Osteoarthritis: Joint Degeneration


Osteoarthritis is a degenerative irreversible condition whose presence, most automatically assume is a sign of getting old, but as the use of diagnostic tools and clinical observations become more precise in acknowledging osteoarthritis it appears we are seeing it in younger and younger persons. The reason for this may be due to a number of reasons, which tends to be thrown around every now and then, from; vitamin D deficiency, malnutrition, harder playing surface, increase training volume and increased BMI placing strain upon the joints. In this article we look at the evidence about osteoarthritis in the athletic population.

Osteoarthritis is a degenerative joint disease which develops due to the interactions associated with genetics, mechanical forces, both cellular and biomechanical processes and foremost joint integrity. The cause of osteoarthritis is secondary to overuse of the joints cartilage which ends in pathological joint changes.
The acts of dribbling, sprinting, landing, jumping, passing, sliding and opponent physicality expose soccer players to increased, intense and prolonged demands upon the body. Additionally, based within the general population things such as joint integrity, mechanical force, cellular and biomechanical processes as well as genetics all play a role in the development of osteoarthritis.
Osteoarthritis can be split into two categories;
Primary OA: an idiopathic phenomenon

Secondary OA: A joint disease resulting from a clear predisposing factor, as mentioned above.

Osteoarthritis of the ankle joint is estimated to be found in 1-4% of the general population and knee osteoarthritis is found in over 10% of those over the age of 55. Additionally, osteoarthritis is believed to be a secondary factor to 15% of musculoskeletal consults.

Breaking down the joints of the lower limb and the frequency they are seen to have osteoarthritic changes are as follows:
Hindfoot – Uncommon
Mid-Foot – Common (post-traumatic)
Forefoot – Frequent
1st MTPJ – 35-65% of adults over the age of 65

Mid-foot osteoarthritis is believed to be a primary instigator of hallux limitus and hallux rigidus by causing a compression of the dorsal aspect of the MTPJ during propulsion in people with excessively wide 1st metatarsals, phalanx or the presence of long sesamoids. This can also be exacerbated by previous footwear uses such as high heels which place increased pressures through both the mid and forefoot.

Diagnosis of osteoarthritis includes a physical examination, X-Ray results and anamnesis combined will produce a number of the following signs and symptoms; abnormal skin and soft tissues, presence of tender areas, synovitis and effusion. Instability of the joint, joint impingement and restricted range of motion as well as muscle weakness and possibility of a limb length discrepancy.
The plain radiograph grading system for osteoarthritis is reported as showing the following;
Grade 0: Normal
Grade 1: Doubtful narrowing of joint space
Grade 2: Definite osteophytes and possible narrowing of the joint space
Grade 3: Multiple moderately sized osteophytes with definite narrowing of the joint space, some sclerotic areas and possible bone deformity.
Grade 4: Marked narrowing of the joint space with severe sclerosis and definite deformation of the bone contour.

Treatment, as with most musculoskeletal conditions should be based on the stage of that particular condition however, in a nutshell, the following options should be explored.
Short term use of NSAIDs have been shown to give moderate relief of symptoms, however, due to the high impact of the bodily organs should not be considered a long term option. For long term symptomatic relief the use of glucosamine and chondroitin are safe and potentially effective aids. The modification of footwear choices or to the footwear itself has been found to be fruitful, with rocker-bottom soles and polypropylene orthotics the commonly suggested modalities. Additionally, regular self-administered or assisted joint mobilization can be used in adjunct to specific exercises to increase muscle strength, activation and neuromuscular function for support of the joint. It is suggested that a healthy lifestyle be worked towards to help weight control and therefore a life coach, dietitian or nutritionist is suggest for referral.
If conservative measures fail then the use of corticosteroids should be considered before the use of surgical intervention.

The medial knee is the number one lower limb area of osteoarthritis with research supporting the use of lateral wedging of the rear to forefoot in the treatment with the interest of reducing varus torque. Medial wedging has been shown to increase the varus torque at the lower leg and more specifically the knee creating a less mobile and everted foot type which encourages knee varus malalignment.
Those with medial knee osteoarthritis have been found to have deficits in afferent and efferent neural pathways demonstrated in proprioception, muscle strength and muscle force control. The neuromuscular systems ability to sense and execute demands is potentially impacted by the presence of pain, neural deficits and damage to joint structures. There is an increase in popularity for the use of exercise based programs and consults to limit the deficits placed on the surrounding structures.

Hip osteoarthritis is the second most common lower limb site of osteoarthritis. It is encouraged that those who are able too with OA of the hip complete 30min of moderate intensity exercise at least five times a week to promote cardio health in addition to a couple of strength session activities as well.

Osteoarthritis is a condition which can be treated in a highly beneficial way if done so by a multi-disciplinary team. Most people live with OA thinking it is just part of getting old. Many practitioners shy away from or undertreat those who have OA due to the treatment only slowing down the progress of the condition as opposed to the quick fix many people are looking to receive. To get the most out of treatment for OA a number of practitioners should be involved, including podiatry, physiotherapy, exercise physiologists, dietitians and if the patient request other modalities can be explored like chiro or Chinese medicine.

I hope you have enjoyed reading!

Jackson McCosker
Director /Chief Editor

References

Drexler, M., Segal, G., Lahad, A., Haim, A., Rath, U., Mor, A., . . . Elbaz, A. (2013). A Non-Invasive Foot Worn Biomechanical Device for Patients with Hip Osteoarthritis. Surgery Current Research, 1-5.

