Walking with knee and foot pain

I have been working on losing weight so have been doing very brisk walks almost everyday averaging between 3.5 - 4.5 miles. Initially I had some toe pain and received some great suggestions from you guys. I am now using voltarin gel on my toes and got a great pair of Merrill walking shoes. Toe pain was better for a bit but is getting worse again and now my knee on the same side is getting painful. I tried voltarin gel on my knee as well. About 1/2 way through the walk I start to feel the ache and by 3/4 of the way I am limping. I walk in the evening and in the morning my knee is still throbbing. Usually it has settled down by the afternoon.

So far i’m down 13lbs and really don’t want to give up the walking. My doctor wants me to lose weight and do the walking.

Does anyone have any suggestions on what might help?

Don't have any suggestions but wanted to say congrats on the 13lbs. Good job and I hope you find a way to keep it up

Thank you! I’m only two weeks in and still have a lot to lose!

I cut about 1300 calories a day by cutting out all the milk I was drinking with my meds. Dr has me on a stomach med now. I know I can lose weight without the walking but I can lose it faster with the walking and get in better shape to boot! I may just have to push through it and hope it doesn’t get worse. I’m going to switch to swimming once the weather gets bad so hopefully I’ll make it to then!! =)


autumnmat said:

Don’t have any suggestions but wanted to say congrats on the 13lbs. Good job and I hope you find a way to keep it up

I don’t have any answers either but I do know how you feel. I lived walking. We have a 2 mile walking bridge over a lake by our house and I loved walking it! Walking was my exercise. It’s good your doc said you can continue. My doc said no more walking, and I am sad. I miss it so much. Hope you find a way to keep going, and congrats on the weight loss!

Roni said:

Thank you! I’m only two weeks in and still have a lot to lose!
I cut about 1300 calories a day by cutting out all the milk I was drinking with my meds. Dr has me on a stomach med now. I know I can lose weight without the walking but I can lose it faster with the walking and get in better shape to boot! I may just have to push through it and hope it doesn’t get worse. I’m going to switch to swimming once the weather gets bad so hopefully I’ll make it to then!! =)


autumnmat said:

Don’t have any suggestions but wanted to say congrats on the 13lbs. Good job and I hope you find a way to keep it up

You could go walking with canes. You don't need to use them the whole time, and can in fact strengthen your arms a bit by using the canes like hand weights in the beginning. When you start to feel the pain, you can use the canes for a little support (and build your arm muscles a bit!).

Try biking i you can, it will make your knees feel better, not worse.

Thanks for the suggestions! I’ve tried a recumbent bike and a regular exercise bike but the pedaling motion makes my hips and sacroilliac joints really sore (much worse than my knees and toes from walking!). My last walk I only did 40 minutes and my knee and toes didn’t hurt too bad. Maybe an hour is just too much. I’m also doing two nights in a row followed by a night off…I may have found a routine that will work.
Thanks so much!

Good luck to you Roni, I admire your determination as well as your willingness to be flexible. What medications have you tried ffor beating the PsA?

Just NSAIDs… I was dx about 15 years ago. It’s gotten worse over the years…speed to more joints. The worst are hips, sacroiliac and spine. The problem is my new family doctor won’t really take it seriously until I drop some weight. I was underweight when I was diagnosed and my previous family doctor (who I went to my whole life) wasn’t concerned about the weight too much. I am not flaring to bad at the moment so am trying to get some weight off so during the next nasty one i don’t hear “you need to lose some weight”. As everyone knows exercising during a nasty flare is darn near impossible!! If i have lost the weight perhaps he’ll be more willing to address the issue!

You can't go to a specialist without your family doctor referring you? If that's the case I would find a new family doctor like tomorrow. Over time the PsA can do permanent damage to your joints. The medicines now are extremely effective. Even MTX, the old standby can work. The biologics can be amazing.

Don't let this disease cripple you. Either make an appointment yourself to a rheumy, or find a family doctor who will. You're doctor sounds like sh*t to pardon the expression. You have a very serious condition for which there is very effective treatment. You're doctor is keeping you from that treatment. It's wrong and it's unethical. Roni go and get yourself treated by a doctor who isn't a quack.

