Commentary by a toe doctor
YOSHIRO YUASA
Keiro Yuasa
Dr. Toe, Director of Toe Research Institute, President of Japanese Society of Functional Foot and Toe Therapy, and developer of Halmek shoes. Former director, vice president, and medical director of General Hospital. He specializes in exercise physiology and anatomy. He is also a foot and shoe specialist and a leading expert in postural occlusion therapy. He has cured various orthopedic diseases (over 70,000 people) with toe therapy alone.
It was proven in 2012 that cartilage wear and tear in the knee has nothing to do with pain.
Cartilage in joints has few nerves, and cartilage itself does not cause pain.
The cause of osteoarthritis of the knee is not entirely clear in general medicine.
Osteoarthritis of the knee usually does not require surgery or regenerative medicine.
Some people weigh over 100 pounds and do not have osteoarthritis of the knee.
Osteoarthritis does not cause knee pain.
・Osteoarthritis of the knee can be caused by a variety of factors, including the type of shoes and how they are worn, the type of socks, foot structure, overuse, and the type of walking surface.
About 25 million people suffer from osteoarthritis of the knee, about 8 million of them are living with pain and suppressing it with medication, and about 100,000 people a year undergo artificial knee joint replacement surgery as the condition progresses.
summary
All human joints undergo cycles of damage and repair throughout life, but sometimes the ability to repair joints becomes impaired, resulting in changes in the shape and structure of the joints. When these changes occur in one or more joints, it is known as osteoarthritis.
A joint is an area where two or more bones are tightly connected, in the case of the knee, the femur and shin bone. In front of the knee there is also a smaller bone called the patella or kneecap. The ends of our bones are covered with a smooth, slippery surface known as cartilage (cartilage). This allows the bones to move against each other without friction and protects the joint from stress.
The knee has two other rings made of another type of cartilage, known as the meniscus or meniscus, which helps distribute weight evenly throughout the knee joint. There is also cartilage under the patella.
Osteoarthritis of the knee causes the cartilage in the knee joint to thin and the surface of the joint to become rougher, so the knee does not move smoothly, causing pain and stiffnessIt is considered to be the most common form of osteoarthritis. Osteoarthritis can affect anyone at any age, but is more common in women over age 50.
Treatment of osteoarthritis of the knee usually begins with conservative methods, and when conservative treatment is ineffective, the patient proceeds to surgical treatment options. Medications can help slow the progression of RA (rheumatoid arthritis) and other inflammatory conditions, but there are no drugs that have proven effective in treating knee osteoarthritis (although there is temporary symptomatic relief).
symptoms
Pain is the most common symptom of osteoarthritis of the knee. Moving the knee or even sitting still may cause knee pain. Other symptoms include
・Knees feel stiff, especially when first standing up or sitting for long periods of time.
Stiff and swollen joints, difficulty in bending and stretching the knee
...Crackling or cracking sound when moving the knee.
Weakness in the knee or bending of the knee
Feels as if the knees are locked or trapped
. Increased joint pain with weather changes
Many people feel that they have a bad knee joint because their symptoms appear around the knee joint, but in fact, the above symptoms are not caused by cartilage wear and tear due to osteoarthritis of the knee joint. There are few nerves in the cartilage within the joint, and cartilage does not cause pain. The abrasion of cartilage causes inflammation of the surrounding tissues (joint capsule, synovium, ligaments, muscles, fascia, etc.), which in turn causes pain.
More than 90% of knee pain complaints are caused by a mixture of sacroiliac joint dysfunction and inflammation of the muscles around the knee due to toe deformity. However, improving knee osteoarthritis (O-leg) can help improve sacroiliac joint dysfunction, so please refer to this page.
Causes and pathogenesis
arisorrhea
The most common cause of osteoarthritis of the knee is aging. Nearly everyone will eventually develop some degree of osteoarthritis. And several factors are also thought to increase the risk of developing significant arthritis at an early age.
Obesity (7 times more likely to develop)
I have a job or play a sport that puts a lot of stress on my knees.
