From the Guidelines
Management for degenerative changes in the right knee and foot should begin with conservative approaches, prioritizing weight management, physical therapy, and supportive footwear, as recommended by the most recent and highest quality study 1.
Key Recommendations
- Weight management to reduce joint stress
- Physical therapy focusing on strengthening exercises for the quadriceps, hamstrings, and intrinsic foot muscles
- Supportive footwear with cushioning and arch support
- Custom orthotics to correct biomechanical issues
- Knee braces or foot supports for stability and pain reduction
Pain Relief Options
- Acetaminophen (up to 3000mg daily in divided doses) or NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (250-500mg twice daily) for short courses
- Topical NSAIDs like diclofenac gel 1% applied to affected areas four times daily for localized relief
Additional Considerations
- Intra-articular corticosteroid injections (such as methylprednisolone 40-80mg or triamcinolone 20-40mg) for temporary relief of moderate to severe pain
- Education on self-management techniques, including activity modifications and lifestyle changes, as suggested by 1 and 1
Prioritization of Treatment
The treatment plan should be individualized according to the patient's wishes, expectations, and specific needs, taking into account the localization of OA, risk factors, and level of pain and disability, as recommended by 1.
From the Research
Recommended Management
The patient's condition involves degenerative changes in the right knee and right foot, which can be managed conservatively. The following steps can be taken:
- Initial treatment can follow the "RICE" principle, which is common and recommended for initial treatment for most sports injuries, as stated in 2.
- Brief immobilization can help reduce the re-injury rate and accelerate the formation of granulation tissue, as mentioned in 2.
- Exercise therapy, including stretching and strengthening, can provide long-term pain relief, as discussed in 3 and 4.
- Physiotherapeutic interventions, such as lower limb physical therapy programme, can be effective in managing patellofemoral pain, as shown in 5 and 4.
- The use of a knee brace with a limited range of motion, stretching, and neuromuscular exercises can be beneficial, as recommended in 5.
- Foot orthoses and acupuncture may also be considered, as supported by evidence in 4.
Additional Considerations
- Patient education and activity modification are essential for effective management, as emphasized in 4.
- A multimodal intervention programme, including gluteal and quadriceps strengthening, patellar taping, and an emphasis on education and activity modification, can be prescribed for patients with patellofemoral pain, as outlined in 4.
- The treatment approach should be individually tailored to address the patient's specific needs and condition, as highlighted in 4.