It’s always interesting to see how modern medicine doesn’t care about how a problem began. This is generally because doctors don’t get paid much to figure things out, just to fix what’s broken. However, at Regenexx we try hard to figure out the complex reasons why our patients have their problems, as that increases the chances that we’ll be successful helping them recover. I’d like to go over such as case this morning.
How your foot hits the ground can be a big deal. Go and check a pair of well-worn shoes. Look at one of the heels. Does it wear evenly, or do you tend to wear down one side or the other more? I personally tend to wear down the outside of my heel, meaning my feet want to supinate rather than pronate. Others have feet that tend to want to go the opposite way.
This change in how forces travel up the leg can obviously impact the next joint up, the knee. These abnormal forces can preferentially wear out the cartilage in one compartment or another. In our case this morning, an old ankle fracture caused too much wear and tear on the inside compartment of the knee, which caused arthritis.
The X-ray above shows a hidden problem. This is a patient who was seen for left knee arthritis. As I was reviewing all of his X-rays, this one stuck out because of the hardware in his left ankle. He told me that his body felt like it was shifted to the left. When I measured the angle between the floor and the tibia bone, it was different. Turns out his left ankle had been set at a different angle than his right, and this was, in fact, pushing his body to the left. In fact, this also was causing extra compression on the inside part of the left knee, consistent with arthritis forming at that location.
While we can’t fix the angle of his ankle, we can use orthotics to help this foot hit the ground better. So in order to help his knee, we need to correct these ground forces as well as use a stem cell treatment. Hence, before he gets the latter, I’ll need to see another X-ray in those orthotics and remeasure his angles.
The upshot? Knowing what’s happening as your foot hits the ground is critical to discovering why your knee or hip hurts. The problems go the other way as well: issues in the low back can cause issues down the other way, toward the knee. So it’s all connected! Hence, a knee exam should always include an exam of your foot/ankle, hip, and back! If that’s not what you’re getting, then find a new doctor!
About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…