Brief Answer:
Please find treatment suggestions below

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

I have read through your query in detail and have had few patients with problems similar to yours.
I will appreciate if you can send across your x ray picture or report to know exactly the extent of bone changes that have taken place.

Initially, every patient who has this problem is treated with non steroidal pain killers. The dose of medications may need adjustment to make you pain free. I suppose this has been tried for you and the pain is not under control.

Steroid injections at the areas of cartilage erosion and small joints are the next method of treatment and you report having been given a couple of steroid injections with little improvement. In my experience, patients do feel better on continuation of injections. However, the response to steroid injections is highly variable with the symptoms recurring quite soon, within days or weeks, although is some patients; there might not be a recurrence of pain for over a year.

Studies show that wearing the right footwear and shoes can also help reducing the pain. It is generally found that the best type of footwear are those that are hard to bend or even completely stiff at the front of the shoe. Shoes that are wide at the front to accommodate the enlarged joint are better. Many people find that they can control the pain and inflammation well if they wear this type of footwear most of the time.

If you do not get any relief from above measures then your doctor may consider surgery for treatment. This usually involves removal of the damaged cartilage and the fixing joint in a permanent position with pins.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.


Regards,
Dr.Vivek

---