Upon inspection we noted that she walked with a significant limp. Her right leg also appeared longer than the left, causing her right hip to be higher. Her right foot had also lost much of its arch while the left remained normal. Her lower back range of motion was normal, but her right knee was moderately limited in flexion and could not fully straighten out. Joint restriction and dysfunction was noted in her right sacroiliac joint and lower lumbar spine. Both were tender with palpation. Bending or compressive forces applied to the knee provoked her pain. Her lower extremity muscles and reflexes were normal, and there were no other significant medical findings. X-rays were taken of her lower back, which revealed mild to moderate disc degeneration of the lower lumbar spine. The x-rays and MRI of her knee showed moderately advanced joint degeneration.
Looking at the patient from many angles, we determined that her issues were complex. Having an anatomically longer leg on the right side placed more pressure on that side from the ground up. This had caused a flattening of the arch in the right foot. The loss of the arch led to a medial rotation of the lower leg, accelerating wear and tear in that knee. The rotation and abnormal length of that right leg also affected the pelvis and lower back, which over time created a significant pattern of dysfunction.
We explained a comprehensive plan of care for her condition. This included Supartz injections to lubricate and cushion her right knee, joint manipulation to the lumbar spine, pelvis, and lower extremity, orthotics for arch support, a heel lift to even out her leg lengths and therapeutic exercises for improved mobility and stabilization. The patient made significant progress and was able to return to activities with little pain.
Her personal goal was to put off the knee replacement surgery until she was at least 70.