He got a knee ache for a long time.
Mr. Patrick,65 years old, is the CEO Of Seara Co. the world-class gymnesium equipments. He got a knee ache for a long time. He was introduced, from an orthopedic doctor who teach at one of a medical colleges, to come see Dr. Somsak Lao wattana. He had an MHTO surgery on the degenerative knee joint. The surgery was performed because the condition of the knee joint of that leg can be healed back to normal.
PROLAPSE DISC AND MINI – DISECTOMY
Minimally Invasive Open Surgery for Discectomy is a surgical treatment of the prolapsed (herniated) spinal disc by using a small incision technique without using an endoscope or camera. The pressure on the tissue, muscle and bone around the affected area is going to be minimal. The orthopedic surgeon must be a specialist on spine anatomy who will put the incision on the skin in a correct starting point to precisely get to the vertebrate with just a small wound size – only 1–2 cm per bone pillow or vertebrate. This procedure gently pushes through the tissue into the innermost layer of the bone disc to ensure that the tissue is only bruised to the minimum.
The operation uses a modern technology instrument called Flu X-ray (the real time x-ray), a fiber optic headlight (high powered lamp) and a very small surgical knife. The instrument helps reduce the incision size as well as the duration of the surgical procedure.
The benefits of MIS are:
- Less pain
- Less blood loss
- Shorter recovery time & hospital stay
This MIS technique may not be possible if the patient is overweight, or with thick or crooked waistline and backbone.
Artificial Knee joint Solution
Hyaluronic Acid (HA) is the compound in the knee joint solution. It is sticky and highly elastic and it helps the joint, especially the knee joint bone disc surface, not to get too much pressing or bumping pressure when we walk or run. The compound also helps grease the cartilage surface when we bend or stretch the knee. It reduces friction or pressure, which in turn helps protect from degeneration of the cartilage. This results in reduction of inflammation, aching, swollen, reddening and heating up of the knee. The normal level of the knee joint solution is only 1-2 cc.
As we age, our HA is lower, especially the ones who suffers from degenerated knees. The patient with severe degenerated knee has HA that is almost dried up. At this stage, the knee degeneration symptom will spread out rapidly. Some will develop an obvious bowleg within a year.
Scientists try to find methods to slow down the drying up of the knee joint solution. They believe that if the solution can be maintained it will help slow the knee degeneration. The artificial knee joint solution was first produced 30 years ago. The effectiveness was not satisfactory. After being injected for one to two weeks, as doctors pierced into the knee to inspect, it was found that there was none left. 
In the year 1997-2004, scientists finally were able to develop the artificial kneecap solution of which the quality is close to the natural knee joint solution. The solution is produced from natural sources i.e. Rooster Combs or from Bacterial Fermentation. The application started in North America, Canada and Europe. The solution was injected into the final stage degenerated knee, and also used to inject into the hip joint and the ankle joint. The number of the patients that need to have the operation to change to the artificial knee joint was surprisingly reduced.
The three advantages of using the artificial knee joint solution are reducing pain, decreasing stiffness and can postpone the knee operation (Knee Arthroplasty Surgery) for 1 to 1.5 years.
The injection method is to directly inject the solution into the space of the knee joint. The doctor might inject the anesthetic at the skin in the area before the injection. This will reduce the pain during the injection of the solution, and this should be done only by an expert. In order to be effective, as being practiced internationally; the dose is to inject once each week for five (5) weeks in a row. At present, it is also the practice with the patient who went through the microscopy therapy of the bone.
The disadvantages can be e.g. allergies to the solution causing rashes on the injected are and high costs. When I first used it three to four years ago, the price of the solution was almost 20,000. Now as it proven to be effective, there are more manufacturers that produce the improved quality products with lower prices.
Above all, the degeneration of knees is nature to all. There are many factors that stimulate the inflammation and pain. So it needs consideration to get the treatment according to the real cause, not to depend only on the solution injection. Ask the doctor if it is worth to do so before you go for it.
What is the artificial knee joint?
There are many cities in the western countries that surprisingly have a lot of senior citizens commuting using buses to get to different towns. Most of these are towns near the beaches, which are quite a distance, where old retirees live alone while having a good rest in the last period of their lives. They do not want to be a burden to their families so the number of these oldies living alone is increasing as time goes by.
As it is the culture of many foreign countries, a lot of senior citizens live alone. They have no one to look after them or even relatives to live with. When they get sick and get difficulties in walking, it will have a big impact on them. When the knee joints degenerate and they start to feel the pain as they walk, they do not hesitate to see the doctor, thus, undergoing an operation to put in the artificial knee joint that helps them to be able to walk again. They do not usually wait until the knee sags or bows too much.
The operation to change to artificial knee joint in the foreign country
Usually it is the patients who ask for the operation in order for them to have their normal lives back. The artificial knee joint is made from a premium quality metal and plastic which can be put into a human flesh without body resistance. It is a Medical Grade, and it is much more expensive than the Engineer Grade that we use in the industry.