And when they finally schedule you an appointment for a month out or whatever, call the rhuemy yourself and keep asking until they fit you in that week. You've suffered long enough.. 15 years. Honestly your doctor should be sued, or shot. I am getting so mad typing this.

Go to psoriasis.org and call them. They can help you work through the medical process.

Unfortunately in Canada you have to go through your family doctor for a referral. I tend to think the same thing…he’s not very good with chronic illness. When he first met me he decided I didn’t need pain meds so refuses to prescribe them. I was dx by two rhuemys originally. I didn’t care for the first one so got a second opinion. I haven’t been back since although I have been to a rehab doctor when the sacroillitis and spondylitis reared it’s ugly head. This new guy didn’t even bat an eye when my ESR was through the roof and I was running low grade fevers for over a month. His solution is always that losing weight will help. So I figure if I lose weight he can’t keep ignoring the issue. It’s the only solution I can figure out.

Andrew said:

You can’t go to a specialist without your family doctor referring you? If that’s the case I would find a new family doctor like tomorrow. Over time the PsA can do permanent damage to your joints. The medicines now are extremely effective. Even MTX, the old standby can work. The biologics can be amazing.

Don’t let this disease cripple you. Either make an appointment yourself to a rheumy, or find a family doctor who will. You’re doctor sounds like sh*t to pardon the expression. You have a very serious condition for which there is very effective treatment. You’re doctor is keeping you from that treatment. It’s wrong and it’s unethical. Roni go and get yourself treated by a doctor who isn’t a quack.

And when they finally schedule you an appointment for a month out or whatever, call the rhuemy yourself and keep asking until they fit you in that week. You’ve suffered long enough… 15 years. Honestly your doctor should be sued, or shot. I am getting so mad typing this.

Go to psoriasis.org and call them. They can help you work through the medical process.

Changing to a new family doctor is not possible at this time. No one is taking new patients and there is a waiting list. At least with this one he still prescribes my Arthrotec. I take Tylenol #1 by the handful when I absolutely need a pain med. It’s available over the counter. I watch to make sure I don’t exceed the daily dosage but take 5-6 at a time once in a 24 hour period just to get a few hours of relief. I also find a heating pad really helps with the sacroillitis.

hmmm what about making very frequent appointments because you're in awful pain? The squeeky wheel gets the grease! You have to escalate the problem in his mind.

Well I did pull a little sneaky move! He sent me for blood work a few weeks ago. Gave me one of those forms where you circle the tests you want done. I added a circle for the lupus test…I’m positive which I already knew but I think protocall for a positive result is a rheumy referral. I know it’s dishonest… But I was just feeling so awful at the time that I didn’t care. I go tomorrow to get the results so I’m keeping my fingers crossed.

Andrew said:

hmmm what about making very frequent appointments because you’re in awful pain? The squeeky wheel gets the grease! You have to escalate the problem in his mind.

I don't think you will be able to do much more than you are doing now. The shoes and gell have helped me also but the underlying cause of the pain is there still. I have found that losing weight is great for helping the feet, ankles and knees and knowing this helps me to continue walking despite the pain. Although I find the level of pain fluctuates, if my medication is working the level does not get so bad that I can't tolerate it. Everything about this disease seems to be about finding a balance of drugs, exercise, diet, having a clear mind picture of what you are doing and why and an acceptance that some days exercise may not be possible but it might be ok tomorrow. I also ride a bike which gives me the exercise without the stress on the feet. but of course my back and hands aren't so keen on it. So some days I walk, some days I ride, some days I swim, some days I do nothing depending on what's best that day.

Congratulations on losing weight. I think the determination you are showing is one of the most important things you can do in dealing with this.

I have never had much of an issue with my knees or toes until I started walking. I think I have my toes figured out though. Seems to start acting up when I’m going uphill so I think maybe they don’t have as much range of motion as they should. I’ve been paying closer attention and adjusted my stride a bit when going uphill and that really seems to help. The knee is a new issue that I may just have to deal with! I’m enjoying the walks with my hubby…it’s some nice downtime away from everyone who wants me to do something. I’m going to keep it up as long as I can and then switch to a pool membership. =)

Allan said:

I don’t think you will be able to do much more than you are doing now. The shoes and gell have helped me also but the underlying cause of the pain is there still. I have found that losing weight is great for helping the feet, ankles and knees and knowing this helps me to continue walking despite the pain. Although I find the level of pain fluctuates, if my medication is working the level does not get so bad that I can’t tolerate it. Everything about this disease seems to be about finding a balance of drugs, exercise, diet, having a clear mind picture of what you are doing and why and an acceptance that some days exercise may not be possible but it might be ok tomorrow. I also ride a bike which gives me the exercise without the stress on the feet. but of course my back and hands aren’t so keen on it. So some days I walk, some days I ride, some days I swim, some days I do nothing depending on what’s best that day.

