The bones that make up the knees of normal healthy people are on the same plane. In other words, they appear close to a straight line when viewed from the front. There is only a slight external angulation in the bone below the knee. In some people, knees can be bent since childhood, and in others later in life. Knee distortion occurs inward in most people. In other words, the inner parts of the knees move away from each other and the legs take an O shape. In these cases, the external collateral ligaments are loosened. In a small number of cases, the knees are bent outwards. In these cases, the leg section below the knees opens outwards. In these cases, the internal lateral ligaments are loosened. Vitamin D deficiency is responsible for the majority of cases starting from childhood. When vitamin D is deficient, the amount of calcium in the blood decreases and bones soften. Over time, under the influence of body weight, the bones bend and distort the knee. Although this distortion is not a complaint other than cosmetic appearance in childhood and adulthood, it can cause serious problems when knee arthritis begins in later ages. In later cases, which we call secorder, which is more sullen, the most important reason is excess weight. Due to the effect of weight, the knees are bent inward and this further increases the pressure on the inner part of the knee. Under the influence of the load on this area, the cartilage is damaged and thinned. The external lateral ligaments of the knee lengthen well. The patient, who cannot walk due to increasing knee pain, gains more weight. This increases calcification even further, and as a result, the patient's knee knock progresses rapidly.
Although we cannot completely prevent this knee knock, we can seriously slow down the rate of progression. Essentially, distortion treatment is the same as arthritis treatment. Because distortion causes calcification, and calcification causes distortion. Although there is no option other than surgery in late cases, early cases can be treated effectively. We have three essentials in treatment. The first is for the patient to take good care of his knee. In other words, one should avoid activities that will strain the knee, such as squatting, sitting cross-legged, sitting with knees bent, walking excessively, going up and down stairs. Our second must-have is protective knee exercises. These exercises are prescribed by the patient's doctor according to the degree of arthritis, the patient's condition and age. g They are generally simple exercises that are not tiring. Patients can easily do these exercises on their own at home. The third and most important thing is weight control. In these patients, the vicious circle that develops as "weight gain-worsening of the knee-increase of pain-immobility-weight gain-worsening of the knee" must be broken. Otherwise, the patient will continue to gain weight very quickly. Patients should get professional help on this issue.
We frequently apply knee injection treatments to break this vicious circle by reducing knee pain. Cortisone injections should be preferred in knees with severe pain. PRP treatment is the most suitable option for patients whose pain is not very severe, with its long-term effect. PRP injection can also be performed about a month later in knees whose pain is relieved with cortisone. If necessary, these injection treatments should be supported by physical therapy. In addition, since the feet press outward due to bending knees, silicone insoles that raise the outer side of the sole, which we call lateral wedge, should be given under the feet. In this way, knee knock can be reduced by creating an external rotation force during the patient's stepping phase.
Since the results are satisfactory with early intervention, treatment should be started immediately when knee knock is noticed. Patient education, exercise, weight control, interventions to reduce pain and insoles are the basis of treatment.
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