The scar of the artificial knee joint operation
The artificial knee joint is designed to be as close in shape as the real knee joints. The knee joints consist of the surface of the joints of the thigh bone (Femur) where it touches the bone of the leg end (Tibia). They are connected with the surface of the kneecap (Patellar). When in good condition, this joint surface will be smooth and slick in order to reduce the friction pressure when we bend or stretch the knee. This is to prevent the joint from heating up and getting inflamed which eventually damages the joint surface.
The severely degenerated knee joints, narrow gap between the joint surface, with the sprouting bone and the knees are also bowed
Similar to the real knee joint, the artificial joint has the metal surface that is very smooth and so shiny that the doctor can even use it as a mirror. There is also a Polyethylene plastic, which is also smooth and slick on the surface of the metal to prevent them from touching each other.
The annual exhibition of the bone surgery tools in Australia
The development of the artificial knee joint is like the development of the car — it gets better and better every year. A new car model has more features for us to choose from. The artificial knee joints, in the present, also offer many designs to suit the patient’s condition, i.e. the model that gives Maximum Flex and Extension, the model with more Rotation Degree (Closer to the original joint); there is also one model that is specially made for female patients. There are more leading companies that conducts research and compete in the manufacturing of the artificial knee joints.
The artificial knee joint, though, is not a permanent thing. After its use in daily life for some time, it will wear out. Luckily, the wearing is only at the plastic surface which can be replaced by a small surgery.
To get a good result when changing to artificial knee joints, you need to know how to maintain them. You are not to put hard load on the joints, not to bend the joints to sit on the floor or lift heavy stuff. It is also imperative to regularly exercise to have a strong muscle around the knee so that the bumping pressure on the joint is reduced. Keeping the wound clean in very important. An artificial knee joint is a foreign thing in the body so it is also prone to infections. When we have infected wounds on the skin, decaying tooth or having tooth extraction, we need to be very cautious not to get any infection since it can get into the blood stream and could accumulate around the artificial knee joint. This will stimulate the knee tissue to get infected. As a prevention measure, take the anti-infection medicine before you go to see the dentist or when you get a skin infection. Take good care of your artificial knee joints so they will stay longer with you.
Do you have Knee Arthritis? : PART 1
Identifying the Early Stages of Knee Arthritis
Arthritis of the knee is a symptom of the wear and tear of the cartilage surface between the joints, making the knee wear out and eventually collapse. Additionally, as an x-ray will clearly show, there is also a ‘sprouting’ of the bone taking effect. Some people believe that if a person is under the age of 60 then this should not be any cause for concern as there is no chance for further damage to occur. However, although this line of thinking may have been accurate in the past, it is not necessarily true in the today’s present climate where people carry out activities that exert more pressure and harsher work on the knee joints. It could also be argued that in the past people would exercise the muscles around the knee a lot more regularly.
Furthermore, incidents of knee arthritis are now being discovered in an increasing amount of patients of a much younger age although, naturally, incidents are more common as an individual gets older. Unfortunately, if we do not pay enough attention and recognise the signs of arthritis it is possible to develop the symptoms without being aware. The symptoms of knee arthritis can be divided into 6 steps, from the least to the most severe as follows:
Step 1
Although at this early stage, individuals should not be overly concerned, as the joint surface is smooth all over and still intact, it is often considered the most important stage of prevention because, if it is detected early enough, the symptoms can be identified and averted from advancing to a further, more serious condition. At this early stage, the patient will feel fatigued but will not feel any pain and will also still be able to walk normally. Negative aspects of this stage can be experienced at night, where an individual will often feel an uncomfortable tiredness and will find it increasingly difficult to go fall asleep. A patient will often find his pain can be relieved by asking a family member to give him/her a leg massage each night.
It should be mentioned that the fatigue of the knee is not directly related to the amount it is used. Individuals who spend the majority of the day sitting down, without walking a great deal, can also acquire symptoms. The signs at this early stage can be seen in people who do not regularly exercise or who don’t consistently play sports, however, these individuals may fashionably take exercise some of the time, e.g., aerobic exercise or yoga. In these cases, often the muscle above the knee is simply not strong enough to withstand the pressure exerted on it and, subsequently, after persistent daily use, it becomes increasingly weaker. This can be very uncomfortable and even regular activities such as walking around a shopping mall can be a painful and exhausting experience. Moreover, if the thigh, leg and calf muscles are repeatedly overused during the day, such as when sitting with a posture that bends the knee for a long time, the muscle will have a gradually accumulated inflammation.
In the evening, the muscle inflammation can develop to the extent that the patient will feel the fatigue; this is why most patients often only feel the pain at night, after continued use during the day. After rest and relaxation during the night, the muscle has had time to recuperate and the muscle fatigue will usually have subsided by the morning. Some patients find that a traditional Thai-style massage is very effective in relieving the muscle fatigue of the day, as it can relax the muscles and help relieve any discomfort, and they will often opt to have a massage after finishing work for the day.
