5 Most Common Causes of Knee Pain

Knee pain can be unbearable but can be even more frustrating if you don’t understand what is causing or why it’s not getting better. Unfortunately, most pain related to your knees gets worse over time. What can start out as stiffness or aches can, if left untreated, turn into a problem that can only be fixed with surgery. Sometimes, icing or over-the-counter medications may help. Other times, therapy or braces may be needed.

Recovery is determined by the condition and its severity. However, the first step in recovery is understanding what’s causing your pain in the first place.

Meniscal Tears

The sturdy and flexible, hard tissue that covers the ends of our bones is known as cartilage. Knee cartilage is supported by two menisci (semicircular cushions of collagen between the cartilage surfaces): the medial and the lateral meniscus. This information is essential because this is where most “tears” take place within the knee.

A meniscal tear is about as painful as it sounds – causing the torn edged to get stuck in the joint, creating a “catching” sensation in joint. Meniscal tears cause swelling and can sometimes lock the knee.


One of the most common causes of knee pain and disability is arthritis. As a general inflammatory condition, arthritis is split into three common types when it comes to knee pain: rheumatoid, post-traumatic, and osteoarthritis. While these all differ based on how they’re caused and what they affect, the most common of the three is osteoarthritis, which is the continual wear-and-tear of cartilage in the knee joint.

Osteoarthritis has a strong genetic component. Most frequently seen in older individuals, osteoarthritis can cause limited range of motion, tenderness, and weakness in the knees. No matter what form of arthritis is present, they all share the common characteristic of stiffness and swelling, making it hard to bend the knee. There is no cure for osteoarthritis at this time; however, there are several treatment options available to treat the symptoms.


Ligament Injuries

Ligaments connect the thigh bone (femur) to our lower leg bones (tibia). Ligaments hold our bones together and keep them stable. Most common in sports injuries, ligament sprains and tears can occur in the medial collateral ligament (MCL), posterior cruciate ligament (PCL), and anterior cruciate ligament (ACL). This type of injury can create severe pain and is characterized by the swelling and instability that these injuries cause. These injuries often need bracing and therapy and may require therapy.



Inflammation of the knee can become a problem for most as it is often the result or cause of other conditions such as arthritis, tendonitis, injuries, tears, etc. Inflammation can affect tendons, ligaments, cartilage, muscles and much more. While the pain you experience from inflammation can vary from mild to severe, you should always make sure to treat it before it gets worse. Chronic inflammation can often lead to more damage, increased pain, and a loss of cartilage. With inflammation, the body produces proteins and chemicals that promote swelling and pain.

Patellar Fractures

The kneecap acts as a protector to the knee, so a break within it is often caused by a fall onto the knee or against the dashboard during a vehicle collision of some kind. For those whose bones are weakened from osteoporosis, a fracture can occur by just misstepping, making it difficult or impossible to walk and straighten the knee. The patella increases the efficiency of the quadricep muscles and is often under a lot of stress. There are many other fractures of the knee possible as well.

Unless it’s a dislocation or fracture, the causes of knee pain may all seem the same to you. It’s difficult to honestly know what your condition is without seeing a professional. Don’t try and self-diagnose, or sweep the issue away, as untreated knee pain can only get worse over time. Contact a specialist today if you’re experiencing any knee pain or discomfort and so that you can start moving toward recovery.

Our Bone & Joint Health Multi is a great option for steadily improving joint health + function every day. Orthopedic surgeon Dr. Meredith Warner designed this multi based on what she recommends for her patients with musculoskeletal conditions – especially those who are considering surgery – so they can recover, faster. 

Shoulder Pain and Common Shoulder Problems

Are You Experiencing Intense Shoulder Pain?

There are a few signs you should look out for when determining whether to visit your doctor for a shoulder injury. The first and most immediate sign is extreme pain. If you’re experiencing severe pain as you move or touch your shoulder, it’s time to visit the doctor.