Abnormal alignment of joints (e.g., eversion/inversion of foot)
Knee injury or old knee injury
Family History
Metabolic disorders (e.g., rickets)
But here is something for you to think about. Why do some people have osteoarthritis of the knee and others do not, even with the factors commonly attributed to it as described above? Medical science says that in many cases, the cartilage on the inside of the knee wears away because people tend to have O-legs. So if cartilage wear and tear is related to O-legs, what are the causes of O-legs? As I mentioned earlier,Toe deformities (hallux valgus, big toe, big toe, crooked toe, floating toe) are largely related.
Osteoarthritis of the knee = thinning of cartilage in the knee joint
O-legs = knees are spread apart (cartilage is not worn away)
*The cause is the same in both cases.
In addition, inadequate arch support orWearing shoes with hard soles and inadequate heel support (shallow or soft heel counter)In some cases, the foot may fall outward, causing knee deformity and placing a heavy load on the knee cartilage, which can lead to osteoarthritis of the knee.
mechanism
In fact, osteoarthritis and knee pain are caused by "toe deformities". Look at the illustration above. You can see that as osteoarthritis of the knee becomes more severe, the lower leg bone (the bone below the knee) collapses outward. As the lower leg bone collapses outward, the femur also collapses outward, and the cartilage in the medial part of the knee continues to be subjected to high stress, making it difficult for the cartilage repair function to work, resulting in a change in the shape and structure of the knee joint. Conversely,If the stress on the medial portion of the knee can be removed, the cartilage repair function can be activated, and some people have regenerated cartilage in their kneesThe first is the
So what causes the lower leg bone to collapse? There are two causes. One is a deformity of the heel bone called "ectropion" and the other is a deformity of the foot itself called "clubfoot.
Ectropion is a condition in which the foot muscles lose strength and are unable to hold the bones of the foot together in their original shape, causing the heel bone to fall inward and the lower leg bone to fall outward for balance. Since foot muscle weakness is caused by toe deformity, it is necessary to restore the deformity and function of the toes in order to straighten the heel bone.
A club foot is caused by dysfunction of the little toe or a toe deformity called hallux valgus. The little toe acts as a "stopper" to prevent the foot from falling outward, so when the little toe is not used, the foot falls outward during the step back of walking. In this case, the lower leg bone also falls outward with it, so the deformity and function of the little toe must be restored in order to straighten the lower leg bone.
(1) Little toe dysfunction → foot collapses outward → lower leg bone collapses outward → knee joint deforms
(2) Deformation of the little toe → foot collapses outward → lower leg bone collapses outward → knee joint deforms
(iii) Deformity of toes → weakness of foot muscles → calcaneus collapses inward → lower leg bone collapses outward → knee joint deforms.
As for (3), it is caused by toe deformities such as floating or flexed toes. In any case, it can be said that the fundamental solution to O-feet cannot be achieved without curing the toe deformity.
Be especially careful if you wear the following types of shoes, as they increase the risk of your foot falling outward when you walk.
Wearing slippers, sandals, or slippers indoors.
...and wearing shoes with loose laces.
Shoes with soft soles and heel supports (heel counters)
Shoes with too much cushioning
Wide width shoes
Shoes with uneven insoles
Wear socks made of slippery materials (cotton or silk)
Causes of toe deformity
Unfortunately, most modern people have deformed toes due to the wrong choice of shoes and the way they wear them, and the foundation has collapsed. When the foot slips back and forth in shoes, the toes try to stop the slippage, resulting in hammertoes or floating toes. Socks and slippers can also cause toes to bend.
The bones of the foot are supported by many muscles to form a straight shape, but most of the muscles are attached to the toes. Therefore, if the toes are not used functionally when walking, the foot muscles lose strength, resulting in hallux valgus, club foot, and osteoarthritis of the knee.
In regular tubular socks (tube socks), which are worn by most people around the world, 4g~9gf/㎠ of force is applied to the toes, causing pressure on the toes. Also, many cotton and silk socks have a silken finish, which makes the feet slip easily in shoes and socks. Socks that slip easily and put pressure on the toes can cause toe dysfunction, leading to bent or floating toes. Conversely, fugly tube socks cause the feet to slide around in the socks, leading to clasped or floating toes.
In other words, to make osteoarthritis of the knee better, it is not surgery or regenerative medicine. Although rehabilitation, massage, myofascial release, etc. performed in hospitals can temporarily relieve knee pain,Unless you treat the "toe," it means nothing.You will find that
Examination and Diagnosis
In the case of O-legs, radiographs show subchondral bone sclerosis, which is hardening of the bone beneath the cartilage, narrowing of the joint gap, and osteophytes, which are thorns in the bone.
