Can treating foot and ankle pain help knee pain go away and prevent knee replacement?
Ross Hauser, MD | Caring Medical Regenerative Medicine Clinics, Fort Myers, Florida
David N. Woznica, MD | Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois
Katherine L. Worsnick, MPAS, PA-C | Caring Medical Regenerative Medicine Clinics, Fort Myers, Florida
Danielle R. Steilen-Matias, MMS, PA-C | Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois
“Everything hurts, but its my knee, that is really bad.”
One of the benefits of regenerative medicine injections is that you can treat more than one painful area at the same treatment visit. For the patient who has significant knee, ankle, and foot pain, treating three joints at the same visit may bring cumulative added benefit to relieving your joint pain, painful walking, and unstableness on your feet. Simultaneous treatment of multiple joints may also help reduce or prevent the need for a knee or ankle replacement.
Joint pain, like a knee or an ankle, is usually not a problem that sits in isolation. This means the bad joint is causing and contributing to pain problems in other joints. We see patients all the time who come in and tell us, “everything hurts, but its my knee, that is really bad.”
In this article we will show you research on how one damaged joint can lead to multiple joint pain and how joint replacement surgery may fix one problem and create another. We will also show you how regenerative medicine injections, given in multiple joints may spare you a lot of knee and ankle and foot pain.
Before we move forward, most articles that involve joint replacement deal with people 55 and over. But what if you are a younger person, a construction worker? Home builder? Someone who makes their living being on their feet all day? What if you are very active in sports? What if your have worsening deterioration of your joints? There is a strong likelihood that you will be pain managed until such time as you get old enough or your joint degenerates enough for joint replacement. Unless of course you decide to look into regenerative medicine.
Are you a construction worker? Home builder? Someone who makes their living being on their feet all day? Can regenerative injections help?
We invite you to explore these articles on our websites for answers on ankle and knee replacement:
- Being forced to wait for knee replacement is painful, significantly deteriorates your condition, worsens your knee pain
- How fast can I return to work after knee replacement? 15 to 30% of patients do not return to work
- When should you consider alternatives to ankle replacement surgery and ankle fusion
Only 1 in 11 patients over the age of 55 have knee pain without anything else hurting – it therefore likely you are in the 90% of people who have multiple joint pain.
On average people over the age of 55 had pain in 4 joints.
Individuals with knee and foot problems were 14 times more likely to experience difficulty standing and walking
If you are reading this article, you probably do not need to be provided with much research to suggest that you have a lot of things that are hurting you in addition to your knee and ankle. But research has a way of showing you that you are not alone and that there are medical professionals trying to help come up with some answers for you.
Here is research from the University of Leeds, Chapel Allerton Hospital in the United Kingdom, published in the journal Arthritis and rheumatism. (1) It makes the suggestion to doctors that they need to treat multiple joint pains. Here is what they found:
- It was more unusual for a person over the age of 55 to have single joint pain than multiple joint pain. In fact the average person over the age of 55 had on average, pain in 4 joints.
- Although the knee was the most frequently involved joint, isolated knee degenerative disease accounted for only 1 in 11 patients with knee pain.
- Although single joint disorders increased the risk of experiencing functional difficulty, this risk was substantially increased with multiple joint problems: individuals with knee and feet problems were 14 times more likely to experience difficulty standing and walking.
CONCLUSION: “Multiple-site joint problems are much more common than single joint problems. Although individual joint problems have a considerable impact on a person’s functional ability, this risk is substantially increased when other joints are involved. With the increasing burden associated with the aging population, it is essential that the management of joint pain be considered in light of the impact of multiple, rather than single, joint problems.”
“I had a knee replacement and now my ankle is killing me”
“Ankle bone connected to the shin bone, Shin bone connected to the knee bone.” There are many of you reading this article who may remember the old song “Dem Bones” and sang it when you were a child. The song gave the Biblical prophet Ezekiel instructions on how to put the dry bones the prophet was shown in the chapter of Ezekiel 37 back together so that they would become people again.
This often used example of skeletal harmony in motion goes a long way to help you understand that if you “fix” one problem, you may be creating another. So is the case of ankle pain following knee replacement surgery.
“Now I need an ankle replacement”
In the medical journal Knee surgery, sports traumatology, arthroscopy, (2) surgeons from the Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University in South Korea published these findings:
“Changes in the parts of the lower extremity below the ankle joint following the correction of varus deformity of the knee (knee replacement) must be considered when Total Knee Replacement is planned and performed. Patients who have problems at the ankle, subtalar, and foot joints in addition to varus deformity (your knees point inward) of the knee are recommended to undergo knee joint correction first.”
Now there are some studies to suggest that ankle pain after knee replacement is “normal.” That your knee is operating in the correct way now and that your muscles just have to adjust. Maube for some, but not for all.
Occasionally, patients experience new or increased ankle pain following total knee replacement and “a worse clinical outcome.”
Against the thinking that ankle pain following knee replacement is normal and that the patient needs to have patience in regard to their rehabilitation, comes this study:
In the American Orthopaedic Association’s Journal of bone and joint surgery, (3) surgeons from the Seoul National University College of Medicine in South Korea published these 2018 findings:
- Occasionally, patients experience new or increased ankle pain following total knee arthroplasty (total knee replacement).