Before scheduling a visit, you may look at your shoulder and note any visible deformities. Your blood vessels and nerves may be damaged if you feel numbness, tingling or cold near the site of injury.

If your shoulder is injured due to trauma, we suggest seeking medical care immediately.

If you’ve been enduring persistent shoulder pain, that has worsened over time call a doctor immediately. Most home treatments are ineffective for serious shoulder injuries, and professional guidance may be necessary to ensure a safe recovery.

A waiting period helps some people determine whether they’ve severely damaged their shoulder. However, you shouldn’t wait longer than a few days if your shoulder is deformed, experiencing loss of feeling or extreme pain.

Again, if there has been trauma or there is moderate to severe pain or numbness and tightening, a professional assessment should occur as soon as possible.

Most Common Shoulder Injuries

People experience many types of shoulder injuries every year and identifying the true condition you’re experiencing is the most efficient route to finding the best treatment.

A rotator cuff tear is one of the most commonly reported forms of a shoulder injury. The condition is caused by tears or strains and often occurs with bursitis or tendinitis.

Frozen shoulder, which causes the tissue in the joint to thickens and tightens, is also one of the more common causes of shoulder pain. Frozen shoulder also presents a loss of motion.

Professional treatment is certainly required for these conditions.

Long-term conditions, like arthritis, cause persistent shoulder pain and are best treated with a professionally-developed treatment regimen.


Why Should You See an Orthopedic Surgeon?

Orthopedic doctors specialize in treatments related to the injuries or damage to the musculoskeletal system, including the shoulder.

Every day these doctors work with patients with injuries that have made it difficult to perform daily activities, suffer from chronic pain, and experience a decreased range of motion.

Orthopedic doctors can identify the source of your shoulder pain and develop a specific treatment path for you.


Care for Shoulder Pain & Shoulder Injuries?

Shoulder pain can result from a number of different causes, including arthritis, tendonitis, and joint dislocation.

Damage can occur from lifting heavy weight or through sports-related injuries, creating a dislocated joint or fracture. If you are experiencing any severe pain, visible muscle deformities, or persistent pain that has worsened over time, you should seek medical care immediately.

The severity of pain and damage to bones or joints will allow specialists to prescribe operative or non-operative treatment plans to help you return to a pain-free life.

Well Theory’s surgeon-curated line of products was designed to give you a safe + natural alternative to invasive measures. Use our cream and spray to gently, safely, and naturally soothe away topical aches and pains. Expertly crafted with soothing lidocaine, menthol, pure Hemp CBD isolate, and a carefully selected blend of essential oils.

Easy and Natural Tips to Heal That Bruise

Muscle contusions (bruise) are common in athletes but also in everyday people. In fact, are the second most common cause of sports injuries. Contusions typically heal quickly without forcing the athlete to take extensive time off. However, severe contusions can cause deep tissue damage and keep them out of the game for months.


Contusions occur after a blow from a blunt object strikes the body and crushes the muscle fibers and connective tissue without breaking the skin.

A contusion can happen from falling or pushing against a hard surface. A contusion can be as traumatic and painful as a tear or break (fracture); however, they are often underestimated since they can’t be seen.


Contusions are known to cause swelling and pain near the area of injury. Damaged blood vessels result in a bluish discoloration. A pool of blood can collect within the damaged tissue and form a bump. The muscle may feel weak, stiff and sore days after the injury is incurred. If damage is extensive a broken bone, sprain, tear or other injury may also be present.

Contusions of the abdomen may damage internal organs. Contusions in superficial locations, such as the shin (tibia) or elbow can have blue, black, brown and yellow discolorations for weeks.



The RICE (Rest, Ice, Compression, Elevation) formula can be applied to the contusion. Some doctors may recommend an non-steroidal anti-inflammatory drug like ibuprofen. The first 24 to 48 hours after the injury RICE will be the best method to employ for relief. If a large hematoma doesn’t disappear within a few days a doctor may need to drain it surgically. Compression marments are extremely effective to treat contusions.



