus: This injury to the cartilage of the knee occurs when the knee is suddenly twisted when it is bearing weight.

Bursitis: Bursitis is inflammation in the bursae, the fluid-filled sacs that cushion the knee. This can be caused by another injury or infection elsewhere in the body.

Tendonitis: Located specifically in the patella, an injury to the patellar tendon is common in athletes or active people who use their quadriceps muscles in their activity. Skiers, cyclists, and anyone who plays a sport with repeated jumping and use of the quadriceps can be susceptible to inflammation of this tendon that attaches the quadriceps muscle to the shinbone.

Any of these injuries, if left untreated, can become worse over time and develop into chronic knee pain.

Wear and tear

Wear-and-tear and other degenerative conditions of the knee is one of the most common causes of chronic knee pain.

Arthritis of the knee can occur over time. Due to contributing factors including age, weight and mechanical wear and tear, arthritis of the knee affects millions of people in the U.S. Pain from arthritis can be treated conservatively with medications, injections, and physical therapy, but advanced cases may require a full knee replacement.

Two other specific types of arthritis can occur:

Osteoarthritis: This chronic knee pain condition occurs over time as the cartilage in the knee wears out with years of repeated use.

Rheumatoid arthritis: An autoimmune condition that can affect every joint in the body, rheumatoid arthritis (RA) can be debilitating. Although chronic, RA symptoms can vary from day to day and may sometimes recede or intensify.

Knee injury can also be due to wear-and-tear, resulting in the following conditions:

Gout: When uric acid crystals build up in joints, a condition called gout occurs. This should not be confused with pseudogout, a condition that also causes knee pain but due to calcium build-up. Treatments for these two conditions can be different, so proper diagnosis is important.

Septic arthritis: This condition can appear with no warning when the knee joint becomes infected and swells. This is generally accompanied by fever.

Mechanical issues

Finally, certain mechanical issues can lead to knee pain, including:

Illiotibial (IT) band syndrome: Common in runners, this type of knee pain occurs when the IT band that stretches from the outside of the pelvic bone to the outside of the tibia becomes so tight that it rubs against the femur bone.

Bone chips: Pieces of bone in the knee can be chipped due to injury or wear and tear and float into the spaces of the knee joint, causing pain. Many people do not realize this has happened until the loose chip gets stuck and the joint will not move, much like a piece of debris caught in a door hinge, not allowing it to close.

Dislocated patella: A dislocated patella is easy to see; the bone actually slips to one side or the other, generally to the outside. This can occur easily in women who are pregnant, as joints become more lubricated and move more easily, or it can occur when walking down the street.

Again, these types of knee pain may start as acute (less than three months) incidents that then progress to chronic knee pain if you don’t take the time to diagnose the issue correctly and treat it before it gets worse.

Risk factors for knee pain

Finally, there are several important factors that increase a person’s chances of suffering knee pain at some point in their life, including:

Being overweight: Taxing the joint by adding extra weight increases the risk of knee pain.

Mechanical problems: Other mechanical issues such as having one leg longer than the other or a spinal issue such as scoliosis put a person at higher risk because the body will compensate for that condition and potentially misuse the knee.

Lack of strength or flexibility: Muscles help support the knee joint, and lack of muscle means less support. Tight tendons also contribute to knee pain.

Treating knee pain

Depending on the injury and severity, your knee can be treated with a variety of methods. Conservative treatments can start with the use of non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen and aspirin. Hot and cold compresses can also be applied depending on whether the injury is inflammatory or involves deep muscle pain or spasms. Physical therapy and acupuncture also can be included as conservative treatments for injuries of less severity.

Knee joint injections are minimally invasive and can be highly effective. Consisting of a corticosteroid injection administered directly into the joint, this method can reduce inflammation and decrease pain caused by the injury. The following video shows how this procedure is done.

