OK, anyone fancy making a diagnosis as I am not getting very far with the NHS sadly.

Last year I had the same problem with my knee that I mention below.
By accident I discovered if I wore walking sandles (fairly firm sole, lots of available foot movement) it caused me no knee problems, so last summer was issue free. This autumn it all reacurred again as soon as I moved back most of the time to winter footwear. I do quite a lot of walking on flat hardish surfaces, often 20-30 miles per week. I wear down the outside heel of my shoes quite fast and turn my foot in slightly as I walk. I asked for gait assessment from the health service but only got a cursory visual check. I have problems crossing the leg as it seems to pull on a muscle in my hip too much.

What happens:
Wearing trainers/softer soled winter shoes I start to get slightly odd sensations in my knee. Would not describe it as pain, only as some kind of grumbling/feeling wrong.

A couple of months or so back I was walking along on a very slight downward sloping pavement when out of the blue I got a searing but very very brief pain horizontally all through the middle of my joint. Think flash of lightening.

Immediately my knee destabilises – the inside feels loose a bit like the bones are sliding about a bit in an semi uncontrolled way. Standing on my knee is not painful in any way after the initial flash but feels kind of disgusting as it feels all wrong. I can only take tiny steps forward. Going down even moderately downhill slopes is unpleasant. Going uphill seems fine. It takes me half an hour to walk back to my car, a walk that normally takes 8 minutes. My knee has started clicking lots by the time I am part way back to the car.

The next day I am getting a sore spot on the inside of my knee at the joint but not in it. There is mild aching but not pain in the back of my knee. Very occasionally the whole area around the knee joint aches but not for long. The clicking however is persistant and the joint still feels like it is sliding about and I am left taking silly short steps as long ones just feel horrible and the knee slides about. I dont feel safe driving the car for several days.

Gradually over the next 3 weeks the clicking decreases and I feel I have more control over the knee, like something is repairing. If I wear trainers it deteriorates, if I wear walking shoes (like from Millets) it improves. Now a few months after the event the clicking never happens but now my heels are starting to hurt from wearing so many hard soled things so often.

The NHS physio observations on the problem:
– I have slight internal rotation of my leg and turn my foot sightly inwards (she says this has no relevance to the problem. She visually checked my walk (up and down the room once) and got me to do some frog jumps.From my personal experience,cycle pedals which do not allow much twist are a no no for me.
– That I have good symmetry
– My muscle tone/strength is good
– There is nothing wrong with my ligaments
– There is nothing wrong with my cartilage
– the searing pain immediately preceding the lameness and the knee clicking which started then are totally unrelated to what went wrong and they should just be ignored in any diagnosis.
– It is her belief I have arthritis.

The prev phsio last year claimed he could not find anything wrong (both times to be fair to the physios, its taken so long to get an appointment at the hospital that many of the symptoms are gone and I can only recount them).

The NHS wont refer me to anyone else or give me a scan as “you are not in enough pain”. I am other than the lightening flash in no pain at all, its just I cant walk properly for weeks, on repeated occasions.

I could really do with some ideas of what could be wrong as until I have some idea I dont see how I can work towards avoiding or limiting repeats of this.

I am really concerned that mismanaging it now might mean the knee being really messed up when I am older. The only advice I have from the last physio is to walk lots and lots (which seems odd advice for damage she says is from joint wear and tear) to do lots of lunges (hard to do as the knee feels unstable and I am scared of setting it off again) and to come to terms with the fact that “everyone gets arthritis” which is not true as none of my older family that I know of have any knee or leg arthritis at all and most of them are in their 80’s.

So, anyone care to take a guess – any starting point for me to look into is welcome.

Tight rec fem. look up some stretches that go across the hip and the knee.

Probably isn’t, but was for me.

only got as far as “OK, anyone fancy making a diagnosis as I am not getting very far with the NHS “

so pay up and go to a good physio, they are worth every penny if you find a good one.
anecdotal forum advice is pissing in the wind compared to a proper diagnosis and treatment from a professional.

Or pay £40 to see a private physio. A good un will have you out and about in a few of sessions and cost about £120 all in. Could well be related to your pronation / gait issues as imbalances in one place trigger problems elsewhere.

