- Foot pain was found to be associated with lower knee or hip pain
- A physician needs to evaluate a patient for their foot pain, hip or knee pain, and address all the issues together
- Patients need to discuss all their orthopedic issues during their visit to the doctor for better treatment options
New guidelines for evaluating and treating lower extremity pain such as the knee and hip pain have been developed, reveals the research team at Hospital for Special Surgery (HSS) and Harvard Medical School.
The research team investigated to find if there is an association between foot pain and lower knee or hip pain and found they were significantly associated.
‘A complete orthopedic evaluation is required for better treatment strategies for the foot, hip or knee pain.’
The research team published their paper in the Journal of the American Podiatric Medical Association.
They said that their overall goal was to provide evidence-based guidance for practitioners to evaluate and give treatment options for their patients.
Evaluation for Knee or Hip Pain along with Foot Pain
In this study, the results showed that a physician has to evaluate a patient for their foot pain and should also ask about possible hip or knee pain, and vice versa, so the patient's issues can be addressed together.
Brian Halpern, MD, a sports medicine physician at HSS and study co-author said that in medicine it usually comes down to 'what does the MRI look like or what does the x-ray look like?' But it's essential to conduct a thorough medical history and physical exam of the patient.
A complete orthopedic evaluation can aid in better treatment strategies and can even refer to another specialist.
It is essential to study the association between the knee and the foot or the hip and the foot as it is a kinetic chain, revealed Rock G. Positano, DPM, MPH. He is the director of the Non-Surgical Foot and Ankle Service, Joe DiMaggio Sports Medicine Foot and Ankle Center at HSS.
The kinetic chain
can play a significant role in pain, as the body's joints and segments affect one another during movement.
Dr. Positano explains, "The foot is the first part of the body that makes contact with the ground. Its primary function is a shock absorber. If the shock-absorbing capability of the foot is somehow altered or minimized, it's going to affect other body parts."
Feet are the foundation of the body.
However, if the foundation is not strong can cause a detrimental effect on the joints, which are above the foot and ankle such as the knee and hip.
In the population-based study, the research team analyzed the information collected from a database of approximately 2,181 people who were part of the NIH-funded Framingham Foot Study between 2002 and 2008.
Howard Hillstrom, Ph.D., explained, "Access to this rich database was indispensable to test our hypothesis that there was a relationship between foot pain and hip or knee pain."
He is the director of the Motion Analysis Laboratory at HSS and also a co-investigator of the Framingham Foot Study. It would have been challenging to organize such an extensive study from scratch, said Hillstrom.
The participants in this study have completed a questionnaire evaluating their foot pain, pain location, and severity. They have also expressed if they have experienced pain, aching or stiffness in the knee or hip and have also specified the side pain.
In this study, about 16 percent of participants have reported bilateral foot pain, 6 percent of them reported only right foot pain and about 5 percent have said that there is only left foot pain, and more women than men were found to have reported foot pain.
Foot Pain Linked with Lower Knee or Hip Pain
The research team found that foot pain was linked with bilateral and same-side knee pain in men and women.
For example, men who had right foot pain were found to be five to seven times more likely to develop pain in their right knee or in both their knees when compared to those with no foot pain.
Foot pain was also found to be linked with hip pain on the same side in men. In women, bilateral foot pain was linked with hip pain on both sides, on the same side and even on the opposite side.
A theory which explains the results of this study looks at how the participant modifies his movements and postures when experiencing pain, which can lead to malalignment of the spine and other problems.
Physicians are challenged to develop a treatment strategy to address all the issues, reveals the research team.
The research team explains, "The correlated and compensatory posture and movement theory may explain how multi-joint arthritis develops, as well as other abnormalities and associated pains that can result from overuse or trauma to one or more structures in the kinetic chain."
The findings show that patients with lower extremity pain such as the knee or the hip pain should be clinically evaluated.
These results emphasized that health care providers
need to do a basic physical examination of the patient and their history remains relevant in identifying the pain and their related patterns.
Dr. Positano explains that it is up to patients to be proactive in discussing all their orthopedic issues during their visit to the doctor.
- Alyssa B. Dufour, Brian Halpern, Rock G. Positano, Howard J. Hillstrom, Marian T. Hannan. Foot Pain in Relation to Ipsilateral and Contralateral Lower-Extremity Pain in a Population-Based Study. Journal of the American Podiatric Medical Association (2017).DOI: 10.7547/15-182