Franz, J. R., Dicharry, J., O’Riley, P., Jackson, K., Wilder, R. P., & Kerrigan, D. C. (2008). The Influence of Arch Support on Knee Torques Relevant to Knee Osteoarthritis. Applied Sciences Biodynamics, 913-917.

Gouttebarge, V., & Frings-Dresen, M. H. (2014). Ankle Osteoarthritis in Former Elite Football Players: What Do We Know. Amsterdam: The Foot in Football, Sports and Traumatology.

Iagnocco, A., Rizzo, C., Gattamelatta, A., Vavala, C., Ceccarelli, F., Cravotto, E., & Valesini, G. (2013). Osteoarthritis of the Foot: A Review of the Current State of Knowledge. Dipartimento Medicina Internae, 35-40.

Kumar, D., Swanik, C., Reisman, D. S., & Rudolph, K. S. (2014). Individuals with Medial Knee Osteoarthritis Show Neuromuscular adaption when Perturbed During Walking Despite Functional and Structual Impairments. Journal of Applied Sciences and Physiology, 13-23.

Levinger, P., Menz, H. B., Morrow, A. D., Feller, J. A., Bartlett, J. R., & Bergman, N. R. (2012). Foot Kinematics in People with Medial COmpartment Knee Osteoarthritis. Rheumatology, 1-8.

Rotating Your Tyres: Why it’s Important to Have Multiple Pairs of Shoes


At the beginning of the year we slightly touched on the different types of shoes available on the market. These fell into the categories of; Minimalistic, Traditional and Maximalist, and while these three broad categories tend to cover the spectrum of running shoes, that which was not touched on was sport specific shoes and the benefits/ negatives associated with these options. Basketball shoes, netball shoes, tennis shoes and skate shoes all flood the market with celebrity endorsements and product placement convincing you it’s the right option for you, but is it?
Let’s have a look at the generic types of shoe available via popular sport and weigh up the points.

Basketball Shoes
When it comes to basketball shoes there is no bigger celebrity based spruiker of merchandise. Everybody wants to be like Mike, rule like King James or have kicks like Kobe. The celebrity endorsement of this type of footwear has been so successful that the technologies placed into these types of shoes have been at a standstill for quite some time. Many people believe that because they see the people they admire, the stars of the game wearing these shoes that it is the best footwear to play in for them. Others are still debating on whether high tops or low cuts give better support to the ankle.
Well in regards to the ankle support argument, the evidence currently suggests that the placing external support at the ankle in regards to high top footwear has no significant affect on the ankle joint itself.
Additionally, it can be theorized that high top support can sometimes restrict ankle joint movement and has potential to lead to injury further up the chain at the knee or hip as momentum is search for at proximal structures.
What we don’t have the privilege to see in many of the elite basketball sporting stars of the world is what they place inside their shoes and what shoes they wear during training sessions when the camera are on them. In many cases the low profile, small/minimum heel drop athletic shoes of basketballers have been modified with custom made orthotics designed to off-load areas of the foot or reduce biomechanical issues which may contribute to injury during game play.

Netball Shoes
When it comes to netball shoes the market seems to consolidated by ASICS and for good reason. The ASICS Netburner range has a number of well developed shoes of varying support to suit people of all requirements. That being said, this does not mean that the Netburner shoe is necessarily the correct shoe for you. Finding a good netball shoe requires knowledge of how you run as well as the movements associated with netball. In many cases a running shoe of any kind will most likely fall apart reasonable quickly when playing a sport like netball due to the high amount of cutting and pivoting moments which place strain on a product primarily made for linear direction movement patterns. A cross-training shoe or a specific made shoe with a wrapped outer-sole which protects the shoe’s upper from being damaged by dragging movements is the best option; additionally a shoe which is well cushion and provides some structured support is also a positive. As stated in the previous paragraph, ankle joint bracing or external support is of little use in games of high impact such as netball and basketball.

Tennis Shoes
Tennis shoes or shoes for most racquet sports require a broad base and increased lateral stability to enhance athlete foot position when cutting or sliding for a far reach shot. K-Swiss seem to be the go to shoe for a lot of athletes looking for a tennis specific shoe. Additionally, similar to that of a netball shoe, having an outer sole which wraps around the base of the shoe to limit friction upon the shoe’s upper and the mesh or soft leather tearing.

Racing Flats
When running competitively many athletes will chose to run in a shoe which is low bulk and low weight in comparison to their traditional training shoe. The benefits of this are decreased weight and better surface change awareness. The negatives include; poor cushioning for the foot, less stability and increased risk of injury. That being said, if a reasonable strength and conditioning injury prevention program has been complete then these risks are substantially limited and may lead to faster competitive times and increased oxygen utilization. See: https://footnotesblogging.com/2014/09/25/90/

As you can see, there are a lot of positive and negative factors associated with popular sports specific based shoes. Those which are touted by the celebrity personas are commonly aesthetically pleasing and confidence boosting as companies try and tell you “you can be like Mike”. The truth is many of these high profile athletes also have very detailed injury prevention programs to reduce their chance of musculoskeletal breakdown as well as some type of inner-sole or orthotic to support them while they play their chosen sport. The shoe they chose to enter the court/ground/pitch with may not be that which they train in and may be kept strictly for the 40mins of game play and not the 10 hours a week of training they participate in.
So there is a little food for thought on the matter of sport specific shoes, I’ll let you make up your mind on that which you believe to be the best option.

Until next time, thank you for reading.

Jackson McCosker
Director /Chief Editor