All physios can really do is give you stretches and strengthening exercises.

Do lots of single leg, body weight exercises step ups, step downs, lunges in all directions. Leg raises, single legged bridges. etc etc.

Go and see an osteopath!

My husband had years of back pain, saw NHS doctors, had X-rays and saw Physio’s, they all said his back was fine. He was still in pain though….

A few sessions with an osteopath sorted it, he has been back for a couple of sessions every few years or so as he has a sit down job ( driving instructor ). Osteopath has been great sorting my knee too….

Not cheap, but we only ever needed a few sessions when treated…..well worth it!

i have has op’s on both knees…………………DO NOT LET THEM OPERATE ON YOUR KNEES!!!.

go see a good physio.

Mr Smith – I would be delighted to, if I had not been made redundant before Xmas. I cant afford a scan either.

I went to a private guy last year, about 6 months after the issue arose as I had waited (foolishly) for my NHS appointment with a man whose only interest was chatting up a nearby nurse.

The private guy could find nothing wrong with the cartilage. there was no mention of arthritis. He thought I could be I have a shortened nerve or maybe it was something sticking when it passed through a ‘hole’ near my knee, but it sorted out not long after as it had been fixing slowly on its own anyway and I was too broke to pay for a scan even back when I had a job – as it was over £500 which I just did not have in addition to paying the private physio.

I must admit I am very puzzled how the pain and clicking cant be related to the instant failure of my knee.. to me it seems likely something broke or tore.

Thanks for the feedback so far.

I should add, that other than this knee problem, I have found the NHS to be quite helpful with other stuff.

Pay for a private consultation with an orthapaedic surgeon…he’ll want to slice you open but will tell you why.

if you find a good one.

Be that NHS or private…. I wish you all the best in getting a diagnosis, i did, eventually,
Seriously, for >20 years I had issues with my knees. Most notability pain for a few days after a good ride.Visits to different NHS and private physios (2 of each) got me nowhere – most annoyingly, the last private one I visited was highly recommended and also a very keen MTB’er…
One last try (I really wanted to try skiing) before I gave up and it was suggested I speak to a friend of a friend in our social circle, and NHS physio. She took time out to check the muscles in my thigh (stop sniggering at the back) where everyone else had not…. turns out my vastus medialis (just looked that up – teardrop shaped muscle above your knee, inside of thigh) were barely in existence. Cue some exercises to suit and i got to go skiing and no more discomfort after exercise. The cost – a few pints when we next saw her 🙂

Yeah, get a good (possibly sports) physio. For what it’s worth, I have arthritis in my knees and it’s nothing like you described. Of course, that doesn’t mean you haven’t got it…

To be fair, I would be thinking OA with that also. Based on the information you have given that is the most probable diagnosis. Using your legs more is the best treatment for it too. There is apparently research out there to show that pretty much everone over 30yrs old has signs of wear and tear in their knees.

If the knee feels unstable and you describe a sliding feeling at the joint then i’d go for ligaments….even if the people you’ve seen so far dont think it is.

Anterior cruciate ligaments and posterior cruciate ligaments should be tight enough to stop forward and backwards sliding of the joint….and yet you describe pain at the side of the knee….which is the lateral collateral ligaments…..this is strange as slack lateral ligaments present as unusual sideways flex….which you arent getting.

I dont envy you, could take years before somebody stumbles on a diagnosis.
I’d gently build up the muscles around the knee for additional support….a poor second to strong healthy ligaments but it’ll help in the short term.

All physios can really do is give you stretches and strengthening exercises.

or they can find the cause of the problem and suggest a way to correct it.

i had a similar issue to marsdenman up there ^ an underdeveloped vastis whateveritscalled and an overdeveloped vastis on the outside of the thigh caused by knee mistracking and a weak glute medius. all sorted with cleat shims a custom footbed to get me pedalling straight and some stretching/foam roller on the ITB. this was all sorted by 1 visit to the sports injury clinic at crystal palace.

to the O.P. can’t help with the money situation but maybe try £40-£50 on a private physio consultation if you can get a good recommendation near you. the first one i tried just wanted lots of repeat visits (£££’s) and wouldn’t tell me what was actually wrong, the second told me straight away what was wrong and the best way to treat it.