Another symptom of the muscle being increasingly fatigued is in the form of a loud noise within the knee, when going up and down the stairs. This can often be so loud that others can hear it. This is caused by the need for the leg muscles to exert more force during the movement of the leg which, consequently, causes the connecting tendon to make noises when moving. If there is frequent movement of the joint, e.g., riding a bike, taking a long walk or doing aerobic exercises; then there will be increased friction on the cartilage surface. The joint will become worn out and inflamed, followed by the second step of the incident.
As they can also be affected by the symptoms in this first step, young people should be encouraged to take care of their knee muscles. It is essential not to underestimate the importance of taking care of the knee at this early stage to avoid further complications.
Wish you health and no knee pain.
Related Articles
Part 1 : Identifying the Early Stages of Knee Arthritis
Part 2 : The Development of Symptoms
Part 3 : The Effect on Living Standards
Part 4 : Pain Increases When Bending the Knee
Part 5 : When an Operation is Required
Part 6 : When a Patient is Unable to Walk
Do you have Knee Arthritis? : PART 2
The Development of Symptoms
Early signs that the second stage of knee arthritis has commenced is when the knee joint starts to ache, becomes swollen, reddens and heats up. At first the ache will not be severe, however, after more than general use of the knee, e.g., when walking for long distances; sitting for a long period of time; tripping but not falling down; or walking on a non-smooth surface, such as in the garden or in the golf course, the patient will develop this ‘ache’. Additionally, some swelling will also start to develop along the knee joint line. When the skin in this area is touched or caressed, the patient will often feel a sensation of heat and feel like the area itself is ‘warming up’. When compared to the other knee, the effected knee will be redder in colour.
Elderly ladies who enjoy walking when doing various activities often complain of an annoying ache that will intermittently occur, making an everyday activity, such as a trip to the shop, an unpleasant experience. This is also true of elderly people who like to visit foreign countries on holiday. As they explore new and exciting settings, they will often find that they need to walk further distances than usual; unfortunately this can lead to problems when they arrive back home. For example; going to visit the Great Wall in Beijing is a very popular activity when visiting China, especially for the elderly. It can be a really captivating experience and something that is often cherished for life. Friends will often walk up together in a group, going as far as possible, whilst holding hands. When walking up the great wall, each step is very big with the fort distances in the wall far apart. In fact, it can be so steep that you almost need to climb to make progress. This can have an unfavourable effect on the knee.
Subsequently, usually a few days after returning from the excursion, it can be a common occurrence for the knee to become swollen and start to ache. Moreover it can also become difficult to put weight on the knee when taking a walk. Unfortunately, in some circumstances, a wheelchair will be required. A visit to the orthopedic doctor to investigate the symptoms can sometimes result in a diagnosis of Knee Arthritis, which can be both regrettable and very daunting news to hear.
Another common mistake made by individuals who are suffering, is regarding the inflammation of the knee cap. On discovery of this symptom, the patient will usually tend to it by applying a hot compress of giving a massage. Regrettably, this can have an adverse effect and actually make the knee become more inflamed. Furthermore, when there is inflammation present, the area around the knee has already become more heated, therefore a massage, or using the hot compress, will increase the pain, often to the extent that the patient is unable to walk. The correct treatment here is to use the cold compress. Nevertheless, there are some exceptions. For example, in cases where the heat has accumulated in the knee joint, such as when an athlete has just finished a run, and the muscle is so tense and tight that it is depleted in oxygen, it is advisable to use the hot compress to relieve the pain. The aim of the treatment at this stage is to quickly reduce the inflammation. Patients are advised to take a rest and not to go on long walks. If the patient feels in so much pain that they feel a visit to the doctor is required, then then they will often be prescribed pain killer medicine including preliminary advice on knee arthritis.
Another type of knee disease that patients often mistake for knee arthritis is gout in the knee joint. The symptoms are quite similar, however, in gout the pain is more sudden and severe and often the knee will become a lot more swollen. Another significant difference is that in gout the skin tends to heat up a lot more. The pain can be excruciating for a patient and usually they are unable to walk and can have great difficulty sleeping. Gout is caused by the accumulation of uric acid in the joints, and the knee joint is no exception. Even when there is small stimulation (such as when wearing new shoes), as this can affect the knee when walking it can also lead to severe pain of the knee joint. It is thought that consuming too much high protein (poultry, animal visceral, all kinds of legumes… nut and pea, vegetable sprouts, alcoholic drinks) is a major factor in the build-up of high uric acid in the body. For those that have an abnormal digestion, the protein will be changed to uric acid.
Related Articles
Part 1 : Identifying the Early Stages of Knee Arthritis
Part 2 : The Development of Symptoms
Part 3 : The Effect on Living Standards
Part 4 : Pain Increases When Bending the Knee
Part 5 : When an Operation is Required
Part 6 : When a Patient is Unable to Walk
Do you have Knee Arthritis? : PART 3
The Effect on Living Standards
Surgeons perform an operation to change to an artificial knee joint, in an overseas hospital.
