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Friday, December 14, 2007

Ankle and foot pain - arthritic talonavicular joint

"I suffer from what has been described as loss of cartilage or wear of the talonavicular joint in my right foot.

This seriously impairs my enjoyment of walking, tramping, golf and other pursuits.

I am seventy years of age and take Voltarin from time to time, when I can tolerate some, but take one tablet of Panadol (500 mg) every four hours to ease the discomfort.

I am also consulting a podiatrist and have been fitted with appropriate orthotic insoles.

I also take 1,500 mg of glucosamine and chondroitin powder every day in a glass of water.

Have you any advice?


Gary Moller replies:
John, I appreciate that you are in a difficult position with your ankle pain and, to a degree, age is not on your side. However; there are several things you can do that might help alleviate the pain while enabling you to continue to enjoy activities like walking and golf.

The talonavicualr joint allows the foot to articulate to allow adduction (toe-in) and abduction (toe-out) movements of the ankle as are needed during the heel strike phase of walking/running for shock absorbing.

While mild arthritic changes may be reversed, anything more tends to be progressive and the treatment goal becomes long term management more than seeking cure.

Pain medication
While nobody has ever died from a sore ankle, many have become seriously ill and some die from the long term effects of taking pain killers of the kind you are taking. Common they might be; but this does not belie the seriousness of the possible side effects which are numerous, ranging from digestive upset to liver disease. Digestive upset may appear to be minor; but can lead to serious malnutrition and diseases of the digestive tract. Sub-clinical malnutrition is widespread among the elderly. So, a primary goal with any interventions is to reduce your need for pain medication.

Get alkaline
Ill health, including arthritis and inflamed, tender tissues tend to be closely associated with an acidic body, principally by leaching essential minerals like calcium and magnesium from your body. A healthy person has a PH of about 7.4 which is slightly alkaline and definitely not acidic. The first step is to measure your saliva PH. If your body is less than 7.0 PH then you need to take measures to alkalise your body. These center mostly about reducing acidic foods from your diet and increasing alkaline foods. You can get a PH testing kit off my website (

Manipulate and massage the feet

Find a strong massage therapist or podiatrist who can spend an hour twice a week massaging the feet and lower legs. This should include gapping the joints of the foot and ankle and repetitively moving the joints back and forth in gliding, twisting and rolling movements. You need a therapist with strong hands for this. While there may be some pain, it should not be excessive and within pain tolerances. Joints thrive on movement. Gapping and moving arthritic joints encourages the flow of nutritious synovial fluid within the joints and stretching excessively taut ligaments and any scar may relieve some of the constant pressure on the joint surfaces.

Walking barefoot on the beach and in the shallows is wonderful foot exercise; but go carefully and progressively so as not to overdo it any time.

Keep the legs warm
As we age, circulation to the feet declines, as can be seen in the deteriorating state of our toenails which become thickened and gnarly like an old bush that is starved of nutrients. Warm blood flows better, so keep the legs warm. Exercise such as hydrotherapy in a warm spa pool is wonderful for circulation, as is a soak in a warm Epsom Salts bath.

Improve circulation and nutrients through diet
Fish oil, flax oil, olive oil, evening primrose oil, vitamin E and vitamin C are nutrients that are beneficial for the joints, circulation and for health in general. These may also assist with pain management, with healing and with maintaining good health in general. As we get older our requirements for vitamins, minerals and proteins increases, so everything that enters the mouth should be chosen for it delicious nutritious qualities. Sugar, cake and cookies are reserved for rare special occasions and should be eliminated from the daily diet.

Natural pain management
In addition to fish oil, vitamin C and other nutrients, it could be well worthwhile taking quite large daily doses of MSM (methylsulfonylmethane). This is a safe anti-inflammatory that occurs naturally in the body. MSM is essential for healthy collagen, including joint cartilage.

Continue with the glucosamine and chondroitin; but take much more and spread it through the day. Continue for three months and see if there is any relief.

A long hot Epsom Salts bath, with a glass of wine and your favourite music in the background is both relaxing and beneficial for circulation and healing.

Bad pain - Good pain
While exercise and movement are important for the management of joint arthritis, avoid activities that make the condition worse by causing more wear. A general rule of thumb is to avoid activities that cause the pain to get worse as the activity progresses, or which makes the pain worse long after you stop. Activities that may be painful initially; but which diminishes as activity continues, can be assumed to be beneficial. Of course, one would cease the activity if the pain were to increase later as the activity continues.

Be creative - modify your lifestyle
As much as I detest them, you might use a golf cart when playing golf. Rather than hike, get a good bike and ride safe trails and routes. Get a kayak and paddle about interesting places. If you are not highly skilled, or are a bit rusty, hire a professional instructor to give you some lessons before you take to a bike or canoe. Do not fall off or drown.

Mix it all up
Ride a little, walk a little, paddle the bay, aqua jog, swim, golf a little and get those massages and Epsom Salts baths in. Your body loves variety! Give it plenty and in doing so, you avoid repetitive stress on your joints.

Experiment with footwear
There are numerous styles of walking and hiking shoes available nowadays. You might find that one of the modern lightweight hiking shoes or boots will give your foot the support it needs during the day and when doing more vigorous activities like golf. Shop around and try all styles. You may be surprised and delighted at the dramatic benefits of finding the right footwear for you. All of your shoes should have Formthotics moulded innersoles fitted, if not your custom orthotics. Try using a pair of Nordic Walking poles for stability and to reduce the load on the legs just that little bit and always travel light. Get another person to carry the back pack for you.

The surgical option
If you are unable to get sufficient pain relief from conservative measures to be able to cut down on the Panadol and Voltarin, then you should probably consult an orthopaedic surgeon. The surgeon may recommend a procedure like fusing the joint. Bearing in mind that all surgery carries risk, this is an option that may still be worth considering and the outcome should enable you to continue most activities, if not a little truncated.

Note: all of the products recommended in this article are available from

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