OA in feet and now in knees

lesley123

Hi

Sorry but I only seem to pop into here when my oa takes a turn for the worse! I'll try and keep it short but I have a few questions.

Firstly, I had steroid injections into my big toes in May and they were fantastic. My biomechanic says that I can only have them every 6 months and that if my toes get bad in the mean time then I'll have to consider surgery. Before I had these injections I was keen on surgery as I couldn't see any other answer to the pain but now I know these injections do work. However, the steroids have obviously worn off and my feet are now very painful. My GP has given me codeine for through the day and tramadol for night time as my knee pain is keeping me awake but I really don't like taking strong painkillers like smarties. Why won't my biomechanic let me have my injections more frequently?

That brings me to my knees. My right knee has been extremely painful for the last 3 weeks. I went to my GP who said that it is OA and gave me painkillers but I suspect that it's being exacerbated by my gait. I am walking on my heels to avoid bending my big toes. Is this possible? It has only become painful since my toes started up again.

At the minute I don't know what to do. I have cut my hours at work as I can't stand being on my feet for 5 days a week. I have quit smoking in case that was playing a part and also in case I do need surgery. However, I have gone up a dress size since quitting and I'm wondering if that has caused my knees to become painful but I've only gone from a 10 to a 12. My GP said that my knees are knobbly and swollen which is a sign of OA and that I'm likely to have had oa in them for some time as the big joints like the knees are usually affected before the smaller toe joints.

Whatever the reason, I can do without the knee pain. My feet only hurt when I walk but my knee hurts all the time, including when I'm in bed.

Any advice, anyone?

dibdab

Sorry to hear that you're having a rough phase. I'm certainly not a medical person, but logic seems to suggest to me that when one joint is painful and we adjust how we walk other joints are inevitably put under extra strain, so maybe that is the link between your knee pain and foot pain? As far as the steroid injections go, I know that my rheumatologist (I have a mixture of RA and OA now) and my GP say that you can only have a limited number because they can cause tissues to change (get thinner I think but not sure :oops: ), they are powerful drugs and therefore need to be used conservatively.

In terms of night time pain, I too suffer, and find myself reluctant to take too many pain killers. I have found that using a small pillow under my knees seems to help, and others suggest a pillow between the knees is helpful, though it doesn't help me so much. Have you tried a warm pack on the sore joints, it might provide some relief? Also there's the option of an anti-inflammatory gel to rub in to the affected area, something like ibuleve gel or diclofenac gel..........I add them in to my regular pain relief.
It may be worth asking your local pharmacist about localised pain relief.....my mum has really bad knees and uses a warming rub or a cooling gel depending on how she feels....both were suggested by a pharmacist.

No doubt there will be others along to share their wisdom and experience soon. .

Deb x

stickywicket

Right. Steroids. Wonderful in part. They really can seem like miracle pills but....they don't just work on the inflamed part. They work all over, thinning tissue and bones, and can do a lot of damage if we overuse them. Hence the gap between jabs.

None of us like taking pills. I take my necessary ones for various conditions but I keep pain relief to a minimum. I know it's with me for life whatever I do and I'd rather have pain than lots of strong painkillers. (What a misnomer!) However, there is a time and place for such things and sometimes they are necessary.

The knees? I think you're right. Your gait will make possibly a big difference to pain experienced elsewhere. The remedy is the same - exercise, rest and pain relief.

You've done well to give up smoking. According to research published by Arthritis Research UK "So in addition to all the usual reasons for stopping smoking it sounds sensible to advise patients with chronic pain that smoking is associated with increased pain, more depression and more anxiety." http://tinyurl.com/ov9fkeo

I think we just have to learn to live with OA. You might find something here of value http://www.arthritiscare.org.uk/PublicationsandResources/Selfmanagement/pathway-through-arthritis

barbara12

SW has given you some good advice there,steroids are not good long term..apart from the pain meds the only thing that helps me in bed is my body pillow..supports my knees and hips..I only take the pain meds when needed.. this is more and more at the min..but like they say ..keep on top of the pain and not let the pain come on first..there are gels out there that you could use on your knees or even ask to be referred to a physio for some sort of support..I hope you get some relief soon..

lesley123

Thanks everyone. I have to be careful with nsaids as I had an extreme reaction to diclofenac a few years ago. I just don't know whether to take the codeine proactively or just when the pain is bad which is pretty much all the time at the minute. Such a shame about the steroids. A friend of mine gets injection into her ankles every 3 months so I was feeling hard done by.