During the third stage of knee arthritis, a patient usually cannot bend their knee all the way through and can find it problematic to extend their leg fully. Towards the end of this stage, a patient will also have great difficulty squatting. Furthermore, when bending their knee more than 90 degrees, they will find it very painful indeed. This can have a dramatic effect on a person’s standard of living. In Thailand, in rural areas in the north, where families often enjoy sitting on the floor when having meals, this issue can be a real hindrance in day-to-day life. Whether people choose to sit with a posture of sitting with the two legs tucked back to one side (pub-piab) or sitting with both legs crossed (kud-smarti), it will still prove exceptionally difficult to sit for a long period of time and will certainly be more problematic than it was in the past. A person who is suffering in this particular way will often need to pause during their meal in order to stretch out the leg and relieve the knee pain. Other issues arise when visiting the temple and siting in the pubpiab posture. Whilst listening to the monks saying the prayer, it can become very difficult to sit for long periods of time. Therefore, during such an enlightening moment when complete focus is craved, this could produce unwanted negative thoughts and could even result in a person privately wanting the prayer to end more quickly.
Elderly people who are living in town will often not be aware of the problem as quickly as their upcountry counterparts. This is due to the fact that in their daily life they do not usually put as much strain on the knee. Unfortunately, some will only realise the problem exists when the arthritis has reached stage 4, or even stage 5, already.
On long distance journeys, when needing to use the toilet, the elderly will often require a sitting-type toilet as the squatting type cannot be used anymore due to the fact that they cannot bend their knees. This is one of the reasons they are often reluctant to go out. Although in Thailand sitting toilets are becoming more and more common, they are still outnumbered by squatting-type toilets, particularly in rural areas. One method of countering this problem is by using a portable sitting post with a tripod, which can be placed on top of the squatting toilet and used to sit on. Younger, more able family members can help to carefully attach the tripod, taking appropriate care to secure it and also wiping around the toilet floor as it can often be very slippery when wet.
When elderly family members are staying at home, it’s important to modify the restroom to meet their specific needs. If present, any squatting-type toilets need to be removed with new, sitting-type toilets installed in their place.
Additionally, the restroom should be modified further to ensure its safety. As sitting for long periods of time can result in blood not circulating to some parts of the legs (and therefore making it difficult to stand) the restroom should also be equipped with a hand rail. This is very important as, when standing up, the leg could have difficulty supporting the weight of the body, resulting in the individual staggering and falling down to the floor. If this does occur more problems are created due to the fall. For example, a problem often seen from this is a broken hip bone or broken vertebrate (sagging down of the spinal cord). Another area to consider is the emotional effects to the person after the fall and their loss of confidence. Holding on to a hand rail for a while will help individuals gain strength and consequently provides more safety, drastically reducing the risk of an accident. The position of the hand rail should be in proportion with the elderly person’s height, within the distance of their reach and should help facilitate them to sit down and standup. This can be installed by a family member at home, providing they have the correct materials and tools. For an example of how the hand rail should be attached, it would be beneficial to refer to a hospital toilet for the handicapped.
It’s worth noting that there are some occasional exceptions. One of the elderly who I am sure does not have knee arthritis is Luang Por Koon. We often see him sitting in a squatting position with a cigarette in his hands. We have to accept that, although he is advanced in his years, his knee joints are still in good shape and strong as he can sit with the knees fully bent without any sign of pain. However, this is a unique case and it is quite extraordinary!
Taking all the above points into consideration, if you want to continuously be able to squat for a long time, you need to ensure that you take good care of your knee joint today.
Wish you well and no knee pain.
Related Articles
Part 1 : Identifying the Early Stages of Knee Arthritis
Part 2 : The Development of Symptoms
Part 3 : The Effect on Living Standards
Part 4 : Pain Increases When Bending the Knee
Part 5 : When an Operation is Required
Part 6 : When a Patient is Unable to Walk
Do you have Knee Arthritis? : PART 4
Pain Increases When Bending the Knee
If stage 4 of knee arthritis is reached, as well as becoming unsteady in the way in which they walk, the patient will also feel considerable pain when bending their knee. This often results in individuals simply attempting to avoid exerting any pressure on the knee at all. Often, for those who are afflicted with stage 4 osteoarthritis, there is a need to stretch out the knee and lift up the hip or even lean the whole body to one side so that the feet can be lifted and will not touch the floor during a walk.
When doing this for a prolonged period of time, it results in tissue around the knee joint adapting to the body’s new method of use. Consequently, the knee joint starts to seize, and it becomes increasingly difficult for an individual to bend their knee to the same extent as they could previously. Finally, they will reach the 4th stage of osteoarthritis, which produces unstable, wobbly walking. When reaching this point, a walking stick is required to assist with balance.