- “A considerable proportion of patients who underwent (total knee replacement) had concomitant ankle osteoarthritis with reduced flexibility of the hindfoot. These patients experienced increased ankle pain following (total knee replacement) and a worse clinical outcome.”
We do understand that we point out a lot of problems with surgery. We have seen so many patients post-surgery who did not have the success that they had hoped for. The research from the surgical community confirms what we have seen clinically there are a lot of people who did not have successful surgery. This does not mean you will not have a good surgery if you choose to go that route. People do have successful surgeries too.
- What is pointed out in this research is simple. If you have significant ankle osteoarthritis and you have a knee replacement, you are at risk for “a worse clinical outcome.”
Treating your foot and ankle pain may help you avoid a knee replacement
In our article The evidence for treating ankle osteoarthritis pain and loss of function without surgery, we suggest that: “Hopefully, you are at a stage where the damage to your ankle is not irreversible. If you have chronic ankle instability but a good range of motion in your ankle, we believe we can help you avoid future surgery and strengthen your ankle. The key is fixing the instability before the instability creates significant bone damage.”
To be clear, some patients have clear clinical deformities of their knee or their ankle that have progressed to a point that realistic assessments of treatments have to be made. When someone comes into our clinics and we do an examination, it is very rare that someone will be told surgery is the only way. But rare as it is, for some patients, their realistic option is surgery. Why? Because their situation has gone on too far and too long. Who are these people? The ones who usually were pain managed with conservative care until such time as their joint degeneration became “bad enough,” to “finally be approved for surgery.” These are the people whose joints continued to erode without a positive means of stopping that degeneration or regenerating or repairing the damaged tissue.
Patients with foot and ankle and knee pain over a four year period – stop the ankle damage save the knee
Here is a study from The University of Melbourne, it was published in the medical journal Osteoarthritis Cartilage (4) in May 2017. The researchers of this study examined patients with foot and ankle and knee pain over a four year period. Here are the summary points::
- “(our) study found that people with knee osteoarthritis who report foot/ankle (pain and instability) symptoms are at an increased risk of knee pain worsening compared to people without foot/ankle symptoms over the subsequent four years (of the study).
- However, foot/ankle symptoms were not associated with worsening of symptomatic radiographic knee osteoarthritis. (Your knee hurt more but the MRI and scans did not reveal anymore osteoarthritis damage.) Note: please see our article My knee hurts worse than my doctor believes it should – my doctor does not believe I have bad knee pain.
- These (study) findings are important given that knee pain worsening has been shown to be an independent predictor of future knee joint replacement surgery. Furthermore, both general and specific causes of foot pain can be treated using simple conservative interventions, suggesting foot/ankle symptoms may be a modifiable risk factor for knee osteoarthritis pain worsening.”
So here the researchers suggest non-surgical conservative care treatment of ankle and foot pain may lead to a lessening of knee pain and the need for knee replacement surgery.
Prolotherapy and regenerative medicine for knee, ankle, and foot
In this article, we will make the connection from ankle ligament instability to ankle osteoarthritis, to the need for ankle fusion or ankle replacement surgery. We will also present Prolotherapy as an alternative to this predicament.
In our office’s 26+ years of service, we have seen countless people with ankle osteoarthritis. Many are very active people, heavily into sports. Many have a physically challenging job, many come to us after suffering an injury or accident that was very damaging. They all have a story of “non-healing.”
Alternative treatments for foot pain
In our article Alternative treatments for foot pain, we introduce Prolotherapy treatment, with supportive research for the following foot problems, hallux valgus, Morton’s Neuroma, Tarsal Tunnel Syndrome, Plantar fasciitis and Plantar Fasciopathy, and others.
1 Keenan AM, Tennant A, Fear JO, Emery P, Conaghan PG. Impact of multiple joint problems on daily living tasks in people in the community over age fifty‐five. Arthritis Care & Research: Official Journal of the American College of Rheumatology. 2006 Oct 15;55(5):757-64. [Google Scholar]
2 Jeong BO, Kim TY, Baek JH, Jung H, Song SH. Following the correction of varus deformity of the knee through total knee arthroplasty, significant compensatory changes occur not only at the ankle and subtalar joint, but also at the foot. Knee Surgery, Sports Traumatology, Arthroscopy. 2018 Nov 1;26(11):3230-7. [Google Scholar]
3 Chang CB, Jeong JH, Chang MJ, Yoon C, Song MK, Kang SB. Concomitant ankle osteoarthritis is related to increased ankle pain and a worse clinical outcome following total knee arthroplasty. JBJS. 2018 May 2;100(9):735-41. [Google Scholar]
4 Paterson KL, Kasza J, Hunter DJ, Hinman RS, Menz HB, Peat G, Bennell KL. Longitudinal association between foot and ankle symptoms and worsening of symptomatic radiographic knee osteoarthritis: data from the osteoarthritis initiative. Osteoarthritis Cartilage. 2017 Sep;25(9):1407-1413. doi: 10.1016/j.joca.2017.05.002. Epub 2017 May 13. PubMed PMID: 28506843; PubMed Central PMCID: PMC5565691. [Google Scholar]