Turkey Break

Turkey Break was a great break for my hips and knees. I got to wear boots to my family gatherings, and did not have any pain! It was good to get full nights of sleep and not be standing and walking all day. Even today was pretty good on the pain scale for my knees at least. I did a lot of walking, not much standing still, so my hips were a little sore. I had physical therapy after school and that started to wear me down. My right knee hurt on the ride home and then once I got out of the car my left knee started to throb. It's just starting to be random pain that makes no sense. I found some interesting information last week after therapy about something called miserable malalignment syndrome. Here's a snippet about it:

"The symptoms of MMS (caused by femoral internal rotation, external tibial rotation and forefoot pronation, and may involve an increased "Q" angle of >20 degrees, genu valgum, patella alta, and generalized ligamentous hyperlaxity) include compensatory internal rotation of the femur to maintain coverage of the femoral head with the hip acetabulum. It can also include a discrepancy between the axis of the extensor mechanism of the knee and that of the femur, resulting in a lateral displacement of the patella with increased quadriceps angle ("Q" angle). Patellofemoral Pain Syndrome from the patella mistracking with internal tibial rotation may result in proximal or distal iliotibial band syndrome, patellar subluxation or dislocation. The internal tibial rotation is a compensation for foot pronation. Achilles tendonitis, plantar fasciitis, posterior tibialis tendon strain and dysfunction and strain of the medial ankle and foot can follow. "
-http://www.curemms.com/syndromes/index.html

The physical therapist said that this syndrome makes sense for what is going on with my legs. Hopefully I can talk to my doctor and find a non-surgical solution for this pain. However, I know there is no getting around the PAO for my hips. I even had some pain in my right hip today (the good one). I was sitting on the couch inputting data into the computer. When I leaned to the left to look at some papers I got a sharp pain in my right hip like it was being pulled out of socket. NOT FUN!

We'll keep trying...

I had physical therapy again this afternoon and we started by going over my symptoms and if they were improving. So far there has been no improvement. Which I guess should be expected since my pain is a result of a deformity and not an injury. I did all my exercises with more reps, and when I left she said "We'll keep trying."

When I got home I called Dr. Scheid's office to find out the name of the surgery and hopefully the costs so that we could start preparing. I did get the name, but they said that they would not know the costs until the doctor ordered the surgery. I also searched my insurance agency's site and found nothing about the surgery. The name is the Elmslie Trillat procedure, and it sounds scary. It involves cutting bone, moving tendons, and inserting screws (sounds like a PAO!) The recovering is easier than a PAO, but still not fun. So I have three more PT appointments and then back to see Dr. Scheid on December 9th to sort everything out.

Zero Change

I have been continuing with my physical therapy and so far there is zero change in the amount of pain in my knee. Friday I worked a full day and by the end of the day I was limping and keeping weight off of my left knee. I had to return to school for a benefit concert and spent most of the night sitting in pain. I cleaned our house for 3 hours straight yesterday and again I had pain all night. I just had a full body massage and could definitely could feel tenderness on my left side. My outside leg muscles were tender and around my hip. I guess my next step is going to be calling the doctor to find out the name of the knee procedure and the cost.

Been reading...

I have spent most of the afternoon reading other blogs and information about my hips and knees. My husband thinks I need to be looking into my knee more since it is probably the procedure I will have done first. But the hip is more scary to me, and so I keep reading about that. However, I did find more technical terms about what is going on with my knee. My deformities have caused me to have Patellofemoral Pain Syndrome. Since it has caused me pain for over 5 years, I will most likely have a procedure done called a Patellar tendon relocation. There is not a lot of info about this procedure online, so I am going to keep digging and hopefully have details to share soon.

Started PT

So I started physical therapy last Thursday, and I go back two days this week. My therapist was perplexed by my situation. She spent a lot of time looking over my legs. She even said that she wished she had a student with her because I would be such an interesting case to study. She taught me 5 home exercises to use to build up my inner thigh muscle that controls my knee cap. I have been doing those exercises daily, and so far I haven't noticed much of a change. My muscles are just a little more sore than normal. I go back tomorrow and will probably do some exercises there and also learn more home exercises.

As for my hip, it seems to be mad that I am spending time on my knees right now. One of my knee exercises irritates it a lot. Also, I attended training yesterday on non-violent crisis intervention strategies. It involved getting up and trying these strategies on the other adults that were there. I could definitely feel the stress on my hip. I'm worried about waiting another year and a half to have my hip fixed with all the pain I am having right now.

I'll update some more after more physical therapy. I'm trying to think of how I can walk around at school less too. One of my more needy students is suspended the first three days of the school week, so hopefully that will give me a little rest.

The Start of a Journey

After reading several other blogs from women who have experienced what I am about to experience, I've decided to start a blog to share my journey for those who need to feel camaraderie. I am 25 years old, will be 26 in less than a month, and I teach special education. I began working when I was 13 and have been on my feet constantly since I was 16. I danced in show choir in high school and became much less active in college. February of 2004 is the first time I remember feeling throbbing pain in my knees. I had worked my first 8 hour shift in a hospital basement serving food and also danced in a sorority competition that night. Since then, I have experienced the pain more often and more intensely. I always thought the knee pain stemmed from my hips. I also noticed my hips clicking, clunking, and popping in college, and they've started aching recently. At the beginning of October I decided that enough was enough and I scheduled an appointment with an orthopedic surgeon to diagnose what was wrong and find out options. They took X-rays and quickly diagnosed me with hip dysplasia. However, the doctor I saw did not normally work with young adults with hip problems. He knew there were more options for me than just a hip replacement, so he offered to find another doctor for me to see. I asked him about my knee pain, and he stated that fixing my hip would straighten out my knee and stop the pain.
A week and a half later, I went to see Dr. Kevin Scheid with OrthoIndy. He confirmed my hip dysplasia and told me about a procedure called a periacetabular osteotomy. Hip dysplasia is when the hips do not form correctly and it creates a shallow socket for the femoral head (top of the femur). PAO (periacetabular osteotomy) surgery corrects the shallow socket by cutting the pelvis and realigning it using screws. The hip bones then heal and more of a surface is provided for the femoral head. This has to be done before arthritis forms in order to be successful and could give me much more time with my original hip(s) and I may never need a hip replacement. I had already read about this surgery online, but it was good to hear from the doctor that the procedure was an option for me. Then I asked about my knee pain, if the hip surgery would help it stop. Dr. Scheid started looking more in depth at my legs, having me walk up and down the hall, and I laid on the exam table while he moved my legs. He told me that when my legs formed, my femur twisted in and my tibia twisted out, causing my knees to be a hot mess (not a technical term). My tendon in my knee is not in the right location, and is causing abnormal rubbing and A LOT of pain. He told me there was an outpatient procedure that could be done with a short recovery to relocate my tendon. He didn't want to rush into the surgery yet. He prescribed me physical therapy 2-3 times per week for four weeks to see if building my thigh muscles takes away some of the knee pain and then I go back to see Dr. Scheid on December 9th (5 days after my 26th Bday).
I start physical therapy for my knee tomorrow evening at Advanced Physical Therapy. I'll post on how that goes and how my pain progresses. I know this post was long, but a lot has happened so far. I'm frustrated by the situation I am in, and I don't even know if it was avoidable. I just hope that Dr. Scheid and my physical therapists will be able to work some miracles and give me a better quality of life.

Here are my knees, bent with feet straight.
Here are my hips: