Foot issue

[polly]

So last night I had the consult with the ortho to discuss the MRI results: osteoarthritis it is, and surgery is off the table. He prescribed 30 days of taking the anti-inflammatory Etodolac, 2x p/d 300mg, and advised me to get good insoles. Upon my asking, he stated that he didn't know if it was psoriatic arthritis or osteoarthritis and that it didn't matter for now. He also didn't show curiosity why this manifested in a otherwise healthy, slim person of 54 years of age (i.e. much yonger than the "normal" onset of this type of affliction, and was more like, yeah, tough luck, don't go play tennis anytime soon! Yeah, right!

We went to the ortho centre today for new insoles, but the lady said that the ones i got last time would not differ much from other ones, same material etc. I wasn't already impressed with those, and glad that we walked out because after watching the video Yupo posted above, it would seem logical for me to get a pair as described in the video: with good, solid arch support and all (thanks Yupo for posting it!). So, now i will get myself an appointment with a podiatrist here, who i read did her studies in the US (i am in Portugal), do a video gait analysis and see what she has to say about getting the correct insoles. I do think though that i would have to go to Holland to have them made there. The first ortho mentioned that the quality in Portugal is quite poor.

At the pharmacy, the helpful guy said that he advised taking each Etodolac pill with the stomach protector Aboco NeoBianacid, which is gluten free and plant based. I read some disturbing side effects relating to Etodolac (other name is Lodine), so I think it might be useful to take the Bianacid as well. There is some inflammation on top of the bone under toe 2, so I really hope it will go down with this drug. As per Laura's post here, i will start taking omega-3 and quercetin again to help counter the inflammation, as well as up the Vit C. If anyone has experience with or comments about Etodolac, I'd love to hear about it. Many thanks!


Thank you once again Yupo for your helpful post. What an ordeal you went through! I bet your foresightedness and action prevented many problems which would only manifest at a later stage in your life. I wanted to ask if by "at least a year of aggressive but more conservative care" you mean, amongst other things, taking NSAIDs like Etodolac (and stroner ones)?


I know! This forum is a true life saver in so many respects! I'm really happy you get so much out of it, and i hope the podiatrist can help you with your big toe issue, good luck to you!

EXCELLENT! How fabulous Laurs! The knowledge you need is freely coming your way from many sources!

 

[Yupo]

I'm actually not a big fan of NSAIDs, as they can cause so many problems with long term use. But they do relieve pain pretty well. To my mind it is better to address what is actually causing the pain and inflammation, and trying to eliminate that. FWIW, I don't see any evidence of Psoriatic arthritis on your films, and that is a very good thing since it can be quite debilitating.
There is something to be said for going easy on your joints, as they will last (in comfort) longer this way.
Podiatry (as a career) attracts a lot of runners and triathletes. Many of my more athletic colleagues (that I knew in school) are today nearly crippled with degenerative (wear and tear type) arthritis. Unlike many of my colleagues (run run run!), I'm more biased toward kindness to the body. And so, it is good to get a variety of opinions.
For example, I have a Morton's Neuroma in each foot. I've never injected myself for these, but certainly would if necessary. I opted to leave them alone when having my Left foot fixed. What works for me is slowing down and perhaps ditching any problematic shoes.
These things are always complex and multi-factoral, of course. Like I said, every case is a bit different, feet being as unique as faces.
Hope all that helps. I wish you the best.

 

[Beau]

There is something to be said for going easy on your joints, as they will last (in comfort) longer this way.
Podiatry (as a career) attracts a lot of runners and triathletes. Many of my more athletic colleagues (that I knew in school) are today nearly crippled with degenerative (wear and tear type) arthritis. Unlike many of my colleagues (run run run!), I'm more biased toward kindness to the body.

Agreed. I always say that recumbent bikes can get basically the same cardio as running, without the punishment that the joints, knees, and ankles take from running on concrete. I know there's a "runner's high" that many people experience, but to me it's not worth it. Just do leg exercises like leg press and you can get a similar mood boost.

