We are not focusing on the foundational functional foot type that is genetically marked for each subject.

Once sub-grouped, treatment can be instituted foot type specific that would reduced abnormal moments, deformity and degeneration (OA) in the knee, hip and lower back.

Dennis

Thanks for reply sir...

Thats means foot type is only reason for devlopment of OA...?

Is there any rational for that. ...?

Plz share if you have any ..?

Dear Hermal,

Articular cartilage covers the bone heads in knee joint and in all the joints. Collagen, Type II (Col-II) is the major collagen of articular cartilage along with very small amounts of some other collagens like collagen VI. COL-II is synthesized by chondrocytes which are the only cells present in articular cartilage. Though half life of Col-II is more than 100 years in human. Theoreitically, articular cartilage should be good to go for more than the life of a human and there should not be osteoarthritis. But practically, the wear and tear of articular cartilage starts much early specially during late age. Reasons are multiple, some are intrinsic known and unknown, others are injury, overwork, side effects of medicines, genetics, collateral damage due to other diseases, food, exposure of uninvited chemicals in food (pesticides, preservatives), contraceptives and sluggish life style and mainly obesity.

Once Col-II is degraded. Articular cartilage layer gets degraded, in joints, bone hits bone in every joints during action and pain starts in joints. In reality, there is not any treatment to repair joint cartilage. Only there are some treatments to reduce pain temporarily. Companies are making big money to inject materials in knee joints, but in my opinion, they are very short-term relief and in the long run, a person is stuck with long-term pain unless decide to to get joint replacement in knees or hip. That is personal decision because of cost and risks of being successful also based on surgeon and body weight of person and other diseases.

Now-a-days, researchers are trying their experiments so that they can inject stem cells in knee and repair cartilage. Theoretically, it is assumed that stem cells while inside the joint capsule, will differentiate into chondrocytes and those, in turn, will make COL-II that will contribute to repair articular cartilage and hence reduce osteoarthritis. Still it is in experimental phase.

On the other hand, I made articular cartilage in a dish from human stem cells and placed in damaged cartilage of rat knee of athymic rat (which does not reject human cartilage). THE CARTILAGE MADE IN DISH WAS able to partially integrate into rat joint cartilage. This is a first step towards repairing damaged cartilage. Hopefully this kind of work will be applied to human knee in next 10-15 years safely. And there is hope for OA reduction and OA repair in future.

Hope that helps,

A poster of my work is enclosed, enjoy

Hermal:

Dr Juneja lists some of the many multimodal underpinnings for OA in the knees that make researching OA frustrating.

I concur with all of them, on a case to case basis.

My comment relates to some of his list where foundational stability, support, strength, symmetry and balance are weak or structurally or functionally incompetent:

Genetics

Overuse

Body Weight

Biomechanics

I am a podiatry trained biomedical engineer of the lower extremity focused on the crippling constants of gravity, grf and shoes in a civilized society at the level of the foot that can be repaired/dampened/restored in either a collapsed foot type R-R, R-F, S-S and F-F) or a rigid foot type (R-R) using The Foot Centering Theory of Structure and Function.

Practically, ones functional foot type is tagged to genetic markers and can be diagnosed clinically early on in life.

Most commonly, one is born with a foot type that predictably will collapse in specific segments of the foot that can then be structurally repaired non-operatively using props such as foot centering strappings and pads and restorative foot centering devices that reduce the knee from receiving pathological biomechanical moments (mostly medially) while reducing the SERM-PERM Interval.

Wolff's and Davis's Laws become more favorable and bone on bone mashing reduces.

Furthermore, future seeding and adaptation of soft tissue is more salutogenetic and in the case of Subhash's work new cartilage would be developed more optimally in closed chain, biomechanically.

This all can be accomplished before, during or after injury or disability.

Dennis

Dr. Shavelson,

Foot type genetics is important towards OA. Now my question is Foot shape differs among population like Greek, Egypt, German, Roman etc. Is there any genetic differences in different races in developing OA.

You are doing good work. Like if someone is limping, he or she is likely to develop OA fast than normal person. Here plays role of biomechanics. Obesity is an important player.

Best wishes,

Subhash

i think both glucosamine and collagen II are currently the best approach to repair the bone cartiliage

Dr Juneja:

I have no contact with large numbers of various populations but I would suggest that cultural and population differences like race, native land, etc., are epigenetic.

I practice in NYC, a race and cultural melting pot. The functional foot typing system, clinically, works excellently as a starting place for diagnosing and treating predictable, underpinning biomechanical pathology.

For instance, I can predict where the primary plantar ulceration will occur in a non-ulcerated diabetic.