At this stage, patients tend to walk without bending their knee. Consequently, in an attempt to avoid the pain, this often involves them lifting their hip and adjusting their body posture instead. Through doing this, they can make forward movements with only minimal aching of the knee joint. However, this can lead to exhaustion when doing regular activities, such as taking a long walk. Although, initially this may not be noticed, after a longer period of time the ‘wobbling’ will become obvious, and the individual will start to stagger, swaying left and right in an almost mechanical way, rather like an old-fashioned robot. The reason for comparing this ‘wobbly’ walking to a robot from the past rather than a modern-day robot is because technology has advanced to the extent where a robot can move like a human with fully working knee joints. For example, when observing ASIMO the robot, its walking technique is comparable to a human’s. It can bend its knees and ankles effectively and can also walk steadily with its body upright, without teetering at all and therefore it looks considerably better than a human with this stage of knee arthritis.
Perhaps we will see robots competing with humans in 100 metre running races in the future? As time progresses, eventually the robot will surely win as, where the human knee joint will wear and tear due to repeated use, if a robot’s knee joint becomes damaged or ineffective it can simply be replaced with the same or a more optimised version. Furthermore, although the human knee joint can be replaced with an artificial one, it is simply not the same standard as the original. Moreover, we can replace the knee joint but cannot stop the deterioration by time, of the body or the spirit of youth.
Regarding the knee, when the patient continually walks, they become increasingly unsteady and will often rely on a walking stick to help support themselves. However, factors such as choosing an inappropriate walking stick or / and holding it in an incorrect way can actually increase the pressure exerted on the degenerated knee joint which will ultimately result in further deterioration to the joints themselves. When considering the improper use of walking sticks, whenever a patient does have knee problem and opts to use the stick as an aid, patients almost always hold the walking stick on the same side of the leg that bears the knee pain. Unfortunately, this only acts to compound the problem as it causes them to lean more and more to that particular side without noticing it. In addition to this, the arm handling the stick will also experience wrist ache because the body weight will not be put on that arm. This is simply not the correct way for a person’s body weight to be supported. The appropriate way to hold a walking stick is to hold it on the side of the fully-functioning knee.
To summarise, if the right knee is aching, when making strides with the right knee, the patient should hold the walking stick with their left hand, whilst ensuring the walking stick is kept in front of the body. It should also be kept level up to the tip of the right foot; this will distribute the body weight to put pressure on the stick, rather than directly onto the bad knee. Interestingly, in many Thai movies when the hero has a debilitating leg injury, the walking stick is often used on the wrong side. This goes against modern medical principles and certainly, in real life, we should aim not to neglect the knee joint in this way.
Ultimately, it’s better to take care of these small details so that we will have a fully-functioning knee that remains in good condition so that we can utilise it fully for many years.
Related Articles
Part 1 : Identifying the Early Stages of Knee Arthritis
Part 2 : The Development of Symptoms
Part 3 : The Effect on Living Standards
Part 4 : Pain Increases When Bending the Knee
Part 5 : When an Operation is Required
Part 6 : When a Patient is Unable to Walk
Do you have Knee Arthritis? : PART 5
When an Operation is Required
To summarise, knee arthritis can cause the following issues:
- Fatigue of the knees and the area around the knee
- Aching, swelling, reddening and heating up of the knee joint
- Inability to extend or bend the knee fully all the way
- Walking will become unsteady and ‘wobbly’, like a robot
For further details about specific symptoms at the various stages of knee arthritis, please refer to previous sections of this article. I will now discuss the symptoms present a stage 5. This is a crucial stage in the process as it has come to the point when, unfortunately, the patient will require an operation. At present, there are 2 operating procedures that are proven to be effective. The first method is to straighten the tibia (Tibial Osteotomy) and the second one is Total Knee Replacement.
When considering the lifestyle of Thai people who are living upcountry, a good place to get a feel for the Thai way of life is to go to the busy morning market. Every day, early in the morning, all kinds of people, from all walks of life gather together. There is a real Thai feel to this and lots of information can be gathered about how the community functions as a whole just by observing different people. Students can be seen leaving their homes for school before stopping on the way to buy Kao Gang, a traditional Thai fast food (rice with curry) to take for lunch; the monks gather with their alms, lined up so that local people can make offerings; the elderly can be seen chit-chatting in the coffee shops; some people can be seen practising Tai Chi. Overall they look alert and healthy. Even for people with bow legs which can be obviously seen, they can often still walk easily without any signs of pain.
Bow Legs
Bow leg is the last stage of knee arthritis. At this stage, the straightened knee will start to bend, like a bow. Some patients will have developed a bow knee gap so wide that a small child could walk through it. People often question why this is referred to as a bow knee. The explanation is that the body weight is constantly pressed onto the inner side of the knee joint when an individual stands up. Subsequently, when the cartilage surface becomes more worn and torn, the inner side of the knee joint will be dilapidated before the outside surface. This will continue until the inner surface of the knee joint collapses, and the bending angle increases in size. The more the knee bends the shorter the leg becomes, which eventually makes an individual stagger as the walking process becomes much more difficult for them.
Often people put the knee support (elastic band) around the knee to prevent it from bending further, or in anticipation of it straightening. However, the reality is that this is not helpful at all in the recovery process. Conversely, it will actually compound the problem by accelerating the bending. The reason for this is that the knee support will wrap tightly on the knee joint and consequently reduce the joint movement, resulting in the muscle around the knee receiving less exercise from its restricted movement.