 

[Laurs]

I'm actually not a big fan of NSAIDs, as they can cause so many problems with long term use. But they do relieve pain pretty well.

Thanks for saying this, i noticed i was not feeling comfortable with taking them yet and besides, the pain is very manageable, so i got them in stock, but will not use them just yet. Actually, ever since France posted her video's i've been practicing being kind to my body, especially my feet, and not taking health or strength for granted anymore nor being harsh and rigid with my body, like pushing beyond what it can take. That is a program running and will take a while to turn it around, but at least this whole adventure brought it to my awareness and i am grateful for that, so i can change my attitude. Thanks for your good wishes, Yupo!

I know there's a "runner's high" that many people experience, but to me it's not worth it.

I actually thoroughly dislike running, but have to say that when i went on my walks, I always maintained a fast pace though. I watched some videos this afternoon about what a good gait is, and one thing they had in common was stating that one should not be making too big strides. Now that I was doing for sure. For the rest there was much conflicting advice from various fysio's, heel down first says one, while the other says midfoot first etc, so will definitely do more research and get the appointment with the podiatrist. Thanks everyone, it's all been so very helpful!

 

[Yupo]

Agreed. I always say that recumbent bikes can get basically the same cardio as running, without the punishment that the joints, knees, and ankles take from running on concrete. I know there's a "runner's high" that many people experience, but to me it's not worth it. Just do leg exercises like leg press and you can get a similar mood boost.

I'm way more of a bookworm than any kind of an athlete. An unexpected benefit of this is that it takes very little strenuous activity to get my endorphins flowing. From Flylady's circle (over in Brevard) comes the truism "If it isn't fun, it won't get done." To that end, I tend to find my best moments of exertion doing stuff that happens to be fun and/or purposeful. I don't walk or ride a bike unless it's to actually get somewhere. I like best smooth movements, such as with ballroom dancing. The music keeps my muscles moving in joy while the shoe-wearing and dress-up opportunities delight my senses. Whatever works!

I also love to go marine sightseeing (swimming/SCUBA diving). I'm as happy with just a snorkel and some fins, as there is way less stuff to pack and maintain. Not sure why, but I find the most satisfying sleep sessions come after a day in water. It's a beautiful world down there.

Off topic:
For the domestically challenged, Flylady might offer some real hope.

FlyLady.net

flylady.net

 

[Laurs]

Here a little update regarding my foot situation.

So I eventually ended up in Holland, at a specialised orthotherapeutic centre where they did many scans and fitted me with insoles. The therapist had never seen osteoarthritis in that particular spot on the foot in her entire 30 year career, and advised me to go to a specialised center (also in Holland) with the insoles to buy specific shoes. So, I booked another trip to and fro, and this week I went over to buy those shoes. This center also did a video gait analysis, and the report concluded that my gait was more or less fine, and pointed to a specific shoe with a sturdy fore shoe, pointing a little bit up. They went out of their way to get me the shoes that are really right for me, and I walked out with two pairs of shoes. Now, it’s going slowly, listening to the body, and I started yesterday with a 25 minute walk. It’s still sensitive when walking but no pain-pain, and I’m more confident now with these insoles and shoes, aware of each step I take that I walk straight and distribute my weight evenly and such. These shoes really fit like a glove, and no pain in the night or today, so today I went for a 30 minute walk, same sensitivity, so I feel that is the limit for now.

From May onwards, I’ve been swimming for exercise, but developed a so called ’golf elbow’ (how ironic) early on. It’s mostly leg work with a noodle I do in the pool now. The water temp has gone down to around 15 C, and it feels really good to be in there for up to 20 minutes every day!