The pillow does sound like a good idea and I'm going to look into the Pathway through arthritis course. I am pleased I gave up the cigs though. Just need to address my chocolate habit now haha. I have tried heat on my joints but it does nothing unfortunately x

stickywicket

Some find heat helps and others ice. If you're using ice (a pack of frozen peas is ideal as long as you don't then eat them ) Wrap it in a towel to protect your skin.

Unfortunately there are no magic wands with arthritis. (If there were we wouldn't be here :roll: ) We each have to find what works best for us. Taking codeine proactively might be the way for you though it wouldn't for me. You can always 'suck it and see' then stop if you feel it's not for you.

When you had the 'extreme reaction' to diclofenac were you also taking a stomach protector? If not, it might be worth another chat with your GP.

As for steroids – this is what NHS Choices says about them. If your friend is blissfully unaware of the dangers it might be worth drawing her attention to it. They are great for short term use but are not a permanent solution. http://tinyurl.com/pjxqn2a

dreamdaisy

I think this is one of the reasons that OA 'spreads' - one part is affected so we alter how we stand and move to relieve the pain in that bit thus throwing other joints out of kilter leading to more trouble. I have OA in both ankles and both knees, extra bone growth everywhere too. Mine resulted from the joint damage caused by my auto-immune arthritis so life's not very jolly.

Steroid injections sometimes work, sometimes not, but they do not address the cause of the problem, only mask its effects. Steroids work by thinning all the tissues in the body which is why they are not a long-term treatment option and have to be rationed. They have a role to play but that role is limited. When it comes to pain relief I take a steady daily amount of at least two 30/500 cocodamol, but more usually four. They take off a sufficient edge so I can get on and do things and allow pain feedback so I know when to stop and rest. I prefer the steady drip-drip of pain relief rather than allowing things to build to such an extent that nothing appears to touch it.

There are other anti-inflammatories out there, because one didn't suit doesn't mean that another won't but a stomach protector is vital if they are to be taken on a regular basis. DD

emmaadams

Hi i have OA in both knees and i feel you pain as its is horrid !!! i have a V shaped pillow to put in between my knees at bed time as well as a ibuprofen gel which i apply and i also take several strong pain killers .. i have been suffering for 5 years with this and it has got worse in my case .. i also use a hot water bottle on really bad days along with all the other stuff ...i also have a electric blanket for winter witch will be coming out again soon as its getting really cold and wet here ...

i have now also got OA in my hips and lower back due to weight baring( even though im only slim and small 7stone and 5ft2 ) as it first started in my right knee to begin with and has now spread to Several joins ...

i got to physio every 2 weeks and this helps out.. but very little in my case.. but it may be worth asking your GP about it ?? . i have never had the steroid injections and i know they can be quite painful at the time . i have been referred to a pain clinic ...maybe ask you GP about this also ??
i hope you can get something sorted soon xxx

Emma xx

lesley123

Thanks again, everyone. I put a pillow between my knees last night and had my 1st unbroken night's sleep for weeks. I'm hoping it wasn't a fluke. I took 30 mg of codeine phosphate before work but found that i was wanting to sleep after a couple of hours. It helped with the pain though.

I will mention the stomach protector to my GP although last time I had diclofenac my blood pressure plummeted and my face, arms and legs swelled up. I ended up in an ambulance and was advised by the hospital doctor to not risk another nsaid.

Dream Daisy, my biomechanic did say that my gait would, in time, affect my other joints. I was hoping that this effect would be temporary and not develop into more OA.

Perhaps I should reconsider surgery before any ore damage is done. I believe that this would incur a long period off work though and I doubt that my employers would keep my job open for me as my sickness record is poor (I also suffer from recurrent hernias). My podiatrist told me that it is better to have this type of surgery at a relatively young age but my biomechanic said that surgeons are loathe to do it too early as it will have to be redone at a later age. My GP doesn't recommend it because he has seen some poor outcomes of fusion surgery. It's all very confusing. From what I have read on here, when it does work it is excellent.

stickywicket

If the diclo problem was low BP and swelling I doubt a stomach protector would be the answer.

If the fusion surgery you mean is of your big toe then, yes, I think it is rather a long recuperation period from what I've read on here. The alternative would be to get some physio for your knees. Strong muscles protect joints and do help with the gait problem albeit to a limited extent.

