HEALTH MATTERS: The dramatic increase in knee arthritis remains a bit of a mystery

• Dr. Joshua Wynne

Dr. Joshua Wynne

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Q. My wife has been having knee pain and needs a knee replacement. It seems like many of our friends are having similar problems. Is arthritis becoming more common?

A. A recent study has found exactly that — a dramatic increase in the frequency of symptomatic knee arthritis, along with an increase in the use of knee replacement surgery over the past several decades. Problematic knee pain due to degenerative arthritis affects about a quarter of adults and can lead to impaired mobility and function, in addition to pain.

Knee replacement surgery in appropriate candidates has been a fantastic development, and often restores mobility and eliminates pain.

However, what remains uncertain is why knee pain has increased so much over the past few decades (as much as twofold in women and threefold in men); the answer is not simply that the population is getting older or more obese, although these two factors are part of the answer.

Even more surprising is that X-ray evidence of knee arthritis has remained the same or even decreased over a 20-year span at the same time that knee pain and surgery has surged. Why this dichotomy has occurred — more pain but no increase in demonstrable arthritis on X-rays — remains unclear, but it does emphasize the importance of having a full and complete evaluation of knee pain before undergoing surgery to ensure that the cause of the pain really is arthritis, and not one of the many other conditions that can cause similar symptoms.

Q. I’ve been having pain on the bottom of my foot near the heel. The doctor said that I have plantar fasciitis. What is it, and what can I do to get rid of it?

A. Plantar fasciitis is a common problem of inflammation of the thick tissue that runs along the bottom of the foot from the heel forward; the tissue (“fascia”) helps form the arch of the foot. I too suffer from plantar fasciitis, so I (literally) feel your pain.

Plantar fasciitis can be associated with weight gain, problems with the arch of the foot (like flat feet), excessive jogging or running, and shoes that have poor arch support. In my case, it probably was due to the combination of too much jogging and gait problems associated with a herniated lumbar disc I suffered about a year ago.

Plantar fasciitis tends to occur in middle-aged men (like me) and can last for months at a time. It typically causes pain near the heel that is worst first thing in the morning or after prolonged sitting. It also increases with too much exercise. Treatment involves anti-inflammatory agents like ibuprofen, stretching exercises especially of the calf muscles, proper arch support with orthotics, avoidance of excessive exercise, night splints applied to the lower leg, and ice.

In some cases, injections of steroids or surgery may be required. In my case, conservative therapy is slowly working, but it’s been bothering me for about six months. Most patients tend to get better over time, but resolution may take nine months or more.

Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.

Submit a question to Health Matters at healthmatters@med.und.edu or Health Matters, 501 North Columbia Road, Stop 9037, Grand Forks, ND 58202-9037. Remember, no personal details, please.

The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.

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