Also, because the swimming was not really a sufficient outlet for my energy, I bought a so called Air Bike, which on top of the foot pedals, has these paddles for the arms as well. Initially I thought of an elliptical, but when I tried it out in the local gym, I still had to do a walking movement with my forefoot, so no go. I understand this Air Bike machine comes from the cross fit world, and really, it’s a tough work out for 20 minutes daily! After that I go into the full spectrum infra red sauna 3 times a week.

In October @Alana advised me to get this special tissue and bone lotion from Dr Christopher, which is a synergistic combination of 12 whole food herbs. Alana said that rubbing it in on the spot will take the extra calcium in the bone and transport it where it is needed. It has been used to treat broken bones, sprained ankles, torn ligaments, scrapes, cuts and wounds, varicose veins, curvature of the spine, skin eruptions, pulled muscles, blood clots, and calcium spurs (which is what I have). I ordered it from iHerb and have used it ever since, also on my elbow. It's very soothing and i hope it helps over time (been using it for 1.5 months now). The bone in my foot has grown during the past months though, but that can be due to me having walked around the house in unfit shoes for 7 months.

Also, @Chu advised me to have my Vitamin D levels tested, as a low level can contribute to making things worse. I had it tested and came in at 60.90 ng/ml. I think that’s okay? I have been supplementing each evening with 5000 iu for about 3 months (with a krill oil capsule). I also put a teaspoon of curcumin in my dinner every night, and take borax orally as described in the Sott article: 1 teaspoon dissolved in 1 liter water, and of that stash I take 1 teaspoon twice a day with meals, I aim to go up to 3 times a day . And after my bike work out, sauna and shower, I put DMSO on the spot (70/30). A Midwestern Doctor has done extensive research on DMSO, I read some of the relevant articles, but have yet to print them out and delve into them properly.

On the mental/emotional/spiritual side, I have made an effort to be aware of musty’s and should’s in my thoughts and to be more out of my head and in the present instead, be more flexible and more going with the flow. The book A Guide to the Good Life: The Ancient Art of Stoic Joy, which we are presently reading in the reading workshop, is helping me with that, and to find joy in all the things I can do.

I do feel I’ve covered a lot of angles, I feel strong and healthy, but there’s always more one can do, so I keep researching and testing things out on myself. No doubt I'll have to live with the sensitivity and probably some pain at times in my foot, but can. I am already grateful for the walks I can do at present, but will be super grateful if I can get back to a daily 1 hour walk in my beautiful surroundings here, I sure missed that! Thanks for reading.

 

[loreta]

Wow, Laurs, what an adventure with your foot. Thank you for giving us all you did and do with your foot and also for all the information that I am sure can help us, those who have foot complications. And yes, joy is the basis of everything. Love, friendship, knowledge, life itself. With joy, anything is possible.

 

[Gaby]

I had it tested and came in at 60.90 ng/ml. I think that’s okay? I have been supplementing each evening with 5000 iu for about 3 months

I would actually aim for 100 ng/ml or higher and do 10000 IU per day for the winter.

 

[meadow_wind]

I would actually aim for 100 ng/ml or higher and do 10000 IU per day for the winter.

Hi Gaby, would this dosage of 10k IU apply to most people with a low score? I was tested in 2022-10 and the results were 64.7 nmol/L.
I usually supplement from October to mai, about 1000 to 3000 IU/ day (when I remember).
I also almost always forget to give it to both my children daily :(

 

[Gaby]

I usually supplement from October to mai, about 1000 to 3000 IU/ day (when I remember).
I also almost always forget to give it to both my children daily :(

Is not that bad, you tested right after the summer. You can take double the amount, 2000 to 6000. You should be safe if you take no more than 10000 for the winter.

 

[Mrs. Peel]

I had it tested and came in at 60.90 ng/ml. I think that’s okay?

I would actually aim for 100 ng/ml or higher and do 10000 IU per day for the winter.