Congratulations on losing weight. I think the determination you are showing is one of the most important things you can do in dealing with this.

As you are probably aware t PsA causes inflammation in the tendons and I have found the pain near the knee is linked right through to the toes. I massage the tendons and muscles starting at the knees and working down to the toes. Even though I was only aware of certain areas being painful , the massage shows all the tendons and muscles are sore, tight and knotted. As I relax the tendons and muscles in the leg the tightness and pain in the feet starts to diminish. If you look at a diagram of the tendons of the foot and legs it makes sense. I also spend a lot of time gently stretching the legs and feet and while this is very painful as I do it, it certainly relaxes and reduces the pain and makes walking easier. I always stretch before walking and have found this helps a lot. Having enough hours in the day to do it all is the problem!
Roni said:

I have never had much of an issue with my knees or toes until I started walking. I think I have my toes figured out though. Seems to start acting up when I'm going uphill so I think maybe they don't have as much range of motion as they should. I've been paying closer attention and adjusted my stride a bit when going uphill and that really seems to help. The knee is a new issue that I may just have to deal with! I'm enjoying the walks with my hubby...it's some nice downtime away from everyone who wants me to do something. I'm going to keep it up as long as I can and then switch to a pool membership. =)

Allan said:

I don't think you will be able to do much more than you are doing now. The shoes and gell have helped me also but the underlying cause of the pain is there still. I have found that losing weight is great for helping the feet, ankles and knees and knowing this helps me to continue walking despite the pain. Although I find the level of pain fluctuates, if my medication is working the level does not get so bad that I can't tolerate it. Everything about this disease seems to be about finding a balance of drugs, exercise, diet, having a clear mind picture of what you are doing and why and an acceptance that some days exercise may not be possible but it might be ok tomorrow. I also ride a bike which gives me the exercise without the stress on the feet. but of course my back and hands aren't so keen on it. So some days I walk, some days I ride, some days I swim, some days I do nothing depending on what's best that day.

Congratulations on losing weight. I think the determination you are showing is one of the most important things you can do in dealing with this.

Can you get him to prescribe Methotrexate? it's dirt cheap and it works.

Allan - I think from the feel of it that it is a tendon/joint combo. The knee itself will get painful when walking. When the pain in the joint lessens there is still a tender spot It’s toward the inside, just below the knee cap. Even when the knee isn’t aching if you press on that spot it feels like a bad bruise. I’m not really sure how i’de stretch that out!

Andrew - He used to be an emergency room doctor but took over the practice when my doctor passed away. I don’t think he knows how to deal with a chronic illness. He isn’t the type to entertain any ideas I have either. This is why I’ve reverted to dropping the weight. I know it’s healthier and all of that good stuff about why I should. Luckily I lose weight fairly easily since food addiction isn’t my problem. I’ve stopped drinking tons of milk (stomach meds instead) and my hubby and I started walking. The nest time I flare badly and he mentions weight I want to be able to say “I’ve lost x amount and it isn’t helping”. Then hopefully he’ll take it seriously.

Hi Roni

When I first started to get knee ankle foot soreness I had no idea I had PsA, nor did the doc! I had similar soreness to that that you describe around your knee. I now know it was caused by the tendon being inflamed and, because I had no treatment, I lost one knee joint within a period of 18 months and the other within a 12 month period. Although I now have artificial knees I get the same pain when the tendons become inflamed and tight.

I agree with Andrew that if you have PsA and are getting these sorts of problems you need proper treatment and medication from a doctor who understands PsA. Many don't. Change yours if he doesn't. Ask the next one if he/she understands PsA or is willing to learn. If not try again. Don't risk losing your knees.