Disclaimer: I am the US Patent holder for functional foot typing that has kept my evidence based science from being diluted and bastardized. In opposition, I have some level of profit motive bias.

Dennis

PS: perhaps we should think tank?

Thanks, Dr. Shavelson,

That is great to hear from you in more details. Sr. Hani Awad is in Rochester NY in Bioengineering, may be you like to collaborate with him. He would be interested. I worked with Hani before.

On the similar lines, high heels in women must be a contributory factor ftowards OA as compared to women who wear simply sports shoes.

Best regards,

Subhash

There is a multi-factorial issue.

1. Social

2. Dietary

3. Experience of health workers

4. Availability of services

Analysing all this

1. Women started to be seen and looked after s equals, so they have the ability to attend the clinics and so being diagnosed

2. The diet is more nutritious and so the people are increasing their BMI and so the load they apply through their joints

3. Health workers are more knowledgeable and better equipped so they are able to make diagnosis and treat the patients

4. There is a greater number of hospitals and clinics available for these patients

All this and possibly more than that can be the reason of seeing more cases of OA of any joint and so much more of the knee as conditions of the hips or the feet and ankles can influence their function.

Technology is something the can help in the treatment and secondary to the prevention in limited cases, as we are not in position to know exactly the real cause of the condition

Dr Zafiropoulos:

I hope my blunt reply here is not taken personally as I do not know you at all.

When keyboarding " we are not in position to know exactly the real cause of the condition" I sense you are coming from the biased perspective of an orthopedic surgeon that I, as a board certified foot and ankle surgeon in NYC, eliminated by slowing down and then stopping the surgical portion of my practice decades ago.

In fact, the exact, real, underpinning primary etiologies of most lower extremity structural and functional pathology are genetic, foot type specific, biomechanical pathomechanics in one or more segments of our two feet as they defend us as closed chain organisms as our first line defense against the negative effects of gravity, hard-unyielding ground and shoe gear in a civilized society from birth to death.

Deep down in your roots lives an inclination to avoid this conclusion as it would reduce the increasing numbers of knee scopings and replacements, the number of hip replacements and the number of L-4/L-5 spinal fusions that are being performed by your brethren in the OR.

Foot Centering Theory of structure and Function interventions have the ability by improving the stability, support, strength, symmetry and balance of the foot and posture (the four "SSSS" and a B of lower extremity biomechanics) before, during or after diagnosing and treating the chief complaints they have fostered.

Dennis

Dr Juneja:

The correlation of stilettos and knee OA is well established in the peer reviewed literature.

The problem here is that the manufacturers of stilettos and the women who must/choose to use them incorporate pain and disability as a given to their use. A healthy stiletto shoe is an oxymoron in the marketplace.

I explain to stiletto users that I cannot set a goal to "fix or restore" a foot optimally in stilettos but I can make them more comfortable and reduce the OA and injury risk. I can only fix and restore feet in gym shoes, comfort shoes and most dress shoes that should be included in the modern shoe wardrobe.

Dennis

Thank you all for your valuable reply and comments.

This all are the reasons for development of knee OA and now we all know that. Still prevalence is going high for knee OA.

As we all know that there are multiple reasons for development of knee OA still we dont have enough research that prove that this are the variables which affect the knee OA.

I think there are enough research done on effectiveness of treatment and correlation of variables. Now we have to find out the real cause and reasons for increasing Prevalence of knee OA.

Over loading on one leg is one of the most important factor to develop Early knee OA. and that we can measure by the Foot Plantar pressure distribution OR Weight Distribution through Legs.

Foot is one of the important part of our body and any changes in foot bio mechanics will altered the kinematics chain of body. Once our kinematics chain is altered than over loading on one side is started and that will increase degeneration of cartilage and joints.

So Foot bio mechanics or Plantar weight distribution is important parameters to see the progression of knee OA.

Hermal:

To my points, your two articles conclude the following:

1, "A growing body of evidence suggests that first-line therapies for early knee osteoarthritis should emphasize unloading the knee joint since any potential therapeutic benefit of regenerative therapies will likely be attenuated by excessive mechanical demand at the knee joint (underpinned by abnormal foot function)

2. "A first-line therapy for the patient with early knee OA should focus on chronically unloading the knee joint before any attempts are made at tissue regeneration or repair"

3. "In conclusion, nonsurgical attempts to alter the course of early OA will likely be futile unless the aberrant biomechanical environment at the knee is first addressed. Arguably, the concerted research effort to identify novel knee OA treatments should be redirected towards modifying chronic joint overload instead of addressing focal targets such as chondral defects.