Within a few days the inflammation should start to go down and the injury should feel less painful. A doctor may recommend gentle heat to the injury at this point. Activity levels can be increased gradually. Returning to sports or everyday activities may take several weeks. Putting too much stress on the area before it has healed can lead to scar tissue and more problems.

A doctor may recommend gentle stretching exercises to restore range of motion. Weight bearing and resistance exercises should be considered after range of motion has improved. Physical therapy is an excellent treatment for contusion; a professional therapist can optimize the muscles recovery and function.


Compartment syndrome and Myositis Ossificans can occur in serious cases. Compartment Syndrome may require surgery to drain excessive fluids and swelling to the muscle. This is a serious condition that usually causes extreme pain. Immediate attention is required. The condition is caused by rapid bleeding, a build up of fluid, and can disrupt blood flow.

Myositis Ossificans is a condition in which the bruised muscle grows bone instead of new muscle cells. RICE can help this condition and improve flexibility; surgery isn’t usually required. Myositis ossifican is common in the thighs of football players; however now all uniforms have padding on the front of the legs.

Use Well Theory’s surgeon-curated cream and spray to gently, safely, and naturally soothe away topical aches and pains. Expertly crafted with soothing lidocaine, menthol, pure Hemp CBD isolate, and a carefully selected blend of essential oils.

For more information on Muscle Contusions visit the American Society of Orthopaedic Surgeons.

Anterior Knee Pain and Patellofemoral Arthritis

Many people with pain in the front of their knee spend months or years without a true diagnosis or treatment plan. Often they are pushed from doctor to doctor, and occasionally are even relegated to pain management. Most patients with pain in the front of the knee, or anterior knee pain, however, are active and do not want to be medicated forever. The problem with anterior knee pain is that it is a difficult diagnosis to make and there are many possibilities.

One of the problems with medicine in the era of healthcare reform and ‘big-box’ medicine is that physicians no longer perform actual physical examinations.

Usually the doctors have a quota of patients to see that day that limit a visit to 8 minutes or so and the majority of that time may be spent documenting the visit in the electronic record.

While this satisfies the government and permits payment for the visit, too often the patient remains without a diagnosis simply because no physician ‘laid hands’ on them.

Anterior knee pain can be diagnosed with a good history and good physical exam with occasional confirmation via imaging. Make sure that your doctor performs a good physical examination of the knee prior to dispensing advice or treatment.

Arthritis is the common term for damaged cartilage. Cartilage is the substance that covers both sides of a joint. A joint is a connection between two bones that allows movement. Cartilage provides both a slick and strong surface that allows the two bones to slide against each other for motion and a surface that accepts impact and protects the surface bone beneath the cartilage.

As cartilage breaks down or after it is damaged, arthritis ensues. Once there is arthritis, the surface is not as strong and is not as frictionless as it should be. Movement becomes less efficient and also painful. Patellofemoral arthritis is a problem between the cartilage surface of the underside of the patella (knee cap) and the front-side of the femur (thigh/knee).


Patients with this problem often report pain, effusions or swelling and mechanical symptoms such as popping, locking or catching in the front of the knee.

Pain is actually coming from the bone under the cartilage and the surrounding soft-tissue as cartilage itself lacks nerves. By lacking nerves, cartilage cannot itself feel pain; however, the bone underneath and the tendons, muscle and ligament around that cartilage certainly can produce pain. Arthritis is more often than not due to life itself or age-related. However, occasionally trauma or injury can cause and progress the symptoms of arthritis.

For trauma to cause arthritis the cartilage itself must fracture (break) or have an identifiable impact injury. This can happen from patella dislocations or subluxations, osteochondral defects, fractures of the knee or patella, or constant improper loading of the joint due to abnormal mechanics and alignment of the knee. Instability of the patellofemoral joint is a problem and can sometimes progress to arthritis if not identified and treatment in a timely fashion. The patellofemoral joint sustains the most load and wear during activities such as ascending or descending stairs and/or squatting. When the knee flexes (bends), this joint undergoes more and more load and deformation. Maximum contact occurs at 90-degrees of flexion, but begins at 20-degrees.


