Osteoarthritis in the knee is a condition that afflicts many. Here in the UK, the approach to dealing with this condition is often focused on the site of pain only, and not necessarily the cause. People are often led to believe that they have no choice to get better once they have been told that they have Osteoarthritis, and they are told to wait till they are old enough to have a total knee replacement.
The knee joint, being next in line after the foot and ankle is dependant on the foot and ankle functioning correctly. Should there be a fault on the way the foot works, then this can have an effect on how the knee works, hips and lower back. One cannot separate the body parts from one another. So if the foot rolls in too much, often referred to as ‘over-pronation’, then this causes the Tibila ‘leg’ to rotate internally. This internal rotation leads to an incorrect tracking of the Patella ‘knee bone’, which in turn leads to additional wear and tear of the Patella on the Femur.
The early signs are Crepitus ‘grating’ sensations as the cartilage behind the knee becomes worn. Pain can arise around the knee cap, the Patellar tendon, Collateral ligaments can also be involved in the stresses that result for incorrect tracking. Once this wear and tear gets severe enough it gives rise to osteoarthritis.
Patients often go to their GP complaining of knee pain, which is often managed initially with pain killers or anti-inflammatories. This may settle things in the early stages of a problem, but often serve to cover up the underlying mechanical changes in the legs. As the pain returns or the problem persists, X-rays may be ordered to assess the knee. X-rays will not pick up on soft tissue inflammation such as ligament or tendon pain, but will show wear and tear of cartilages. The next stage is often a referral to Physio or Osteopathy. Pain relieving techniques, massage, acupuncture, heat, taping, utrasound all have a place, in addition to streching and strengthening.
Should this not work, the patient is referred to an Orthopaedic Surgeon, who may perform and Arthroscopy to clean the knee out. If the pain in the knee persists, then the next stage is often knee replacement. This is not necessarly done until the patient is old enough.
The one approach that is overlooked is functional biomechanics. How the foot and legs work and their effect on how the knee works. This can be the reason why early treatment interventions do not work to solve pain, as the forces involved in creating the pain are still alive and well.
Podiatrist are able to assess, foot and leg function to determine the foot’s influence on how the knee works. Exersises, insoles, orthotics and footwear advice can play a role in improving foot function and reducing the forces on the knee, assisitng knee alignment and patellar tracking. If the patellar tracks better, there is less wear and tear, and less chance of developing Osteoarthritis.