Written by staff | 18 July 2011

For the amount of force it handles, it is not surprising that knee pain is the most common joint ailment. Chances are someone from a local sports team is currently recovering from a knee injury, but knee pain isn’t just a problem for athletes. Almost 20% of adults report knee pain or stiffness annually—more than double any other joint. (Adults Reporting Joint Pain or Stiffness in the Past 30 Days )¹ From mild swelling and discomfort, to structural bone or ligament damage, knee pain consistently proves to be one of the most inconvenient, worrisome ailments. Proper diagnosis is paramount when treating knee problems. Continued activity on a structurally damaged can permanently damage the joint and vastly increase recovery time.

The knee’s primary function -- to bend and extend -- is critical to walking. Made up of an inner, outer and lateral compartment, the knee joint connects the femur and tibia to the kneecap. The joint is surrounded by ligaments, which strap the inside and outside of patella to provide stability. The meniscus is a cartilage pad, which separates the kneecap from both joints. Fluid-filled bursa sacs surround the entire joint to reduce friction and promote smooth motion. Large thigh muscles move the knee. (Knee Pain)² With aging, this complicated joint is susceptible to degeneration. Osteoarthritis, which is sometimes known as degenerative arthritis, is one of the most common causes of knee pain. The wear and tear of years of use can cause cartilage in the knee to deteriorate. The result is bone-on-bone contact between joints, which can make movement uncomfortable. More debilitating forms of knee degenerative pain include rheumatoid arthritis and gout, which build up uncomfortable material in joints. Osgood-Schlatter syndrome also results in a disruptive build-up, but occurs more commonly in athletes. (Staff)³ A combination of heat and ice is usually recommended for these progressive ailments, along with physical therapy. Ice can help alleviate tissue build-up and swelling, and stretching takes pressure off the joint.

More serious knee problems involve structural damage, which can lead to harsher pain and more involved solutions. Anterior crucial ligament tears are the most common form of structural knee damage. Most commonly a sports injury, ACL tears usually occur from a knee being traumatically twisted. This injury sometimes induces a “popping” sensation upon initial trauma. Meniscus tears are another common structural knee injury. When the cartilage between joints is torn, it can cause swelling and limit motion. In some cases, the torn piece of cartilage can flip inside the joint, causing the knee to lock. Some ligaments sprains can be treated with rest and anti-inflammatory remedies, but tears usually require surgery. Ligament surgery takes months of rest and exercise to build up strength in the joint. Meniscus tears require a less invasive arthroscopic surgery and patients usually recover in 4-6 weeks. (Knee Arthriscopic Surgery)⁴

Like any other bone, knee pain can be the result of a simple bruise. The complicated nature of this joint and its importance to daily life make it wise to not assume the pain will dissipate, however. When caught early, knee discomfort can be sorted out with exercises and slight life-style changes, such as running on a treadmill instead of hard pavement.

Resources

1. Adults Reporting Joint Pain or Stiffness in the Past 30 Days . (n.d.). Retrieved July 11, 2011, from Centers for Disease Control and Prevention : www.cdc.gov/Features/dsJointPain
2. Knee Pain. (n.d.). Retrieved July 11, 2011, from MedicineNet: www.medicinenet.com/knee_pain
3. Staff, M. C. (n.d.). Knee Pain: Causes. Retrieved July 11, 2011, from Mayo Clinic.
4. Knee Arthriscopic Surgery. (n.d.). Retrieved July 11, 2011 , from Encylopedia of Surgery : www.surgeryencyclopedia.com/Fi-La/Knee-Arthroscopic-Surgery

Written by staff | 13 July 2011

The foot is the basis of human locomotion, providing movement, shock absorption and balance. With time, most people clock a great deal of time on their feet, and about 75% of people in the US experience foot pain at some time. In fact, according to a 2009 American Podiatric Medical Association (APMA) survey, nearly 40% of Americans experience foot pain that is so severe, it impairs day-to-day life—and this pain should never be ignored¹.

Ill-fitting or complicated shoes such as high heels take their toll on feet, as does wear and tear from sports and aging. Pain in the foot can be a sign that internal or external components of the foot have sustained damage. Damage to the foot can occur from mechanical injury or from disease processes.

The foot is a complex structure comprised of muscles tendons, ligaments, and bones. The chief support structure of the foot is the 28 bones and more than 30 joints². The muscles of the foot, along with tough, sinewy tissue called fascia, also provide support to the foot. Ligaments connect bones in the foot to other bones, and tendons connect muscles of the foot to bones. Fat pads in the foot join the ligaments in bearing weight and absorbing impact.

During a lifetime, the physical components of the foot sustain an unfathomable amount of physical use and abuse, which is why mechanical injury is the most common reason for foot pain.

Since feet are very small relative to body, they carry a tremendous amount of weight and disperse a great deal of force. Although feet are built for a lifetime of service, sudden injury or gradual wear and tear can harm the feet.

Mechanical injuries such as sprains and strains are commonly the result of acute (sudden) trauma to the foot. Sprains refer to stretching or tearing of the ligaments. In particular, ligaments on the soles of the foot bear a great deal of weight and can sprain when subjected to excessive stress. The sister ailment to sprains is strains, or stretching or tearing of tendons. Like ligaments, tendons are subjected to constant stress and are prone to injury. Another common problem often seen in tendons in the foot is tendonitis, or inflammation and irritation of the tendon due to mechanical stress. Achilles tendonitis is a common irritation of the thick tendon located at the heel.