The goal of treatment is to restore normal function (if possible) and reduce pain.

Usually, nonoperative treatment is the best course of action. This usually involved physical therapy, gait analysis and correction, orthotics and bracing, medications (topical and oral) and flexibility improvements. Soft-tissue balance of the knee capsule and surrounding ligaments and tendons is very important. Generally, this balance is difficult to achieve with a home-exercise-program and formal therapy or chiropractic care is necessary. In addition, the knee functions better if the hip motion and strength is optimized; this too requires formal analysis and correction.

Another method to treat arthritis of the patellofemoral joint is through viscosupplementation. This involves injections of hyaluronic acid directly into the knee itself. This substance improves the viscosity of the joint fluid. Improved viscosity allows better resistance to compressive forces. The injection also acts as an anti-inflammatory treatment and reduces the inflammation associated with arthritis. This inflammation is a source of both pain and swelling. Also, the viscosupplementation provides supplemental nutrition to the knee cartilage; this is especially important for areas as small and as hard to reach as the patellofemoral joint. Hyaluronic viscosupplementation is an excellent treatment method for arthritis of the patellofemoral joint.

Surgery has historically not had great results for this problem. Today there are newer technologies and better reported outcomes.

However, it should still be considered a last resort. There are procedures to restore the cartilage that involve cartilage substitutes and one’s own cartilage transferred to any significant lesions on the patella.

There are procedures to realign the patella and its tendons such that the biomechanics of the knee joint change. This typically involves actually removing the bone where the patellar tendon attaches and physically moving it over and then reattaching it with a screw. This type of surgery is done to unload the patellofemoral joint and reduce the forces across that joint.

Arthroscopy is utilized to perform what is known as ‘chondroplasty’. This is basically a procedure whereby the damaged cartilage is literally removed from the knee. This is very difficult to achieve due to the anatomy of the patella; the results have been limited and there are many times poor functional outcomes of that surgery. Also through the arthroscopy, the structures stabilizing the patella can be released to effect an offloading. This is known as a ‘lateral release’. Occasionally this procedure is accompanied with a partial resection of the patella.

Anterior knee pain is very common and very debilitating. Many patients spend years without a proper diagnosis or treatment plan. The physical examination should be thorough and supplemented with advanced imaging such as MRI or CT scan. Treatment should be nonoperative if at all possible. Surgery is possible, but functional outcomes are not guaranteed and the procedures require a great deal of technical expertise and significant rehabilitation afterward.

Looking for an alternative to surgery that will help you reduce your arthritis symptoms naturally? Download our free Arthritis Guide and start managing your symptoms today!


What is Hallux Rigidus & Your Options For Treatment

Dr. Meredith Warner is an orthopedic surgeon and founder of Well Theory, your resource for maintaining and promoting full body wellness and improving function as you age.

The MTP joint or the metatarsophalangeal is on of the most common sites of arthritis in the foot. Located at the base of the big toe, this joint is important because it must bend every time that you take a step. Once arthritis sets in and the joint begins to stiffen, walking can become particularly painful.

When two bones meet and move together, that is called a joint. The ends of the bones are coated in cartilage which is very smooth and allows motion. Eventually, this may cause reactive bone spurs to develop. In hallux rigidus a prominent spur will develop in the top of the bone and the joint. This spur prevents the toe from bending as much as it needs to when you walk; resulting in hallux rigidus or a stiff big toe.

Hallux rigidus generally develops in adults between the ages of 30 and 60 years old. While there doesn’t seem to be any scientific reason as to why it affects some individuals and not others, it is thought to result from differences in foot anatomy that increase stress on the joint. In addition, some specific injuries to the toe can damage the articular cartilage and cause hallux rigidus.