At first, using the knee support will give the patient a feeling that the pain has been relieved. Furthermore, they will be able to do some activities, such as walking, in much more comfort. The patient may also believe that the knee joint will return to the same working condition as previously and that painkillers will not be necessary anymore. However, when this support is taken away, walking without it will become a lot more painful and the muscle around the knee is so emaciated that it becomes visibly smaller in size.
The muscle around the knee is very important within daily routines as it helps buffer the pressing force of the body weight on to the bone. These muscles also help hold the small tendons around the knee so that they don’t work too hard and become inflamed or torn. When using the support every day, these muscles tend not to be used because the knee has the support of the band. Occasionally, people actually become over-reliant on the support, to the extent that they are not willing to walk without it.
When bow-knee is obvious to see in a patient but there is no pain associated with it, there is not a need for a cure. However, aesthetically, some patients feel it is not a good look and they can often feel insecure about the way they are perceived by others when walking. Some, like people in more rural areas upcountry, can still walk for long distances without any issues; the bow knee alone is not the indication that there is a need to get the operation. However, if a patient has bow knee combined with pain, the discomfort will be comparatively higher when compared to a patient without bow knee. This is because each step of the walk will require a lot of energy. Additionally, the wear and tear of the cartilage would mean there is no coating on the bone to handle the friction of the walk. Subsequently, this would cause further inflammation on every step. The patient would certainly not be able to walk for longer periods. After persevering with all therapeutics without noticeably positive results, the choice is to take one of the above 2 operation methods.
For more details on the above points, please see High Tibial Osteotomy and Total Knee Replacement at the website: thaihappyhealth.com
The next article in the series (part 6) will discuss the last stage of knee arthritis, where the patient is not be able to walk at all.
Related Articles
Part 1 : Identifying the Early Stages of Knee Arthritis
Part 2 : The Development of Symptoms
Part 3 : The Effect on Living Standards
Part 4 : Pain Increases When Bending the Knee
Part 5 : When an Operation is Required
Part 6 : When a Patient is Unable to Walk
Do you have Knee Arthritis? : PART 6
When a Patient is Unable to Walk
Stage 6 of Knee arthritis can be considered the final stage of the process. As explained earlier in this article, with all of the 5 stages of knee arthritis, it is generally accepted that a person’s quality of life is reduced. Clearly, as the symptoms reach an advanced stage, the patient will start to lose all confidence in walking for long distances. For example, when the children or even grandchildren want to take the afflicted family members out for a meal they will often feel the need to use excuses such as: the expense of going out, the meal being cooked insufficiently, or the restaurant appearing overly crowded. Often this is simply not the case. They are actually afraid of having knee ache and being a huge burden to the children, especially when they require extra support when visiting the restroom. In some cases, individuals can acquire knee arthritis at an unusually advanced age, as early as 50 years old. In these instances the patient’s general health is fine, but unfortunately their knees may have already given in. It is possible that they have now reached Stage 6 arthritis and that they are now unable to put weight on the impaired leg whilst walking.
This shows an elderly person with Stage 6 arthritis
The 2 main causes of stage 6 Knee Arthritis, as recognised by doctors and patients are: the inflammation of the knee joint and the weak muscle around the knee. More importance should be attached to the second cause in that, even after the High Tibial Osteotomy (HTO), where the tibia is straightened, or following a Total Knee Replacement operation (which cures the inflammation and knee ache), if a patient has existing weak muscles, the success of the operation is limited and results cannot be fully effective. Furthermore, usually the weak knee muscle continues without the patient being conscious of it; this is known as QMA (Quadricep Muscle Atrophy).
The demo of the computer- guided knee replacement operation
When looking further at the causes and symptoms of knee arthritis, it’s clear that not only does the knee ache when going up and down the stairs, additionally; the knee on the problematic side is without strength and cannot support the body’s weight to do various activities. The weak knee muscle can be seen at an early stage and it can also be the principle reason for the progression of the symptoms. An individual with weaker knee muscles can subsequently reach the last stage of knee arthritis at an accelerated rate, several times faster.
At this advanced stage, patients are usually unable to walk which can often cause a pressure wound at the hip area. The wound is persistent and can spread out to the extent that it reaches the bone. The patients can also easily contract a respiratory tract infection due to their decreased body movement. Moreover, the lungs expand less and the exhaustion of the bad air is reduced which, unfortunately, results in the germ being retained in the lungs.
A patient with stage 6 knee arthritis who is unable to walk.
If a patient reaches this final stage, they need to have Total Knee Replacement Surgery and muscle therapy, in order to recuperate the muscles and allow them to return to full strength so that they can perform daily routines sooner rather than later.
The wound of the knee arthritis surgery, with HTO method
The wound of the knee replacement surgery, with MIS + computer- guided method
Do you have this stage of knee arthritis? If not, it is advisable to take the necessary steps in order to find a cure before it reaches this stage.