In addition to X-rays (radiographs), MRI, joint fluid tests, and blood tests may be performed as needed.
Progression of osteoarthritis of the knee
The diagnostic criteria used for osteoarthritis of the knee is the Kellgren-Lawrence (KL) classification based on radiographic imaging, which evaluates the severity of the disease in five grades based on osteophyte formation, narrowing of the joint gap, and subchondral bone sclerosis. Osteoarthritis of the knee (O-leg) is generally diagnosed when grade II or higher is reached.
Knee pain tends to occur over a wide area, mainly in the medial joint fissure and the popliteal fossa, and the more severe the KL classification, the more pain tends to occur, but the ROAD (Research on Osteoarthritis Against Disability) Study showed that the pain prevalence in the KL classification 3 or higher group was approximately 401 TP3T in men and 601 TP3T in women. The ROAD (Research on Osteoarthritis Against Disability) Study showed that the pain prevalence rate in the KL classification 3 or higher group was approximately 401 TP3T in men and 601 TP3T in women, indicating that higher severity does not necessarily mean more pain.
medical treatment
Treatment is mainly divided into "conservative therapy" and "surgical therapy. Regardless of the degree of progression of the disease, conservative therapy is the first step. However, if the pain does not decrease with conservative therapy and the disease interferes with daily life, surgical treatment may be considered.
Conservative therapy is based on "lifestyle guidance" and a combination of "diet," "exercise," "physical therapy," "medication," and "orthotic therapy.
In both cases, the primary goal is to relieve pain, not to cure it, so although there is a temporary effect in relieving pain, it keeps recurring.To resolve the deformity itself, osteoarthritis of the knee, and to prevent it from recurring, foot stretching through self-care is recommended. In conjunction with this, it is also important to choose the right shoes and the right socks to prevent the feet from slipping in the shoes.
self-care
More than 90% of osteoarthritis of the knee progresses with age, regardless of conservative and regenerative therapies. I myself started researching the toe in 2006 after my wife's knee osteoarthritis improved. Osteoarthritis of the knee has a root cause called "little toe," and it is something that can be sufficiently improved by self-care if the muscles of the feet are strengthened.Foot stretching is one of the best treatments for osteoarthritis of the knee.
Hironoba Exercise, a toe stretching exercise to improve knee osteoarthritis
Try doing this once a day for 5 minutes; if you do not see any change in your symptoms after 2-3 days, we recommend increasing the number of times to 2-3 times a day. The goal is to be able to do the toe par for 30 seconds.
Corrective five-finger socks for optimal support of knee osteoarthritis
We have produced functional 5-finger socks made of cotton and silk and tried them on many patients in clinical settings, but we were unable to solve the problem of feet slipping in shoes and socks. Therefore, we spent two years working with a textile company to perfect the ideal fiber, and the corrective 5-toed socks "YOSHIRO SOCKS" were born.
prevention
By making small changes in daily life, such as toe stretching and wearing corrective five-toed socks (YOSHIRO SOCKS), the knee joint can be protected and the progression of arthritis slowed down.
Walk with a small gait.
∙ Activities that involve the use of toes, such as walking up hills and stairs
. Avoid wearing footwear indoors.
Try to walk at least 6,000 steps a day.
Make sure the laces are tight.
...Avoid using ordered pillows and mats.
Choose the right shoes.
Use a shoehorn to put on your shoes.
With osteoarthritis, exercise is recommended to improve pain and function. Toe stretching and wearing corrective five-toed socks (YOSHIRO SOCKS) will allow you to be active without thinking about reducing stress on your knees. Combining balance, agility, and coordination exercises with traditional toe exercises can help improve function and walking speed.
physical therapy
Rehabilitation in hospitals and clinics can delay deformity and reduce pain, though,He concludes that the only treatment for osteoarthritis of the knee is surgical therapy, which cannot cure bone deformities....... I recommend that you quit going to the hospital and use that time for toe stretching and small leg walking.
auxiliary equipment
The use of a cane or other equipment, orthotics or knee sleeves can assist with stability and function, although they are helpful when arthritis is concentrated on one side of the knee,Prolonged use weakens the muscles and ligaments around the knee joint....... It is also not recommended to put custom insoles in shoes to reduce knee deformity.