  • Swelling around the great toe joint
  • Pain in the joint when active, especially when walking
  • A bump that develops on top of the foot at the joint
  • Stiffness in the great toe coupled with the inability to bend it up or down
  • Hallux rigidus often looks like a bunion


If you begin to find it difficult to bend your big toe up and down or you are walking on the outside of your foot as a result of the pain in the toe, please contact us right away. Hallux rigidus is easier to treat when the condition is caught in the early stages of development. If you wait until the development of bone spurs that are visible in the form of bony bump on the top of your foot then the condition will be far more difficult to treat. However, it is still treatable with the right skills and technology.

Your doctor should examine your foot and will look for any evidence of bone spurs. She will also check the toe for mobility and to see exactly how much movement can be achieved without pain. X-rays will pinpoint the size and location of any bone spurs, as well as, the progression of any degeneration within the joint space and cartilage. X-rays are helpful to determine the overall architecture of the foot and to plan surgery or treatment.


Non-Surgical Treatment

Anti-inflammatory medications may assist in reducing swelling and easing the pain of hallux rigidus. Applying ice packs or taking hot and cold baths may also control the symptoms and reduce swelling and inflammation for short periods of time. Your physician will likely recommend wearing a stiff-soled shoe with a rocker or roller bottom design or even a shoe with a steel shank or metal brace. This type of design supports the foot while walking and also reduces the amount of bend in the big toe. Taping often helps. In addition, physical therapy can be very successful in treating this condition.

Surgical Treatment

Arthrodesis: Fusing the bones is recommended when there is severe damage to the cartilage. The damaged cartilage is removed and screws, pins or a plate are then used to fix the joint in a permanent position. The bones grow together over time. While this procedure has traditionally been the most reliable in terms of reducing pain, it is important to note that you will not be able to bend your big toe at all. Fusion should be a last resort procedure only.

Cheilectomy: This surgery is recommended for patients with mild to moderate damage. This procedure removes the bones spurs and a portion of the foot bone, so that the big toe has more room to bend. An incision is made at the top of the foot. It is important to note that while most patients do experience long-term pain relief after the surgery, the toe and the operative site may remain fairly swollen for several months post-op. When one has a cheilectomy it is expected that another treatment will eventually follow.

Arthroplasty: This procedure is best suited for patients who do not place many high impact functional demands on the feet. Arthroplasty is a joint replacement surgery in which the joint surfaces are removed and an artificial joint is then implanted. This procedure may relieve pain and preserve some joint motion. It is possible to remove one side of the joint or both sides. The surgery is successful for pain relief but often the will eventually need to be changed or revised.

Cartiva: Unlike traditional fusion procedures, Cartiva eliminates your joint pain without sacrificing the natural movement of the foot. The minimally invasive procedure places an implant, composed of a biocompatible organic polymer, that functions similar to that of natural cartilage. The procedure allows the foot full weight-bearing capacity shortly after surgery. Cartiva can be implanted with a block of regional anesthesia. Cartiva is a technology that is innovative and can reduce pain while preserving more normal foot motion.

Improve joint function and reduce inflammation with Well Theory. Try our Bone & Joint Health Multi to promote musculoskeletal health, and use our Hemp Cream + Spray to reduce inflammation and pain on contact.

How Plantar Fasciitis Slows You Down

Plantar fasciitis affects over 2 million people a year and is thought to be the most common cause of pain in the inferior heel. If left untreated plantar fasciitis can become a disabling long-term condition. Plantar fasciitis affects a patient’s level of activity and affect mobility.

The natural history of plantar fasciitis can mean pain lasts up to two years without proper treatment. If treatment is implemented correctly and in a timely manner the patient can return to their regular activities quickly.


The plantar fascia is a band of fascia that runs directly beneath the skin and subcutaneous fat on the bottom of the foot. The plantar fascia connects the heel to the front of the foot and supports the arch. Passively, the plantar fascia helps bear the weight of the body and some studies estimate it supports as much as 14 percent of the total load of the foot.

The plantar fascia is also important during gait because it elongates as you move throughout the motion. As the plantar fascia elongates or stretches it provides increasing support to the arch and augments foot movement/function.