Rebeccarockchick

Hi Lesley,You sound similar to me, I have OA in my big toes, a bunion and two bones that are too long in my feet. I also have OA in my knees (very painful). Due to my other medical issues going on at the moment I cannot have steroid injections or surgery. I did see a surgeon in June though. I really do believe that a percentage of my pain comes from my feet. I walk different because I cannot put the weight on the correct parts of the feet and then i am using the wrong muscles in the legs and hips and this causes more pain in the knees. It causes more pain than should be there. I have found my insoles special made from podiatry are starting to help a little and keeping active helps a little. But nothing helps a lot. I know the only thing that will fix my feet is surgery. The surgeon told me it would take around 3 different surgeries(one of those being a fusion) and i could be pain free and arthritis free in that joint-sounds good to me!could be- not defiantly, that can only be a benefit to the rest of my body. Also I would prefer to have the foot surgery whilst I am still able to move around (even just a little bit) before my knees get so bad I cannot walk at all or I won't recover well or be offered the surgery as my muscles will be too weak. This is why physio is so important to keep those muscles strong around the joints.You do get mixed reports off different medical experts, my podiatrist is totally against surgery, my doctor didn't think i would be offered it and the surgeon took one look at my xray and said i needed it! hmmm, Also I cannot take nsaids due to other medication I am on, however the doctor has given me all different types of rubs and gels he said they are better/fine to use as such a small amount actually goes into the blood stream. I mentioned on a previous post about a rub off the doctor that contains chillis that may be worth a mention to your doctor next time you go. I have just bought a reheatable hot water bottle it stays warm for 5 hours and has a pocket to put your feet or hands in, it has replaced my wheatbag, its the best thing i have ever bought totally recommend it to everyone!!!!this moght be nice for your feet and knee xx becks

lesley123

Thanks, Rebecca. It's lovely to know that someone is in the same boat as me. I think I might ask to see a surgeon next time I see my biomechanic. It can't hurt to find out y options and he may not recommend surgery anyway.

I have special hard soles in some of my shoes but they couldn't put inserts in then because the bunions and bone growth at the base of my big toes is so big and they said that there wouldn't be room. I think you are right about some knee pain being a result of the way you walk. My knees were a bit stiff but pain free until about 3 weeks after the pain returned in my feet and hence me walking on my heels.

I have a horse and try to ride about twice a week. I also walk a lot, not through choice but because I can't drive and my job involves a lot of walking. So I do get some exercise.
hanks for the advice about hot water bottles and gels. I might try some anti inflammatory gel on my knee when my son gets in. My knees don't look particularly swollen to me but my right one is very painful

Rebeccarockchick

It is a good idea to find out your options and take it from there and well done for keeping so active when in so much pain, it is not easy. Best place to be, on here, I find for myself also with those who are going through it or similar... Let us all know how you get on

Oh and I nearly forgot an important thing I was going to say 'well done' on giving up smoking! I have just given up after 21 years..10 weeks now...

lesley123

Rebeccarockchick wrote:

It is a good idea to find out your options and take it from there and well done for keeping so active when in so much pain, it is not easy. Best place to be, on here, I find for myself also with those who are going through it or similar... Let us all know how you get on

Oh and I nearly forgot an important thing I was going to say 'well done' on giving up smoking! I have just given up after 21 years..10 weeks now...

I surprised myself with the giving up the cigs. I didn't even tell people I was doing it as I was sure I'd fail. I'm not really missing them at all but just a bit worried I'll become complacent like last time. I thought I had them beat after 3 months so thought I'd have the odd one when I was out drinking. :oops:

Well done you too. It's not easy

stickywicket

Congratulations to both of you on giving up smoking. It's not easy. Many many years ago I did it – twice :roll: I never took it up again as I knew I'd never be able to give up again. It's 'the odd one' which was my downfall first time round. You think you have it beat so one will do no harm but it does. It leads to “Well, I've proved I can have one and then walk away again so I can now have another....and another....” Don't do it :zombie-cat:

lesley123

That's exactly what happened to me, Stickywicket

dreamdaisy

I've slept with a pillow between my legs for years now, I am a side sleeper and it certainly helps to soften the pressure of the upper leg on the lower. I stopped smoking because I couldn't park close enough to the only tobacconist in town who sold my favourite Gitanes - buying them wasn't worth the pain. Now I could easily get there but the thought of starting again is repellent - as is the smell of smokers in queues - no way do I want to return to that gang! DD