Related Articles
Part 1 : Identifying the Early Stages of Knee Arthritis
Part 2 : The Development of Symptoms
Part 3 : The Effect on Living Standards
Part 4 : Pain Increases When Bending the Knee
Part 5 : When an Operation is Required
Part 6 : When a Patient is Unable to Walk
Morton’s Neuroma and High Heeled Shoes
Morton’s Neuroma and High Heeled Shoes
People who wear tight, narrow, high heeled shoes for fashion or for their main occupation are at a much higher risk of contracting a condition known as Morton’s Neuroma. This is a painful condition that affects the ball of your foot and can cause a sharp, burning pain. It results in the thickening or enlargement of the toe nerve and unfortunately, if not treated, in come cases it can develop into the tumor of the nerve.
Morton‘s Neuroma will also cause pain when walking. It usually affects the nerve between the base of the third and fourth toes (third web space). The size of the nerve in this area is bigger than other web spaces, making it easier for it to become irritated. Furthermore, people who wear tight, narrow, high heels or those with flat feet are more prone to having this nerve compressed.
This nerve function is a sensation response. When compressed or squeezed the patient will feel a darting pain, similar to having an electric shock. They will also be reluctant to have the area touched, particularly in the ball of their foot. Other symptoms include a tingling or numbness in their toes or a burning sensation in the ball of their foot that may radiate into their toes. During examination, when their toe is held and pressure is exerted on the tip, or when the area between the base of the third and fourth toes is tapped, the patient will feel a darting pain to both toes; consequently, they are keen for the doctor to take their hand away and not to touch the inflamed area. Patients have also reported that when walking for long periods of time the pain will escalate to the point that they will be in too much discomfort to continue.
Diagnosis
After administering an x ray to see the shape of the bones in the patients’ foot, there is also a need to perform an MRI (Magnetic Resonance Imaging) scan in order to observe the inflamed and swollen nerve. MRI is a type of scan that uses magnetic fields and radio waves to produce detailed images of the inflamed area and can also show the nerve as a 3D image. This can confirm whether the patient conclusively has the condition.
Treatment
Treatment depends on the severity of the symptoms. An initial measure can be for a patient to change their shoes to a pair that are more supportive, however, perhaps not as aesthetically pleasing. Another approach is to take medicine, usually through an injection of anti-inflammatory steroids into the the affected area. However, if the symptom persist for a long time, these conservative treatments can be less and less effective and therefore a doctor may recommend surgery as the best option. In this relatively minor surgical procedure the surgeon will remove the permanently ruined nerve that cannot be recovered as it could potentially develop into a tumor.
The Surgery
The surgery is often done on the top surface of the feet rather than on the sole side, making it easier to clean and dress the wound. During the operation, the patient’s sensation will be controlled by either a spinal anesthesia or general anesthesia. The procedure itself will usually take around 20 to 30 minutes. Following this, the patient will be required to take a day’s rest before they can resume walking on the heel of their foot again. The wound is stitched by a soluble thread, which should remain in place without being removed. Furthermore, the effected area also needs to be kept dry for 7 to10 days, therefore it is advisable for the patient to apply a waterproof plaster to the wound.
After a successful surgery, the patient should not feel any further pain in the affected area. As the nerve has been removed, they will also have no sensation of the skin on the third and fourth toes. As time passes, sensation will return to the the skin around this area from the nerve of the nearby toes.
In conclusion, it is an individual’s choice whether to risk looking pretty in high-heeled shoes at the expense of a potential need for surgery. Of course, a doctor can offer medical guidance but essentially it is an individual’s personal preference.
I am SUPER HAPPY that I can wear my fashion shoe which at the same time also treat my knee.
I am Karine from Brazil.40 years old. I was suffering with knee pain for one and a half years. I went to consult many doctors but no solution. Finally, I knew exactly what the root of my knee pain. My legs were not even about 1cm. Then I got final solution!!! and now I am a different person just by wearing “Body Balancing Insole”. After 2 months, my knee pain was gone!!! The best part is I am SUPER HAPPY that I can wear my fashion shoe which at the same time also treat my knee and my body structure.
HEALTHY SHOES
Are you wearing proper shoes?
Here at Smiling Foot and Shoe Center, we believe that feet are one great part of the body we, often times, neglect. Many times we seem to be unaware of how important our feet are. They take us to places we need to go, and for every step, when our feet touch the ground the vibration force produced affects the body structure.
We take on average 5,000 to 8,000 steps a day. The force, thus, affects the joint’s health especially at the spine and knee. This is why we need to take good care of our feet. The way we choose the types of shoes we wear for 8 to 10 hours a day is a very important matter to always keep in mind.
Not only can a pair of shoes protect our feet from the outside risk factors, they are also a delight to look at, as we display as our very own stylish shoe designs
Heel Pain
Heel Pain
Symptoms
A common foot problem that many people suffer is heel pain. This is a condition in the foot that can effect any individual from any walk of life. The chance of a person developing these symptoms depends on how much they use their feet during the week. For example in a job that requires long hours standing up, the pain can be more severe as more strain is put on the feet. Another factor that can effect the severity of the pain is how well a person looks after their feet.