Since the plantar fascia functions as one of the primary support structures in the foot is prone to being overstressed. Too much pressure or overexertion can damage or tear the tissue. People who are overweight or constantly on their feet are specifically susceptible to developing plantar fasciitis. Individuals with flat feet or high arches are also more likely to develop the condition.

People who participate in running or walking are capable of developing plantar fasciitis because of the stress placed on the feet during these activities. Many people who have heel spurs develop plantar fasciitis however heel spurs are not the cause of plantar fasciitis. Nonetheless, the size of one’s heel spur corresponds to the intensity of pain.



If you feel pain in the heel and/or arch as soon as you step out of bed in the morning you may have plantar fasciitis. Patients who suffer from plantar fasciitis often report pain after long periods of being inactive; for instance, heel pain after a long drive or after working at a desk. Pain can also begin after periods of heavy activity; this is likely due to the stressors placed on the structure.



Simple home-based treatments can be effective in about 10 months for over 90 percent of patients struggling with plantar fasciitis. Reducing or stopping activities that make the pain worst can quickly reduce pain in most patients. However, over time inactivity is actually worse for the foot. Icing the heel three to four times a day can also be effective. Plantar fasciitis can be worsened if the muscles in the leg and foot are tight. Stretching and exercises can reduce pain and improve mobility. Physician directed treatment could further shorten healing time to one to three months.

Anti-inflammatory medication can reduce pain and inflammation as well. Supportive shoes and orthotics can benefit the plantar fascia as well and provide essential support. Night splints are sometimes recommended to wear as you sleep to stretch the plantar fascia as you sleep. Physical therapy is an excellent treatment for this condition. Occasionally injections are required. PRP therapy is also known to work for plantar fasciitis as well.

Surgical treatment is only recommended after 12 months of non-surgical treatment if the pain is still present. Plantar fascia release is a surgery some doctors recommend if you still have normal range of motion but continued heel pain. During this procedure the ligament is partially cut to relieve stress and tension in the plantar fascia.

Gastrocnemius recession is a surgery that lengthens the calf muscles to decrease stress on the plantar fascia. Tight calf muscles increase tension in the plantar fascia and gastrocnemius recession aims to reduce the amount of stress caused by plantar fasciitis. It is the goal at Warner Orthopedics to avoid surgery for plantar fasciitis if at all possible.


For more information about Plantar Fasciitis visit the American Academy of Orthopedic Surgeons.

What to do if You’re Still Dealing with Pain after Bunion Surgery?

Unfortunately, bunion surgeries are not always successful. In the scientific literature on this subject, there are different types and severities of bunions; there are about 130 described ways to operate on a bunion. Usually, when there are this many options, it means that the best option has not been discovered. Historically, bunion surgeries have been painful and often fail.

A successful result from bunion surgery should mean that the patient is better and they have also increased their function. In addition, the patient should be able to wear the shoes they want to wear, such as high heels. A good bunion surgery will also allow the patient to walk relatively soon after the procedure and return to work quickly as well.

Revision Surgery

If you have had a surgery for a bunion and find that you still have pain, or that it has moved, you may benefit from what is called ‘revision’ surgery. Revision surgery simply means that the previous surgery is changed or revised.

The goal of a revision bunion surgery is to achieve the successful result described above. This type of surgery is complicated and requires a significant amount of training and experience to do well.

A patient’s radiographs and any other imaging must be analyzed and measured, and the foot anatomy and relationships between the various parts must be carefully examined. The foot doctor or surgeon should understand fully the patient’s activity levels and work description before planning the appropriate surgery.

Post-Surgery Transfer Metatarsalgia

Many patients have pain under the second and third toes at the ball of the foot after a bunion surgery. This pain is usually with activity and can be burning, aching or throbbing. Sometimes there is swelling there as well.

This type of pain is called ‘transfer metatarsalgia’; this basically means that the pain was simply moved from the bunion to the area under the ball of the foot; pain remains, even after surgery.