Geeze, I had mine tested in July and was only 37.7 ng/mL and I'd been taking 5,000 IU every day, plus it was summer. I've since updated to 10,000 IU per day now. A year ago (July 2023) it was 43.3 ng/mL so its gone lower since then even though I take a supplement every day. The D3 doesn't have K2 in it so I take that separately.

 

[Gaby]

Geeze, I had mine tested in July and was only 37.7 ng/mL and I'd been taking 5,000 IU every day, plus it was summer. I've since updated to 10,000 IU per day now. A year ago (July 2023) it was 43.3 ng/mL so its gone lower since then even though I take a supplement every day. The D3 doesn't have K2 in it so I take that separately.

You might be a better candidate for calcifediol, but if you can't get it, yes, do 10000 of D3.

 

[Breo]

Thank you for the update Laurs. I was thinking, how its going. Your new shoes look comfy and beautiful and its impressive that you feel strong and healthy in times like these

 

[Laurs]

And the story continues. After just 1 week on the new shoes with the new insoles, gradually ‘walked in’ and the foot doing just fine, both my knees blew up and were very painful.

Now I have had trouble with both knees since my teenage years, and had the first arthroscopic surgery on the right one when I was 17. A big tear in the meniscus, but they thought it was best to let it sit. After recovery, I continued playing sports, with occasional swell ups and periods of rest for recovery. When I was 28 I had 2 surgeries on the left knee, and was drugged up in bed for 3 months as they thought I had a bacterial infection from the surgery. From then on no more sports, until I was 35 and took up golf. In 2008 (38 yo at the time) I had an MRI of the left knee as it had swollen up again, and they said there was loads of floating cartilage and oedema. Then it quietened down and for the next 17 years there were ups and downs but with rest it always quieted down and I could continue walking and playing golf, that is, until April last year when the foot issue commenced.

So, I thought I wanted a MRI of both knees and see what’s really going on in there. The report came back last evening, and it’s not good. If I understand correctly, I have osteoarthritis of the knees (gonarthrosis) and it’s pretty advanced (grade IV).

Here is the DeepL translation of the report’s interpretation and conclusion:

INTERPRETATION:
Discrete bilateral femorotibial osteophytosis, with external predominance, as well as left femorotibial osteophytosis.
Irregularity and extensive erosion of the chondral lining of the external facet of the left femoral trochlea, with exposure of the
subchondral bone, given the underlying medullary oedema of around 3cm in length. Deep chondral fissures coexist
scattered over the remaining articular surfaces of both knees, with bone involvement only in the external femorotibial compartments, where
compartments, where small foci of subchondral bone marrow oedema are visible.
Heterogeneity of the signal of the posterior horns of the internal menisci, compatible with mucoid degeneration, which on the
which on the left is associated with a slight irregularity of its free edge, suggesting the presence of a small flap-type lesion.
Complex rupture of both external menisci, which show partial extrusion of the bodies and are
multifissured along its entire length, with a long, well-defined transfixive horizontal fissure on the left and a small fissure on the right
and on the right a small incomplete horizontal fissure on the periphery of the anterior horn associated with a 5mm parameniscal cyst.
cyst of 5mm.
The ligaments, including the cruciate and collateral ligaments, as well as most of the muscles and tendons, appeared to be intact.
muscles and tendons.
Scarce joint effusion on the left associated with exuberant thickening of the synovium in the sub quadriceps recess,
in connection with synovitis.
Baker's cyst measuring 3cm on the right.
No other significant alterations.