Heel pain usually occurs under the heel or just behind it. The most common symptom for a patient is that when they wake up in the morning and put their feet on the floor to make their first steps of the day, they will immediately feel a sharp pain in their heel. In order to not exert any more pressure on the area producing the pain, the patient will feel the need to tip-toe and avoid walking on their heels, as they move around the house. After a few minutes of walking, the heel pain will decrease as the process of walking stretches the fascia. However, after sitting down for a period of time, when walking is resumed the heel pain will return and will be as intense as previously felt.
This type of discomfort can be very frustrating and can leave a patient feeling as though they will never fully recover. In addition, as the symptoms develop, the pain will increase and will not subside as before. Furthermore, when taking a walk, or doing other exercises that exert pressure on their foot, the pain will continue to persist.
Causes
When the base of the foot (sole) muscle becomes so weak that the foot is unable to carry a person’s body weight during daily routines, this will result in heel pain. In this troublesome problem, muscle fiber tears off repeatedly at the same spot, producing a wound or fibrosis.
Heel pain appears to be more of an issue for people that work in the city, such as in office jobs. This is due to the fact that they usually wear smarter shoes with a harder sole. Furthermore, they will often walk on a harder, flatter floor for the majority of the day so the smaller muscles of the base of their feet will not be stretched as much; they will progressively become weaker day by day, until finally, during a period of heavy use, the muscles at the underside of the heel will tear off followed by inflammation. This incident will occur repeatedly in patients and, since the cause of these symptoms are the weak muscles under the feet, it can be very difficult for it to be cured unless the muscles on the underside of the feet are recovered beforehand. In contrast, people that work in other occupations or away from the city may not be exposing their feet to the same levels of intensity so their symptoms are usually much milder.
An x-ray picture of the heel bone with the calcite
An x-ray picture of the normal heel bone
Treatment
Taking painkillers does provide some relief, temporarily. However, after finishing a one or two week dose of pills, the pain will often return. Moreover, there is also potential for a stomach ulcer to develop as a side effect of taking painkillers for a prolonged period of time. Furthermore, some patients have also reported that they have felt the symptoms so often that painkillers are not having any effect. With this in mind, a viable option is to opt for treatment. If this is chosen, patients are injected with a medicine containing steroids into the most painful point of their heel. Some patients are reluctant to carry out this form of treatment and believe that steroid injections are dangerous. A common reason for this is because they have heard of the side effects of the steroids used in some painkiller pills and in the general medicinal balls. Needless to say, all medicines are dangerous if not used correctly or if not used with the guidance of experts. An injection differs from taking oral medicine for various reasons. Firstly, the oral medicine will be digested and absorbed into all parts of the body through the blood stream, however, an injection will only be effective in reducing the inflammation within the 2-3 centimeter area around the injected position; there is no effect on other parts of the body. Furthermore, as an injection is effective on a specific spot, it can be administered into the heel of a pregnant woman who may be suffering, without any complicated side effect, therefore the medicine itself is rather safe to use.
The effects of the injection will last for approximately three months. However, if the patient has weak muscles in the base of their foot, unfortunately the heel pain is likely to return. Also, if the problem is ignored and the issue is neglected for too long, there is a possibility that a calcite attached to the heel bone could develop. In this case, when taking a walk an individual will feel like there are thorns continually ‘pinching’ on their heel on each step that they exert pressure on the heel. The calcite will become so thick and long that the other treatments become inadequate and have little to no effect. In this situation, the only viable treatment option is to undergo surgery.
The surgeon takes out the calcite by using the special x-ray equipment, providing them with a crucial real-time picture.
If a patient does decide upon having surgery, this can be thought of as an effective method to cure heel pain. The surgeon will perform a small surgical procedure where a small incision is made into the heel area that harbours the wound. Next, the surgeon will trim out the fibrosis from the wound and take out the calcite, before also repairing the attached point at the underside of the foot muscle. This procedure is the cure of the root cause and prevents the heel muscle repeatedly tearing off. which is the main cause of the heel pain.
Who should take the surgery?
The following patient groups should seriously consider taking this surgery:
- Patients with chronic heel pain.
- Patients who have calcite in their heel.
- Those patients who have been continually injected with steroids, where symptoms persist.
- Patients who are unable to take anti inflammation medicine for a long duration.
- Patients who cannot walk for a long time.
- Those patients who walk in an unstable way or have back pain.
If patients are not comfortable with undergoing surgery to prevent heel pain as described above, they can make some small alterations to their day that will help ease their pain. One option is that they can take off hard sole shoes from time to time during the day. Another solution is to avoid walking on hard surfaces, by walking on grassy patches or smoother surfaces, where the option is available. This will give the muscles in the underside of the foot the exercise needed and will allow the inflamed muscle to rest, recover and get back to normal.