Many times this pain happens after bunion surgery because the bone for the great toe was shortened a little too much during the correction of the bunion. The shape of the foot is changed, and the patient’s weight moves over to the next toes during walking. The bones for the second and third toes were not designed for bearing so much of the body’s weight and they react with pain due to stretching out and compression of the tissues around these bones.

For this problem, a revision bunion surgery would create the normal balance in the foot again through a complex process of lengthening the appropriate bones.


Surgery should not be considered lightly.

However, if a patient has undergone surgery and feels that they still have too much pain, a consultation is in order to determine if revision surgery is necessary. There are surgical and non-surgical options available that can help to alleviate bunion pain, even if you have already had surgery.

What’s the Best Treatment for Plantar Fasciitis?

A recent study from McGill University in Canada looked at treatments for plantar fasciitis. The authors compared three groups of patients with pain from plantar fasciitis; each group had a different treatment.

The Study

  • One group underwent extracorporeal shock wave therapy (ECST) with orthotics and a home exercise program 
  • One group had a low-level laser (LLLT) with orthotics and a home exercise program 
  • The last group received only orthotics and a home exercise program 

Treatment Plans

  • The ECST group had to undergo shockwave treatment weekly for three weeks  
  • The LLLT group had to have treatment three times a week for ten sessions 
  • The last group did not have to go to a clinic for treatment 

The Results

The insoles that each group wore were non-custom and shock-absorbing. The exercises were heel cord (calf) stretching and plantar fascia stretching.

The participants were monitored in the three months following their treatments.

All three groups had a reduction in pain.

However, the LLLT group did the best in this study. LLLT and ECST have been recommended to increase cell activation and to stimulate healing. In this particular study, there was no additive effect of going to the clinic for ECST as opposed to simply wearing the orthotics and doing the exercises. However, the LLLT group did have an additive effect. That is, the LLLT therapy group had the most reduction in pain in this study.

The issues with both ECST and LLLT are that neither are covered by insurance and require multiple visits. Also, shock wave therapy is known to be painful. It is up to you to decide if such treatments are worth it for a modest improvement in pain control over conventional therapy, exercise, and insoles.

Cinar EE, Saxena S, Uygur F. Combination therapy versus exercise and orthotic support in the management of pain in plantar fasciitis: A randomized controlled trial. FAI. 2018; 39(4): 406-414

What is Ankle Arthritis?

The manifestation of ankle arthritis causes as much psychological and physical damage to the body as does the arthritis of the knee, hip, and back. In addition, we now know that ankle arthritis also causes as many functional limitations as does arthritis of the knee and hip.

However, ankle arthritis is only recently being recognized nationally as an actual pain source and entity worthy of treatment. Ankle arthritis has been considered secondary to hip and knee arthritis for a while.

Dr. Warner has been treating ankle arthritis for over a decade and is up to date on all cutting-edge treatments.

An unstable ankle due to ligament damage (sprains) that heal improperly can cause enough shear force to an ankle to produce arthritis. Also, a previous break/fracture will have abnormal motion if it is not repaired anatomically and that leads to abnormal forces on the cartilage; thus arthritis develops. It is very important that ankle fractures be corrected with exquisite attention to detail and anatomy.

The ankle is a small and perfectly shaped joint; it was not designed with the same amount of give and play that the knee and hip have. Therefore, fractures of the ankle have many more long-term consequences with regard to arthritic change.

Fractures that cause significant cartilage damage lead to ankle arthritis.

More often, fractures that heal poorly or heal in a poor position lead to arthritis. This is because even a 1mm shift in the ankle joint surface can dramatically increase the contact pressures inside the joint and cause chondral damage (arthritis). Again, this is not true for the hip and knee.

A mal-united fracture can be corrected to either prevent or treat arthritis. If you have an old fracture that has healed in a bad position, there are a number of treatment options available to correct that problem.