In severe cases, surgery may be advisable. If a meniscus tear is the cause of pain and debilitation, laparoscopic surgery may be an option. Consisting of surgery done through a small incision and using a scope, this surgery is preferred over full open knee surgery because it is less invasive and involves a shorter recovery and rehabilitation period. Full knee replacements may be warranted due to either degeneration due to arthritis, or severe injury.

If you suffer from chronic knee pain, remember that your pain isn’t normal and it’s not an unavoidable part of getting older. There are pain doctors who can help diagnose the cause of your pain and suggest treatment options that could work for you. Click the button below to get started.

Know how to prevent yourself from OSTEOPOROSIS

What is osteoporosis?

Before knowing the way to prevent or reverse osteoporosis, we should know what osteoporosis Is?

  -World Health Organisation defines osteoporosis as;
"progressive systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with consequent increase in bone fragility and susceptibility to fractures".

In simple words we can say it is a medical condition in which the density and the quality of  the bone are reduced. As the bones become more brittle and fragile, the risk of fracture increases.

Below table explain Bone Mass Density Measurement:-

  Half of all women will have osteoporosis by age 60. One in five women will have a hip fracture in her lifetime, and 50% of them will never walk again.

  Men are not immune to this problem. 30% of osteoporosis happens in males, and 50% of men who suffer hip factures will die within one year.

Here are 10 ways you can prevent or reverse osteoporosis:

1. Avoid carbonated drinks 
     Carbonated beverages such as soft drink, champagne and sparking water deplete calcium from             your bones. carbonated beverages also have excess phosphates, which cause even more calcium loss.


 2. Reduce protein         intake
    Excess protein intake causes acidity in the body, which in turn causes calcium to be lost in the urine. Most people need only two to 4 ounces of lean protein, three times a day.


3. Keep your stomach acid 
    Many people are on antacids for problem such as heartburn. stomach acid is necessary to absorb minerals such as  calcium, magnesium, and zinc. Blocking stomach acid significantly increases the risk of osteoporosis.

4. Cut out caffeine
Each cup of coffee that you drink makes you lose 150 mg of calcium in your urine. Naturally decaffeinated teas are a better option, but you must drink caffeinated coffee, at least increase your calcium intake by 150 mg for each cup you drink.




5. Get the right kind of calcium 
Calcium citrate and calcium hydroxyapatite are the best forms of calcium to take. they need to be taken on empty stomach for best absorption, an only 500mg at a time (that's all our bodies can absorb at one time). A total dose of 1000 to 1200 mg per day is adequate for most menopausal women.


6. Get some sun
Vitamin D helps to absorb calcium and put it in the bones. It is made in your skin when you get out in the sun.




7. Have your hormones checked 
Hormonal decline is one of the most common reasons for bone loss after menopause in women. Andropause, the ale equivalent of menopause, also causes bone loss in men. Adequate levels of estrogen, progesterone, and testosterone are important for bone maintenance.

 8. Change your diet
Excess refined sugars and starches, elevated your insulin levels and cause an increase in osteoporosis. The ideal diet is one called a "low glycemic index" diet.


9. Reduce stress  
Stress raises cortisol levels. If cortisol levels are high for long periods of tie it can cause bone loss.


 10. Exercise more
When the muscles pull against the bones during exercise, it stimulates the bones and  tells the they are needed. Walking, hiking, climbing stairs and weightlifting can increases bone density. 15 to 30 minutes a day can be helpful.

Awareness for joint replacement

I being a joint replacement surgeon don't like seeing my elderly citizen suffering in pain and deformity. such scenarios are do common in india because of lack of proper knowledge and awareness in public, moreover we rely so much on others advise that we make the problem very severe. My sincere advice is to show a proper replacement surgeon so that timely treatment is done for best outcome.

Joint replacement is a highly successful treatment that is one of the most popular forms of major surgical treatment. 

These treatments can free sufferers from significant pain and disability, and often enable patients a long time of restored activity and self-reliance.

Regards
Dr. dilip mehta  

Watch pre and post operated patient of knee Joint Replacement :-