Hi folks. Thanks lots for ideas so far.
As some of the earlier people seem to be missing the post
(sorry for shouting)

I HAVE NO MONEY

as was made redundant back before xmas, so cant go private.
🙂

go back to your doctor, ask to see another doctor or ask for a 2nd opinion.
you can go to see a physio for free on the nhs.

What deviant said ^^^^

I had years of pains in my right knee (pretty much as you describe) especially when walking down slopes and was advised (by a doctor) that it was loose lateral ligaments.

Then I snapped the anterior cruciate ligament playing football – that was fixed and I’ve had no problems since.

Mind you snapping an ACL is probably a bit drastic and I wouldn’t recommend it as the way to get your knee sorted……

go back to your doctor, ask to see another doctor or ask for a 2nd opinion.
you can go to see a physio for free on the nhs.

+1

after spending the whole of 2011 seeing various people within the NHS – three GPs and a physio.. all with different ideas about what may be wrong.. and a lot of frustrating time taking 1 step forward and 2 steps back with recovery I was finally referred to an orthopaedic surgeon..

after a consultation yesterday I’ve been referred for an MRI scan.. I was so relieved I could have kissed the fella..

my point is though that I had to keep going back to the GP.. it was only after getting a third opinion that I got a referral..

Arthritis as i know it – is it painfull/lock up/feels unstable in the cold, or when your leg is at an awkward angle ie with your legs crossed?

Unfortunately though, it could be just about anything – but pain on the inside of the knee sounds like a medial collateral. From my experience tearing the medial seemed far more painful than completely buggering up my cruciates, if i recall as there is more natural movement, but on its own does not always require surgery.

I suppose the idea about walking lots is if you don’t keep your leg muscles strong things just keep deteriating. I know after one operation my associated leg strength deteriated to only 20% the strength of my good leg, but i was able to build the strength back up in 2 months or so. Also my arthritis from knee injuries going back over 20ys, gets worse if i don’t exercise, which as you say, sounds odd.

go back to your doctor, ask to see another doctor or ask for a 2nd opinion

Ditto this. Hopefully you’ll be examined by a more experienced/better doctor.

Friend of mine had loads of trouble with hip pain and was repeatedly fobbed off by the doctors at his local practice who couldn’t find anything wrong.

Eventually, basically by demanding it, got referred to another doctor/specialist who fairly quickly diagnosed the issue (more experienced or just more professional, who knows) …

Unfortunately your having knee problems at the wrong time. Most regions within England are currently cutting back on Ortho referrals and as has been stated to you before, your not in continous bad pain so there isn’t much they can do about it (rightly or wrongly) unfortunately this is just where people are going to have to realise the NHS will not pay for everything and anything..

By accident I discovered if I wore walking sandles (fairly firm sole, lots of available foot movement) it caused me no knee problems, so last summer was issue free. This autumn it all reacurred again as soon as I moved back most of the time to winter footwear.

don’t wear your ‘winter’ shoes then – stick to the sandals.

i suffered with all sorts of foot pain for a couple years, and then discovered that the pain went away immediately if i wore sandals (or barefoot).

so i looked at all of my shoes, and saw that they all had sculpted foot-hugging insoles.

so as an experiment i replaced the sculpted insoles with simple flat ones, and now i have no foot pain.

Temperature seems to have no affect on it.

I dont think I can wear sandals all winter, what with the ice, rain etc 🙂 but I do think freedom of foot movement seems to have a bearing, hence my having hoped they would have done some kind of gait analysis.

If it turns out to be arthritis, I wonder why it would have started with the single searing pain and instant instability?

No, the knee does not lock up and its feeling more stable now, no sense of sliding about the last couple of weeks – but it went wrong in early November so its taken a while, long steady improvement. Just afraid it will go again in the middle of nowhere instead of in town.

get a self refferal to your local nhs podiatrists who are lower limb specialists.

Thanks, thats a new suggestion. I am hoping to go back to the local doctor next week or the week after. I will mention that idea to them as the local doctor has been quite helpful, before I was referred on.

well podiatrists do specialize in the area where you have problems, I can’t quite believe you haven’t been referred to one really!