Another result of acute trauma to the foot is fracture of the bones within the foot. Fracture can be caused by sudden, excessive force, or by repetitive motion that eventually results in breakage. Repetitive trauma to the bones, muscles, and ligaments can also result in extra bone growth known as spurs or exostosis, plantar fasciitis, and acute and chronic osteoarthritis.

Bruises can also result from sudden trauma. Particularly when they occur in the heel, bruises can cause severe pain when an individual puts weight upon the bruised foot. Another cause of bruises is excessively tight footwear. For example, shoelaces tied too tightly can cause bruises across the arch of the foot.

Another cause of damage to internal and external structures of the foot is poor biomechanical alignment of the feet and body. Poor alignment can result from poor posture and gait. Poor alignment can also be caused by wearing shoes that are ill-fitting, tied too tightly, or high-heeled.

In addition to poor alignment, footwear can cause other mechanical injuries such as blisters, calluses, and bruising. Over time, damage from footwear can manifest as bunions, bony bumps at the base of the big toe, corns, round calluses of built-up dead skin, nerve irritation, ingrown toenails and misalignment of the toes.

A variety of diseases, ranging from common and manageable to infrequent and severe, can cause foot pain. Plantar warts, which appear on the soles of the feet, are caused by a virus and can result in pain. In certain people with diabetes, nerve damage can result in peripheral neuropathy within the feet. This is generally felt as pain, numbness and tingling. Diabetes can also cause inadequate circulation (ischemia) in extremities such as the feet, resulting in severe pain. Poor circulation deprives tissues in the foot of blood flow, leading to ulcers that are resistant to healing, tissue necrosis (death), and eventually amputation.

Nerves in the foot can also be affected by neuroma, a benign growth of nerve tissue frequently found between the third and fourth toes. Like peripheral neuropathy, neuroma can cause pain, a burning sensation, tingling, and numbness in the affected area.

Another common disease responsible for foot pain is gout. Gout is a complex form of arthritis characterized by sudden, severe attacks of pain, redness, and tenderness in joints, generally in the joint at the base of the big toe³. Gout occurs when urate crystals accumulate around the joint, causing the inflammation and intense pain of a gout attack.

In addition to gout, arthritis can produce other types of painful changes in the bones of the foot. According to the American Academy of Orthopedic Surgeons, osteoarthritis, also known as degenerative or "wear and tear" arthritis, is a common problem for many people after they reach middle age⁴. Over the years, the smooth, gliding surfaces covering the ends of bones (cartilage) become worn and frayed, resulting in inflammation, swelling, and pain in the joint. Similar to osteoarthritis is post-traumatic arthritis, which can develop years after a fracture, severe sprain, or ligament injury⁵.

APMA stresses that, whether a person is young or old, foot pain is not normal⁶. In order to combat foot pain, it offers the following tips^7,8:

• Inspect feet regularly.
• Wash feet regularly, especially between the toes, and dry them completely.
• Trim toenails straight across, but not too short.
• Make sure shoes fit properly.
• Wear the right shoe for specific activities (such as running shoes for running).
• Don't wear the same pair of shoes every day.
• Avoid walking barefoot, which increases the risk for injury and infection.
• It is critical that people with diabetes see a podiatric physician at least once a year for a checkup.
• Control weight: obesity puts extra strain on the feet.

References

1. "May 26, 2009." American Podiatric Medical Association. American Podiatric Medical Association, 2011. Web. 4 Jul 2011. www.apma.org/MainMenu/News/APMA-in-the-News.
2. "Arthritis of the Foot and Ankle ." American Academy of Orthopedic Surgeons. American Podiatric Medical Association, 09-2008. Web. 5 Jul 2011. www.apma.org/MainMenu/News/APMA-in-the-News.
3. "Gout." MayoClinic.com. Mayo Clinic, 04-04-2011. Retrieved 5 Jul 2011 from www.mayoclinic.com/health/gout
4. "Arthritis of the Foot and Ankle ." American Academy of Orthopedic Surgeons. American Podiatric Medical Association, 09-2008. Web. 5 Jul 2011. www.apma.org/MainMenu/News/APMA-in-the-News.
5. "Arthritis of the Foot and Ankle ." American Academy of Orthopedic Surgeons. American Podiatric Medical Association, 09-2008. Web. 5 Jul 2011. www.apma.org/MainMenu/News/APMA-in-the-News.
6. American Podiatric Medical Association. American Podiatric Medical Association, 2011. Web. 4 Jul 2011. www.apma.org/foot-pain.
7. "General Foot Health." American Podiatric Medical Association. American Podiatric Medical Association, 2011. Web. 4 Jul 2011. www.apma.org/MainMenu/Foot-Health.
8. "Study Finds Obesity in Children Increases Foot Injury Risk." American Podiatric Medical Association. American Podiatric Medical Association, 2011. Web. 5 Jul 2011. www.apma.org/Study-Finds-Obesity-in-Children-Increases-Foot-Injury-Risk.