4. Finally, when stating "There is ample evidence that anterior cruciate ligament (ACL) rupture and meniscal tear are two major risk factors for developing EOA", the authors reflect a tunnel vision mindset that lacks the closed chain understanding of functional lower extremity biomechanics that when the foot is weighted on the ground in upright stance or function, any lack of shock absorbancy (too rigid) or any structural collapse (too flexible) of the pedal segment of the posture are the primary, foundational risk factors and any "knee related" risk factors are compensatory (secondary at best) and futile to conceive of as primary.

My point is that, in theory, Functional Foot Typing, when used as the starting platform to develop cohorts for research and clinical care of the knee from birth to death exponentially improves the level (Sackett), validity and applicability of the findings.

Dennis (Dr Sha)

Hello Hemal, If I´m not mistaking, your first lines are a quote. Can it be that you´ve misread the piece? It doesn´t say that over the last years the prevalence of Knee OA ist higher, it says that older age correlates with Osteoarthritis. If there is a rise in Knee osteoarthritis I would suspect obesity, which is becoming a more world wide problem.

It think the subject of OA is related mostly to life style (physical activity during early life and food intake quality (fast food). in the last 50 years we have seen more people live sedentary life, sitting for long time, and eat processed food

I believe these two factors are having more tendency for cartilage damage

Hello all,

Kindly read this research project for risk factors.

There were lots of risk factors is affected to knee OA. And that's the reasons prevalence of knee getting high.

According to your risk factors for knee OA proven by existing peer reviewed research in your paper, I should be explaining to my patients that they should:

· Stop aging

· Stop being female

· Stop being obese

· Stop performing work that involves kneeling, squatting or lifting

· Stop performing high intensity exercises such as running over long periods

· Avoid mineralizing their bones too much

How much money, time and debate did it take to arrive at these conclusions?

I suggest that Sackett’s methodology when used to research knee OA is at the top of the error of your ways.

Your suggestion that “Generally speaking, researchers focus their studies on a very specific risk factor” is the pearl inside the shell of your paper. In future studies, it might be worthwhile for them to examine the impact of the interaction of two or more risk factors. A Stochastic Model of research that utilizes a multimodal treatment plan whose components are symbiotic and safe may produce better, more valid and more applicable clinical outcomes.

Theoretically, any methodology that improves overall foot and postural stability, support, strength, symmetry and balance should reduce the existence, progression and life-altering of knee OA (think foot typing).

The knee joint is akin to the transmission of a car in that it has little functional importance of stabilizing or moving the machine as a whole. It simply translates the motions and moments generated from the hips downward and the foot upwards in order to have a more efficient, more productive, less injured biomachine. While it is important for every car to have a well oiled and functional transmission, it is the ability of a car to resist degeneration, deformity and performance issues by dampening and buffering forces generated by the engine and the ability of the tires and chassis to absorb the impact shock of the road and degenerative forces of gravity, friction, etc.

You conclude that “In the future, it could also be useful to do systematic reviews of the effectiveness of care approaches that combine various treatment modalities”. Biomechanically, I have been doing that successfully for decades in real time. Perhaps with your insightful addition to the literature, more of us will consider your suggestions.

I remain available to assist any or all open minded researchers and clinicians in meeting this challenge.

Good fortune to all our knees.

Osteoarthritis is the one of the most prevalent health concern amongst the population. Various health conditions have been researched over many years, with many showing dramatic symptomatic improvement, better survival rates, better treatment options, and prognosis. However, two main conditions that still continue to not have made marked progress are dementia and osteoarthritis.

Osteoarthritis is a multifactorial issue. Some of the most common etiologies; modifiable or non-modifiable, are:

1. Age

2. Female

3. Genetics (family history of osteoarthritis)

4. Trauma/ Injury

5. Joint Laxity/ Joint Hypermobility

6. Obesity

7. Lifestyle (physically demanding work for many years or high intense exercising for long periods of time)

Unfortunately, the success rates of growing our own cartilage have not been spectacular. Stem-cell studies are available, however, cost is exponential.

What should a person do? Stop living? Live in a bubble? No. Best way to slow it down is, as we tell our osteoarthritis patients, "everything in moderation". We cannot change the non-modifiable factors but we sure can manage the modifiable ones. Good healthy, well-balanced diet, control the diabetes mellitus, exercise daily for 30 minutes; low to intermediate intensity, weight loss, core-strengthening/ muscle toning exercises and good posture.

To prevent OA there should be good amount of nutrition to the joint as it is a degenerative condition. This can be achieved by

• improving the circulation - regular exercise, massage and heat therapy, leech therapy
• regular body purification
• Bone and muscle strengthening food like sesame, ghee