How to choose the right shoes
The most common cause of toe deformity is the choice of shoes and how they are worn.Many foot and back and other problems are caused by not using the toes properly. Choosing the right shoes is important to keep the toes moving while wearing shoes.
How to choose the right socks
Pure cotton and silk materials are slippery
There is a silken finish (or mercerization process). Silkette treatment is a process that gives silk-like luster to yarns, and involves soaking yarns in a caustic soda (sodium hydroxide) solution and stretching them like hand-pulled udon noodles to straighten the cross section of the yarns. It is overwhelmingly used mainly for cotton and silk fibers (cotton).
The cross-section of the cotton is aligned, coloration is improved, and fluff is suppressed when processed, giving it a luxurious appearance. It is smooth and slippery to wear, but as the words "smooth" and "slippery" suggest, it is easy for the feet to slip inside shoes and socks. In other words, it is a material that can easily cause deformation of the toes.
Of course, there are cotton and silk materials that are not silken, so choosing such materials is also an important factor in preventing osteoarthritis of the knee.
Five-toed socks allow toes to function.
Common socks are also called tube socks, and most people around the world have this type of socks. It is a shape that has been used for many years, but the tube type makes it difficult to use the toes properly. For this reason, socks with five separate toes are better, but there are many different types of this type.
The most important thing is to make sure it fits your own feet just right.The socks should be worn with a soft, comfortable, and comfortable footwear. If the fingertips or instep area is loose, even a good 5-finger sock will "slip". On the other hand, 5-finger socks that fit too tightly and feel oppressive are not recommended, as they can impede blood circulation. It is important to find 5-toed socks that feel "comfortable" when you try them on.
There are more and more socks with corrective power, but when I tried them, I found that many of them press down more strongly than I expected. Particularly in the area of the arch of the foot.Supporting the arch is important, but arch structure is a property that can lose its function if it is lifted too stronglySo, be sure to choose an arch that is also not too oppressive.
When you take it off, you say, "Ha, that feels good!" then the pressure is too strong.This is the case.
story of one's experience
One woman diagnosed with osteoarthritis of the knee came to us for a consultation.
He has had knee pain for about two years and has been unable to sit upright and has trouble going up and down stairs. The back of his knee is swollen and painful, and he can't figure out why after going to an orthopedic surgeon to have it checked out.
Maybe it's because you're fat." I was also told.
Obesity does not cause knee pain. If that were the case, all Americans would suffer from knee pain. But they don't. Maybe the hospital you visited was wrong, but there is always a "cause" for knee pain. In any case, the knee was staying still and remaining painful for the rest of my life.
He has been draining water from his knee weekly and has had hyaluronic acid injected into his knee. Since knee pain is a "result," the first priority is to find the "cause" of it. The "cause" is almost always the shoes.
The "toes" are simply deformed by the choice of shoes and the way they are worn, causing an imbalance in the body. Looking at the toes, they were causing a deformity called "hallux valgus. Since the toes are not able to par, the foot tends to fall outward.
Therefore, we started using "HIRONOBA EXERCISE" and "YOSHIRO SOCKS" to help them use their toes.
Then two weeks later...
He is now able to sit upright normally. The patient could not believe it. He has been walking very well and has returned to work in the fields. Human recovery is unlimited. Why don't you try stretching your toes without giving up?
According to a survey of the general population, about 40% of women and 20% of men over the age of 60 have knee deformities; in people in their 80s, more than 60% of women and nearly 50% of men have knee deformities. However, only about 20% of them have subjective symptoms such as pain. In other words, there are many people who do not suffer from pain even if they have deformity.
Finally.
It may be that you just happened to have knee pain and took an x-ray and found that the cartilage was worn away, and that is what was diagnosed as the cause of your pain. However, without comparing the pain to an x-ray taken before the knee pain, it is impossible to know if the pain is really caused by worn out cartilage in the knee. If the pain is caused by worn out and deformed cartilage, then the pain will not get better unless it is cured, and that can only be done by surgery. However, when we focus on the toes at the Toe Institute, most of our patients are pain-free even though the cartilage in the knee is still worn away.
References
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