Causes of Ankle Arthritis

About 1% of the adult population has ankle arthritis. Of those, 80% are post-traumatic in nature. The ankle is different than most joints in that the arthritis is typically due to trauma. Most other joints, such as the hip, knee, and back have degeneration as the primary source of arthritis. The ankle breaks down and becomes arthritic after either a fracture (broken ankle) or due to sprains and ligament damage. For post-traumatic arthritis to occur, the actual bony plate that the cartilage sits upon must break as well as the cartilage itself.

Most cases of late ankle arthritis also have an alignment problem; that is, the ankle is in a varus or valgus position (tipped inward or outward). The mal-positioning of an ankle increases abnormal forces and also instability at times; this is associated with arthritis and pain. Any treatment plan should include a correction to normal alignment. If your treatment plan for ankle arthritis does not, ask your doctor if he or she has considered that.


Diagnosis Process

Pain is often associated with arthritis. However, some people with arthritis have no pain at all; it is not predictable who will have pain or who won’t. Many times other factors play into the perceived pain beyond the actual arthritis that is present. Ankle arthritis is no exception to the association of arthritis and pain; typically ankle arthritis hurts during activity (work, walking, running, etc.). Occasionally pain occurs with changes in the weather or after activity. Sometimes pain is spontaneous. There is a genetic predisposition to chronic pain related to arthritis. Cartilage itself has no nerve endings and arthritis in and of itself cannot be painful.

The pain that is associated with arthritis is typically due to associated damage to the bone that the cartilage sits upon, the synovial tissue or joint capsule and the ligaments around the ankle. In addition, the muscles of the leg can hurt, as can the nerves that surround the joint. The inflammatory fluids that are released due to the inflammation can sensitize nerves; this may contribute to pain as well. It is important that the actual source of pain be recognized prior to beginning or selecting any treatment method.

Just because there is the presence of arthritis on an X-ray and the pain is at that joint does not necessarily mean that there may not be another source of pain. Diagnosis of actual pain source should be mandatory prior to any surgical intervention.

Upper Back Pain: Your “Disc” Pain May Actually Not Need Surgery

Many people with chronic upper back pain eventually undergo unnecessary surgeries and un-indicated disability. This is because many patients’ chronic upper back pain is misdiagnosed as having a skeletal cause, when instead the patient is suffering from unrecognized myofascial trigger point syndrome (MPS). Although MPS is a leading cause of chronic pain and disability in this country, most providers who deal with pain are not taught about MPS. In part, this is because muscles generally receive little attention in modern medical schools as a source of pain.

A patient with MPS will present with non-specific, poorly localized, aching, regional pain in tissue that includes muscles and joints.

Myofascial pain is also associated with spot tenderness, pain that is referred in a characteristic pattern for that tender point (also called a “trigger point”), a local twitch response and a painful limitation of range of motion of the associated joint.

Muscular imbalances and postural deficiencies often cause these painful nodules; the nodules in turn, cause further pain and dysfunction. Overload can do this, as can poor posture. Trigger points may also be brought about by stress and emotional illnesses or constitutional problems. Trigger points may be identified by the electrical signals they produce, but ultrasound may also be used to see these.

Trigger points are characterized as either latent or active. Latent trigger points cause muscular dysfunction but do not actually hurt. Active trigger points hurt, and are painful for nearly everyone at some point in life. In the chronic pain population, trigger points are present 85-95% of the time.

Pain from active trigger points most often presents in those aged 31-50. At this point, most people are in the mature years of maximum activity. Later in life, latent trigger points and stiffness are more common.

Treating MPS is much more conservative, safe and effective than the treatment of the mistakenly diagnosed syndromes and conditions it mimics.

Treatment includes injections at the trigger points, massage, stretching, management of stress and tension and often a home self-treatment program. Patient education along with a home-treatment program is an excellent form of treatment also.

It‘s important to recognize a trigger point early on when a patient presents with upper back pain. If acute MPS is neglected or ignored, it may become chronic and then is complicated, more painful and time-consuming and expensive to treat reliably.