INTERPRETATION:
Discrete bilateral femorotibial osteophytosis, with external predominance, as well as left femorotibial osteophytosis.
Irregularity and extensive erosion of the chondral lining of the external facet of the left femoral trochlea, with exposure of the
subchondral bone, given the underlying medullary oedema of around 3cm in length. Deep chondral fissures coexist
scattered over the remaining articular surfaces of both knees, with bone involvement only in the external femorotibial compartments, where
compartments, where small foci of subchondral bone marrow oedema are visible.
Heterogeneity of the signal of the posterior horns of the internal menisci, compatible with mucoid degeneration, which on the
which on the left is associated with a slight irregularity of its free edge, suggesting the presence of a small flap-type lesion.
Complex rupture of both external menisci, which show partial extrusion of the bodies and are
multifissured along its entire length, with a long, well-defined transfixive horizontal fissure on the left and a small fissure on the right
and on the right a small incomplete horizontal fissure on the periphery of the anterior horn associated with a 5mm parameniscal cyst.
cyst of 5mm.
The ligaments, including the cruciate and collateral ligaments, as well as most of the muscles and tendons, appeared to be intact.
muscles and tendons.
Scarce joint effusion on the left associated with exuberant thickening of the synovium in the sub quadriceps recess,
in connection with synovitis.
Baker's cyst measuring 3cm on the right.
No other significant alterations

Conclusion
Bilateral gonarthrosis, particularly affecting the external femorotibial and left femorotibial compartments,in which osteophytosis and chondropathy (grade IV - ICRS) are more significant, and also associated with bilateral complex external meniscopathy and probable chondropathy.
complex meniscopathy and probable in Bilateral gonarthrosis, particularly affecting the external femorotibial and left femorotibial compartments,in which osteophytosis and chondropathy are more pronounced (grade IV - ICRS), with associated bilateral complex external meniscopathy and probable meniscopathy in and probable incipient internal meniscopathy on the left, as well as subquadricipital synovitis also on the left.
also on the left. Small Baker's cyst on the right

Right now, I am researching what it all means, and in the meantime I have contacted 2 friends here who just had knee replacements to tell me all about their experiences. Coming Monday, I will see the doctor who ordered the MRI, and see what he thinks before finding and shortlisting a few orthopaedic surgeons, to find out what they think. So far, from what I’ve read it seems like the type of treatment is pretty individual and having knee replacements and such depend on quite a few factors. Perhaps some of you here may know something more about these types of afflictions and treatments?

Here are some practical things I’ve been doing: When my knees were totally blown up, I put on a ginger poultice as described by Barbara O’Neill, which helped REALLY well in reducing pain and swelling. Castor oil also seems to help. I completely cut out alcohol since 4th December and eat anti-inflammatory organic foods plus supplements. Up till yesterday, I did a daily 30 minute walk on flat terrain, but now I'm not sure if I should continue with that. A session of 20 minutes a day on the AirBike, which does wonders for the leg muscles to alleviate pressure on the knees, weight lifting and some yoga asana's, and basically keep a no-nonsense optimistic attitude. Last night the thought crossed my mind that this presents yet another opportunity to develop myself and find out about other aspects of life I previously hadn’t had to consider. All there is is lessons, right, and we are not our bodies. My husband is really fantastic and is 100% supportive à la “in sickness and in health” and I am super grateful for that!

To be honest, taking into consideration my troubled past regarding my knees, this diagnosis really doesn’t come as a surprise. I think it’s amazing that those knees continued to function so well for the 40 years since the first problems arose! And fortunately, so far the pain is bearable.
So yes, onwards and upwards, no expectations, no anticipation, just making sure I do my homework and gather as much information and knowledge as possible to make the best possible decisions. And hope.
Thanks for reading.

 

[Mrs. Peel]

I'm sorry to hear your knee problems have returned, although as you say, it's not surprising considering your history. I know several people who have had knee replacements with mixed results. Most of the not-so-positive experiences came from those who did not properly do the rehab exercises afterwards. Also, it seems like other with surgeries, they have come up with new techniques over time which give better results. You will want to ask around to find the best surgeon and facility for the surgery if you decide to. One friend with a bad knee told me her doctor said that she should wait a bit, she's in her early 60s and her doc told her the knee replacements only last so long (I forget how many years she told me) and she should wait as long as she could so as not to have another one years down the line.

Best of luck whatever you do!